Immunopathologic Study of Herpes Gestationis in Mother and Infant

Herpes Gestationis in a Mother and Newborn

“…This was an extreme rare opportunity to be able to follow the BP180 ELISA index in a mother and neonate, because most neonates of mothers with HG are born with normal skin and neonates with vesicular lesions are rare (estimated at 1 per 100 000 cases). 11,12 Our case clearly proves that vesicular erythematous lesions in the neonate are caused by transplacental passage of pathogenic antibodies against BP180 NC16a, from the mother to the neonate, as shown by the fact that BP180 ELISA indexes in the umbilical artery and vein were 1225 and 1022, respectively, compared with 1522 in maternal venous blood. Interestingly, indexes from the neonate at 1 and 4 days after birth were 1154 and 784, respectively.…”

Herpes gestationis in Mother and Erythemato-Pustulous Rash in the Newborn with Positive Direct Immunofluorescence

“…Her baby had an ex tensive eruption with IgG and complement deposit on the dermo-epidermal junction compatible with the diagnosis of herpes gestationis. We found only 16 observations in the scientific literature concerning a pos sible transmission of the disease to the child [1,[4][5][6][8][9][10][11][12][13][14][15][16][17], The skin lesions may be present at birth [6,9], or may occur later, un til the 5th day of life [10], The pattern of these lesions is variable: features of bullous pemphigoid of the scalp [6], a few bullae [11] or vesicles on the chin [9], typical herpes gestationis [8,12], severe bullous dermatosis [13], transient rash preceding the onset of polycyclic papules forming vesicles 8 days later [4], lesions of erythema multiforme [10] on lower limbs, 3-cm-wide annular erythematous bands with blistering evolu tion [13], or discrete facial erythematous papules [1] with a few pustules.…”

“…Although the so-called 'herpes gestatio nis factor' is an IgG antibody [3,4] which may pass through the placenta to the fetus, the disease very rarely involves the newborn [5,6], We report herein on such an observa tion because of a very unusual clinical pat tern of extensive pustular rash that might have been misdiagnosed as a pustular erythema toxicum. This clinical pattern sug gests considering erythema toxicum as a nonspecific expression of transplacental transfer of several antigens or antibodies.…”

The Role of Pathogenic Autoantibodies in Autoimmunity

“…Herpes gestationis yes [21,22] no [23] antigen differs yes [24][25][26][27] yes [28] Requires neutrophils yes [29] IvIg [20] Collagen VII Epidermolysis bullosa acquisita yes [30] limited cross-reactivity yes [31] yes [32] Requires neutrophils yes [33] IvIg [20] TSH receptor- 47] yes [48] yes [49] yes [50,51] Presynaptic voltagegated Ca ++ channels…”

“…BP is characterized by skin lesions appearing as areas of urticaria that develop into large bulla, with separation of the epidermis from the dermis, with an intense infiltration of inflammatory cells in the underlying dermis, and destruction of components of the hemidesmosome and extracellular matrix [26]. PG also known as herpes gestationis, is a non-viral variant of BP that occurs in early pregnancy or post-partum and can result in transient neonatal PG [21,22]. In BP and PG, autoantibodies are directed to hemidesmosomes that are cellular structures involved in anchoring keratinocytes to the basement membrane, and the major autoantigen is BP180, a transmembrane protein belonging to the collagen family, also known as collagen XVII.…”