ABSTRACT
BACKGROUND: Systemic corticosteroid is the main treatment of severe forms of pemphigoid gestationis. We report a case of generalised pemphigoid gestationis successfully treated with very potent topical corticosteroid. CASE: A 37-year-old woman developed during her third pregnancy with a new partner an urticated generalised eruption associated with bullous lesions. The diagnosis of pemphigoid gestationis was confirmed by direct immunofluorescence which detected a linear C3 deposition along the basement membrane zone and the positivity of Herpes Gestationis Factor (10 units). Local treatment with potent corticosteroid (betamethasone dipropionate 0.05 p. 100) failed and the patient was successfully treated by clobetasol propionate 0.05 p. 100 cream. The infant, in good health, was not delivered prematurely. DISCUSSION: Severe form of pemphigoid gestationis are currently treated with 0.5 to 1 mg/kg/day of systemic corticosteroids, with maternal and pediatric possible side effects. As in bullous pemphigoid, this observation underlines the efficiency and good tolerance of very potent corticosteroid in severe forms of pemphigoid gestationis.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Betamethasone/analogs & derivatives , Betamethasone/therapeutic use , Clobetasol/therapeutic use , Pemphigoid, Bullous/drug therapy , Pregnancy Complications/drug therapy , Administration, Cutaneous , Adult , Anti-Inflammatory Agents/classification , Betamethasone/classification , Clobetasol/analogs & derivatives , Clobetasol/classification , Female , Fluorescent Antibody Technique, Direct , Glucocorticoids , Humans , Pemphigoid, Bullous/pathology , Pregnancy , Pregnancy Complications/pathology , Pregnancy Outcome , Treatment OutcomeABSTRACT
The effects of topical corticosteroid therapy upon human epidermal Langerhans cell surface markers were studied. The reduction in numbers of human leukocyte antigen-DR+/T6+ Langerhands cells proved to be a potency-related effect and Langerhans cell enumeration may therefore have some use as an adjunct in the assessment of steroid potency. Further studies showed that corticosteroid therapy also reduced the function of Langerhans cells in terms of epidermal cell alloantigen-presenting capacity. However, experimental variation and the high antigen-presenting potency of residual flow cytomterically sorted human leukocyte antigen-DR+/T6+ Langerhans cells following steroid application (1) mean that such functional assessments of epidermal cell alloantigen-presenting capacity cannot be recommended as an easily reproducible method for measuring steroid potency.
