Herpes Gestationis Persisting for 12 Years Post Partum

Holmes, Robert C.

doi:10.1001/archderm.1986.01660160025005

Cited by 19 publications

(9 citation statements)

References 3 publications

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“…[7][8][9][10] The rst of our cases appears remarkable for the recalcitrance to different types of aggressive therapy, in contrast to the good results obtained with doxycycline and nicotinamide combined treatment. [7][8][9][10] The rst of our cases appears remarkable for the recalcitrance to different types of aggressive therapy, in contrast to the good results obtained with doxycycline and nicotinamide combined treatment.…”

Section: Discussionmentioning

confidence: 99%

“…It usually starts in the sixth to ninth month of gestation (but can develop 5-6 days after delivery), clears up in the last weeks of gestation, frequently ares up postpartum (50-60% of ares are described 1-2 days postpartum), and nally disappears in the following weeks. [7][8][9][10] Systemic corticosteroids represent rst-line therapy in PG; the use of cyclophosphamide, dapsone, pyridoxine, methotrexate, plasmapheresis or ritodrine has also been reported, with contradictory results. [1][2][3][4][5][6] Clinical presentation is characterized by pruritic, polymorphous, gurate erythematous-oedematous lesions evolving into vesicles and blisters; such lesions usually occur on the abdomen (especially the umbilical region), forearm, thigh, trunk, mammary region and buttocks.…”

Section: Introductionmentioning

confidence: 99%

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Successful treatment with doxycycline and nicotinamide of two cases of persistent pemphigoid gestationis

Amato

Coronella

Berti

et al. 2002

Journal of Dermatological Treatment

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Pemphigoid gestationis (PG) is a rare dermal-epidermal autoimmune bullous disease of pregnancy and postpartum, which relapses more seriously and earlier during following pregnancies. PG also occurs in association with trophoblastic tumours or oral contraceptive treatment. The term 'persistent PG' represents the cases where active disease persists for months to many years after delivery. Four cases of persistent PG have been reported to date in the literature. So far, systemic cortico-steroids have been the main PG therapy and the use of cyclophosphamide, dapsone, pyridoxine, methotrexate, plasmapheresis or ritodrine has also been reported, with contradictory results. In this paper are described two patients with persistent PG who were successfully treated with doxycycline (200 mg/day) and nicotinamide (500 mg/day), a treatment that was demonstrated to be safe and efficacious in bullous pemphigoid.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Successful treatment with doxycycline and nicotinamide of two cases of persistent pemphigoid gestationis

Amato

Coronella

Berti

et al. 2002

Journal of Dermatological Treatment

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“…The lesions usually occur on the abdomen (especially umbilical region), forearm, thigh, trunk, mammary region, and buttocks. The face, scalp, neck, and mucous membrane are only occasionally involved 3–8 . Cases in which active disease persists for months to many years after delivery are designated by the term “persistent HG.” Currently four cases have been reported in literature 6,7,9–11 .…”

Section: Commentmentioning

confidence: 99%

“…The face, scalp, neck, and mucous membrane are only occasionally involved. [3][4][5][6][7][8] Cases in which active disease persists for months to many years after delivery are designated by the term "persistent HG." Currently four cases have been reported in literature.…”

Section: Commentmentioning

confidence: 99%

Persistent Herpes Gestationis

Berti

Amato

Coronella

et al. 2002

Skinmed

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A 36-year-old woman at the 31st gestation week of her second pregnancy presented with erythematous-edematous lesions associated with little blisters localized on the periumbilical area that spread to the abdomen, mammary area and folds (Figures 1A and 1B). Histologic and immunopathologic exams were performed. She had not developed any cutaneous lesions in her first pregnancy or in association with menstruation or oral contraceptives. The patient was treated with local corticosteroids with a modest and temporary improvement. She delivered a healthy boy with a normal birth weight and a normal Apgar score. Small bullous lesions continued to appear in the postpartum period and during the feeding (for 9 months postpartum), which were associated with mild pruritus and partially controlled by topical corticosteroids. ResultsA lesional skin biopsy specimen routinely processed and stained with hematoxylin and eosin demonstrated a subepidermal vesiculo-bullous dermatosis and a perivascular and interstitial infiltrate of lymphocytes and eosinophils, localized in deep and superficial dermis. Direct immunofluorescence (IF) of perilesional skin performed on 6 µm cryostat-cut sections using a standard technique with fluorescein labeled antihuman immunoglobulin (Ig)G, IgA, IgM and C3, showed linear IgG (+) and C3 (+++) deposit at the basement membrane zone (BMZ). Using direct salt-split skin technique, IgG antibodies on the epidermal side of the separated skin were demonstrated (Figure 2). Indirect IF on a monkey esophagus substrate, demonstrated circulating IgG1 autoantibodies against BMZ antigens, at titer 1:80, and an indirect complement fixation test using the patient's serum, on human saltsplit skin, showed C3 deposits along the BMZ on the epidermal side (titer 1:160). Immunoblot analysis on patient serum revealed that circulating autoantibodies were directed against a 180-kd antigen (BPAg2).Routine blood examinations revealed lymphopenia (18.8%) and fibrinogen (565 mg/dL), alkaline phosphatase (450 U/L), cholesterol (308 mg/dL), and triglyceride (320 mg/dL) increases. Antithyroid autoantibodies, antigastric mucosa autoantibodies, and antinuclear autoantibodies were negative. HLA typing demonstrated an A3, A25, B18, B38, Cw7, DR4, DRw53, DQ5, and DQ8 phenotype.At 9 months postpartum, the patient stopped breast-feeding and was treated for the persisting cutaneous manifestations, with doxycycline (200 mg/daily) and nicotinamide (500 mg/ daily). This pharmacologic treatment was progressively reduced (doxycycline 100 mg/daily and nicotinamide 250 mg/daily) and we obtained a complete remission in 2 months of therapy. After 6 months from therapy suspension, no new cutaneous lesion appeared. CommentHerpes gestationis (HG), also known as pemphigoid gestationis, is a rare dermal-epidermal bullous, autoimmune disease of pregnancy and puerperium. The first onset of HG is usually in the second or third trimester of pregnancy, but it can develop from 2 months before, until 5-6 days after delivery. HG usually clears up in the last weeks...

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“…The incidence of PG is estimated at between 1 in 10 000 and 1 in 50 000 pregnancies 1 . In most cases PG affects women in the sixth to ninth gestational month and usually resolve spontaneously within weeks to months after delivery; however, flares can occur at or immediately after delivery and very uncommonly the disease persists for months or even years postpartum 2–6 . Corticosteroids are the mainstay of therapy, but administration of high doses for a long period of time has considerable risk of severe irreversible side‐effects.…”

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confidence: 99%