ABSTRACT
El penfigoide gestacional es una dermatosis rara, que se presenta durante el embarazo. Se caracteriza por una respuesta autoinmune contra las proteínas de los hemidesmosomas, que genera un clivaje entre la epidermis y la dermis tanto de la piel como de las mucosas. Clínicamente, presenta prurito intenso, placas y pápulas eritematosas, que evolucionan a apollas con distribución en el abdomen y los miembros. Como complicaciones, en el feto puede generar parto prematuro y bajo peso para la edad gestacional, con alto riesgo de mortalidad. (AU)
Gestational pemphygoid is a rare, autoimmune dermatosis that occurs during pregnancy. It is characterized by an autoimmune response against hemidesmosome proteins, generating a cleavage between the epidermis and the dermis in the skin and mucous membranes. Clinically it presents with intense pruritus, plaques and erythematous papules that evolve to blisters that are distributed mainly in the abdomen and limbs. The complications are preterm birth and low weight for gestational age, with high risk of mortality. (AU)
Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Adult , Pemphigoid Gestationis/diagnosis , Pemphigoid, Bullous/diagnosis , Prednisone/analogs & derivatives , Pemphigoid Gestationis/drug therapy , Pemphigoid, Bullous/etiology , Pemphigoid, Bullous/drug therapy , Diabetes, Gestational/diagnosis , Glucocorticoids/therapeutic useABSTRACT
Pemphigoid gestationis is a rare, autoimmune blistering dermatosis of pregnancy. No increase in fetal or maternal mortality has been demonstrated, but a greater prevalence of premature and small-for-gestationalage babies has been reported. Topical and systemic corticosteroids and antihistamines are the manstay of treatment. The authors report a case of a 27-year-old woman at 28-weeks gestation with sudden onset of pruriginous vesicles and blisters in the abdomen and limbs. Systemic corticosteroids were introduced and maintained throughout gestation to prevent flares and tapered after the birth of a healthy child.
Subject(s)
Humans , Female , Adult , Pemphigoid Gestationis/pathology , Skin/pathology , Biopsy , Pregnancy , Methylprednisolone/therapeutic use , Pregnancy Outcome , Pemphigoid Gestationis/drug therapy , Treatment Outcome , Fluorescent Antibody Technique, Direct , Glucocorticoids/therapeutic useABSTRACT
La embarazada es susceptible a cambios en la piel y fanéreos que pueden ser fisiológicos como patológicos. El reconocimiento de estas entidades es fundamental para un correcto manejo. La clasificación y nomenclatura de las dermatosis del embarazo ha sido controversial y confusa, principalmente dado el pobre conocimiento que se tiene sobre el origen de estas entidades. El objetivo de esta revisión es informar sobre el conocimiento actual del penfigoide gestacional a partir de un caso clínico, centrándose en su diagnóstico y tratamiento como patología multidiscilpinaria.
The pregnant woman is susceptible to both physiologic and pathologic changes of the skin and appendages. Recognition of these entities is important for appropriate management. The classification and nomenclature have been controversial and confusing, mainly because of the poor knowledge that we have regarding the origin of this entities. The purpose of this review is to contribute to the current knowledge of pemphigoid gestationis, based on a case-report its diagnosis and treatment as a multidisciplinary pathology.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Pemphigoid Gestationis/diagnosis , Pemphigoid Gestationis/drug therapy , Clobetasol/therapeutic use , Prednisone/therapeutic use , Chlorpheniramine/therapeutic useABSTRACT
INTRODUCTION: Pemphigoid gestationis, also known as herpes gestationis, is a rare autoimmune blistering disease associated with pregnancy. It usually occurs during the second or third trimester, but it may be present at any stage of pregnancy or the puerperium. The clinical, histologic, and immunopathological features of pemphigoid gestationis are similar to those of the pemphigoid group of disorders. METHODS: We hereby report seven patients who were diagnosed with pemphigoid gestationis and followed at the Autoimmune Blistering Disease Clinic in the Department of Dermatology of the University of Sao Paulo Medical School between 1996 and 2008. DISCUSSION: Demographic and clinical findings, such as median age, sites of involvement, and gestational age of onset of our patients, coincide with those described in previous reports. The majority of patients (85 percent) exhibited complement C3 or C3 and immunoglobulin G (IgG) deposition along the basement membrane zone (BMZ) on immunofluorescence. Herpes gestationis factor (HG) factor was postitive in four out of six patients (67 percent), and three out of five patients recognized the bullous pemphigoid recombinant antigen (BP180) by ELISA. CONCLUSION: This study revealed a good outcome of the newborns from pemphigoid gestationis affected mothers, based on the absence of pemphigoid gestationis cutaneous lesions, mean birth weight, and normal Apgar scores and gestational age at birth.
Subject(s)
Adult , Female , Humans , Infant, Newborn , Pregnancy , Young Adult , Pemphigoid Gestationis/pathology , /analysis , Immunoglobulin G/analysis , Pregnancy Outcome , Pemphigoid Gestationis/drug therapy , Pemphigoid Gestationis/immunology , Pemphigoid, Bullous/immunology , Pruritus/pathology , Urticaria/pathology , Young AdultABSTRACT
El Herpes Gestacional, también denominado Penfigoide Gestacional, forma parte de las dermatosis específicas del embarazo. Este artículo pretende revisar los conocimientos actuales sobre esta patología.
Subject(s)
Female , Pregnancy , Adult , Humans , Pemphigoid Gestationis/pathology , Pemphigoid Gestationis/drug therapy , Prednisone/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Pregnancy Trimester, Third , Pruritus/etiology , Treatment OutcomeSubject(s)
Humans , Female , Pregnancy , Pemphigoid Gestationis/drug therapy , Pregnancy ComplicationsABSTRACT
Herpes gestationis, also known as Pemphigoid gestationis, is a rare autoimmune disease of pregnancy. It is characterized by itching and skin lesions. The disease causes prominently maternal discomfort but fetal and neonatal complications have been reported. There are only scattered reports of cutaneous neonatal herpes gestationis in the literature; however, the frequency and severity of fetal illness are still debated. We describe 2 cases of herpes gestationis diagnosed and managed at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
Subject(s)
Humans , Female , Pregnancy , Pemphigoid Gestationis/etiology , Pemphigoid Gestationis/drug therapy , Prednisolone , Pregnancy OutcomeABSTRACT
Herpes gestationis é dermatose relacionada à gravidez, rara, caracterizando-se pela erupçäo de vesículas e bolhas sobre a base eritematosa, no tronco e membros, mais freqüente no segundo e terceiro trimestres da gestaçäo. No presente caso, os quadros clínicos e laboratorial säo sugestivos
Subject(s)
Humans , Female , Pregnancy , Adult , Pemphigoid Gestationis/diagnosis , Pemphigoid Gestationis/drug therapy , Prednisone/therapeutic use , Pregnancy Complications , Pruritus/etiology , Contraceptives, Oral , Diagnosis, Differential , Recurrence , Skin Diseases/diagnosisABSTRACT
Os autores relatam um caso de penfigóide gestacional iniciado no quito mês de gestaçäo, confirmado por meio de técnica de imunofluorescência e com boa resposta à corticoterapia. Fazem breve revisäo da literatura e chamam a atençäo para a substituiçäo da terminologia herpes gestacional por penfigóide gestacional.
Subject(s)
Humans , Female , Pregnancy , Adult , Administration, Topical , Dexamethasone/administration & dosage , Pemphigoid Gestationis/diagnosis , Pemphigoid Gestationis/drug therapy , Pemphigoid Gestationis/therapy , Prednisone/therapeutic use , Pregnancy Complications , Fluorescent Antibody Technique , Pregnancy ComplicationsABSTRACT
O herpes getacional é uma dermatose polimórfica rara, pruriginosa, incidindo na gravidez e puerpério. As características morfológicas das lesöes iniciais incluem pápulas e placas urticariformes, vesículas e bolhas de crescimento centrífugo. O herpes gestacional pode iniciar-se durante qualquer trimestre da gravidez ou no pós-parto imediato. Cinco casos novos såo relatados, discutindo-se aspectos clínicos e laboratoriais, bem como o tratamento e evoluçåo da doença
Subject(s)
Humans , Female , Pregnancy , Adult , Pemphigoid Gestationis , Adrenal Cortex Hormones/therapeutic use , Pemphigoid Gestationis/drug therapy , Pemphigoid Gestationis/pathologyABSTRACT
A case of recurrent gestational herpes in the first trimester of gestation is presented by the authors. Her history pointed similar infection in the third trimester of her first pregnancy, resistant to the treatment. This time an abortion was indicated in view of the great risk of an hospitalar infection. Out of pregnancy, the patient had a slight infection during her first menstrual period, with rapid remission.
Subject(s)
Humans , Female , Pregnancy , Adult , Herpes Simplex , Pemphigoid Gestationis , Amikacin/therapeutic use , Azathioprine/therapeutic use , Cephalosporins/therapeutic use , Clindamycin/therapeutic use , Herpes Simplex/diagnosis , Herpes Simplex/drug therapy , Pemphigoid Gestationis/diagnosis , Pemphigoid Gestationis/drug therapy , Prednisone/therapeutic use , Pregnancy Trimester, FirstABSTRACT
Two patients presenting "herpes gestationis"in the 2 and 3 trimester of pregnancy, are reported. They had characteristic dermatologic lesions and positive immunofluorescent diagnosis at skin biopsy. The first patient was treated with local corticosteroids and antihistaminics with poor results. The second, used only oral corticosteroids in a dose of 40mg/day, with good response. The first newborn was delivered at 36 week and presentedc skin lesions of HG with deformities ar foot and hands.The second one, was delivered at term, without any skin lesions or deformities.
Subject(s)
Humans , Female , Pregnancy , Adult , Pemphigoid Gestationis/diagnosis , Pemphigoid Gestationis/drug therapyABSTRACT
Se presenta la evolución clínica de un caso con penfigoide gestationis (P.G.) típico, confirmado por inmunofluorescencia directa positiva para C3 en Z. M. B. . Se halló consistencia aumentada de glándula tiroidea, T4 y Ac. antimitocondiales levemente aumentados. El brote ampollar se controló con 80 mg. de metilprednisona por día, sin efectos colaterales adversos para la madre, ni el feto. La paciente comenzó con contracciones uterinas a las 33 semanas, controladas con ritodrina; el parto se produjo a las 36 semanas. La madre no presentó rebrote puerperal y el recién nacido fue normal. Además de losa spectos clínicos se señala la estrecha correlación del penfigoide gestationis con el tejido placentario en su caráter de aloinjerto como factor desencadenante y la expressión aberrante de antígenos de la clase II del complejo mayor de histocompatibilidad en la estroma de las vellosidades coriónicas junto a la decidua, con posible presentación exarcebada de antígenos paternos. El antígeno cutáneo, reconocido por los sueros de penfigoide gestationis es una proteína del estrato lúcido de la membrana basal epidérmica con un peso molecular estimado en 180 KD. Difiere del antígeno mayor del penigoide ampollar (P.A.), cuyo peso molecular sería de 220 KD, si bien el segundo Ag. en frecuencia reconocido pr 47% de los sueros con P.A. pesa también 180 Kd, desconociéndose si se trata del mismo antígeno. Se identifica un antígeno similar al Ag. cutáneo de P.G. en la membrana basal de amnios, que es un constituyente normal del mismo y que se expresa solamente en placentas de segundo y tercer trimestre. Este aloantígeno placentario tendría un papel clave en la etriopatogenia del penfigoide gestationis, a través de reacciones cruzadas con el antígeno cutáneo de la madre. Las inmunoglobulinas específicas anti-membrana basal, circulantes y tisulares, son a predominio de IgG1, presente en el 100% de los casos, a diferencia del penfigoide ampollar que presenta una población heterogénea de subclases, con mayor contidad de IgG4. La fijación de complemento, por la vía clásica de la "cascada", parece un eslabón fundamental en la injuria tisular; en el penfigoide ampollar el mismo sería un fenómeno secundario, después de producido el daño en los queratinocitos basales
Subject(s)
Pregnancy , Adult , Humans , Female , Pemphigoid Gestationis , Pregnancy Complications, Infectious , Pemphigoid Gestationis/drug therapy , Pemphigoid Gestationis/etiology , Pemphigoid Gestationis/pathologyABSTRACT
Exponemos el caso de una paciente que cursando un embarazo de 32 semanas presenta Herpes gestationis, manejado en nuestro servicio. El caso tuvo una evolución similar a la descrita en la bibliografía, con buena respuesta a la terapia esteroidal. El recién nacido padeció un cuadro similar al de la madre remitiendo en forma espontánea
Subject(s)
Pregnancy , Infant, Newborn , Humans , Female , Pemphigoid Gestationis/drug therapy , Pemphigoid Gestationis/transmission , Pregnancy Complications, InfectiousABSTRACT
Säo apresentados dois casos de herpes gestacional, com uma revisäo da literatura. Embora a incidência seja baixa, a doença é extremamente desagradável, por produzir intenso prurido, pelo aspecto repulsivo e por poder atravessar a placenta e atingir o feto. Sua etiologia é uma condiçäo auto-imune e seu quadro clínico muito parecido com o do penfigóide bolhoso, com o qual deve ser feito o diagnóstico diferencial, o que só é possível com a análise ultra-estrutural da membrana basal. No tratamento, as drogas de escolha säo os corticoesteróides, seguidos de piridoxina, e é citada a troca de plasma materno. Antihistamínicos, corticoesteróides tópicos e loçöes antipuriginosas säo de açäo limitada. Descrevem-se os dois casos vistos pelos autores, mas apenas um feto foi avaliado. Este concepto näo apresentou qualquer lesäo herpética ou malformaçäo ao nascer
Subject(s)
Pregnancy , Humans , Female , Pemphigoid Gestationis/diagnosis , Pemphigoid, Bullous/diagnosis , Pregnancy Complications, Infectious , Adrenal Cortex Hormones/therapeutic use , Diagnosis, Differential , Pemphigoid Gestationis/drug therapy , Prognosis , Pyridoxal Kinase/therapeutic useABSTRACT
A raridade do herpes gestationis justifica o relato do maior número possível de casos desta doença. Apresentamos um caso e discutimos os aspectos etiofisiopatogenéticos,clínico-evolutivos, histopatológicos, ultra-estruturais, de imunofluorescência e terapêuticos da doença. Aceitamos a hipótese de que esta bulose ocorra em mulheres imunogeneticamente predispostas quando entram em contato com antígenos do parceiro sexual presentes no seu tecido placentário. Aceitamos também a importância patogenética do fator HG, embora reconheçamos a insuficiência de conhecimentos sobre a etiofisiopatogenia desta intrigante doença