Advanced Pemphigoid Gestationis Initially Misdiagnosed as Pruritic Urticarial Papules and Plaques of Pregnancy

Roche, M. C.; Hamidi, Odessa P.; Weyant, Grace W.; Pauli, Jaimey M.

doi:10.21767/2471-8165.1000050

Cited by 1 publication

(2 citation statements)

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“…The clinical and histopathologic differentiation is difficult in atypical presentations, as the absence of bullae does not exclude a diagnosis of PG biopsied in the pre-bullous stage. 1,3,8,9,13 A previously reported case 16 of advanced PG was initially misdiagnosed as PEP where the patient presented with pruritic rash on her legs that failed to respond to treatment, highlighting the importance of keeping a high index of suspicion to prompt a diagnostic biopsy in cases of atypical PEP presentations or failure to respond to treatment.…”

Section: Discussionmentioning

confidence: 99%

“…A previously reported case 16 of advanced PG was initially misdiagnosed as PEP where the patient presented with pruritic rash on her legs that failed to respond to treatment, highlighting the importance of keeping a high index of suspicion to prompt a diagnostic biopsy in cases of atypical PEP presentations or failure to respond to treatment.…”

Section: Discussionmentioning

confidence: 99%

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Histopathological features of pemphigoid gestationis and polymorphic eruption of pregnancy: A blinded retrospective comparative study of 31 cases

et al. 2022

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Background Pemphigoid gestationis (PG) and polymorphic eruption of pregnancy (PEP) are pregnancy‐related dermatoses. Definitive diagnosis often relies upon histopathology and direct immunofluorescence (DIF). PG is associated with fetal and neonatal risks, while PEP confers minimal risk. Objective We aimed to compare histopathologic features to determine key differentiators. Methods A retrospective cohort study of PG and PEP cases, with accompanying DIF, conducted from 1995 to 2020. Skin biopsies were examined independently in a blinded fashion by two dermatopathologists for a list of histopathological features. Results Twenty‐one cases of PG and 10 cases of PEP were identified. PG had significantly denser eosinophils than PEP (mean 155 vs. 48 cells/5 hpf; p < 0.018). PG was also noted to have eosinophilic spongiosis and eosinophils at the dermal–epidermal junction more frequently compared to PEP (80% PG vs. 10% PEP; p < 0.001). A mean cutoff value of 86 eosinophils and a mean optimal sensitivity and specificity of 81% and 83%, respectively, for eosinophils density's diagnostic power of PEP versus PG were achieved. Subepithelial separation was exclusively seen in PG (40% vs. 0%; p < 0.007). Conclusion Eosinophilic spongiosis, eosinophilic epitheliotropism, and dense superficial dermal eosinophils were diagnostic of PG. Given overlapping clinicopathologic features, however, DIF results with clinicopathologic correlation, remain the gold standard.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Histopathological features of pemphigoid gestationis and polymorphic eruption of pregnancy: A blinded retrospective comparative study of 31 cases

et al. 2022

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show abstract

Advanced Pemphigoid Gestationis Initially Misdiagnosed as Pruritic Urticarial Papules and Plaques of Pregnancy

Abstract: Background: Dermatoses of pregnancy are a common diagnostic challenge faced by obstetricians.

Cited by 1 publication

References 6 publications

Histopathological features of pemphigoid gestationis and polymorphic eruption of pregnancy: A blinded retrospective comparative study of 31 cases

Histopathological features of pemphigoid gestationis and polymorphic eruption of pregnancy: A blinded retrospective comparative study of 31 cases

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