Treatment of Pemphigoid Gestationis
Many pregnant women avoid medications at all costs to avoid potential risks to the fetus. The significant pain and discomfort associated with pemphigoid gestationis, however, typically requires some sort of soothing action, keeping the safety of mother and child in mind. Unfortunately, like many other rare diseases, PG treatment has not been studied extensively, and often mirrors the treatment of other dermatologic conditions.
As with many of those, the first line of defense is usually topical (cream) corticosteroids. In mild to moderate cases, this is often enough to placate the PG monster, make it tolerable and keep it from getting worse. Stronger versions are available if the less potent options aren't doing the trick. Oral antihistamines are also often employed to help with the itching. Very severe cases may warrant oral corticosteroid treatment like prednisolone/prednisone, which has a pretty decent safety rating [source: Huilaja et al.]. Less aggressive methods include tepid baths, moisturizers and compresses to relieve itching [source: Freiman].
Although the risk of miscarriage is about the same as normal pregnancies, women dealing with PG are somewhat more likely to experience preterm births, and the babies might be smaller than average. This could be because of "mild placental failure" due to antibodies associated with the disease, or even a reaction to higher-dose steroids used to treat the disease [sources: Huilaja et. al., EADV]. It is possible, but relatively rare (5 to 10 percent of pregnancies), for the baby to wind up with a rash after delivery. Fortunately, the rash usually goes away once the antibodies are eradicated, six weeks or so after birth [source: EADV].
From the mother's perspective, most cases of PG clear up a month or two after delivery, if not sooner, usually with little to no scarring [source: Freiman]. But unfortunately, once she's had the disease she's likely to develop it again in later pregnancies, at a rate of about 90 percent. To add insult to injury, it is more severe and occurs earlier the second time around [source: Lardenoije]. And there is a higher, albeit small, risk of her developing other autoimmune conditions, like Graves' disease. This potential exists for the rest of her life [source: Moore].
Author's Note: Is it possible for a pregnant woman to be allergic to the placenta?
To think, I thought the heartburn, sciatic pain and weight gain I experienced during pregnancy was trying. Seems like a walk in the park compared with what ladies dealing with pemphigoid gestationis go through!
More Great Links
- American Autoimmune Related Diseases Association (AARDA). "Descriptions of Diseases." 2015 (May 19, 2015) http://www.aarda.org/descriptions-of-diseases/
- Bisits, Andrew. "The role of the placenta in pregnancy." Child Magazines. March 26, 2013 (May 19, 2015) http://childmags.com.au/pregnancy/pregnancy/5385-the-role-of-the-placenta-in-pregnancy
- European Academy of Dermatology and Venereology. "Pemphigoid (Herpes) Gestationis (PG)." July 2013 (May 19, 2015) http://www.eadv.org/patient-corner/leaflets/eadv-leaflets/pemphigoid-herpes-gestationis-pg/
- Freiman, Anatoli M.D., F.R.C.P.C., D.A.B.D. "Pemphigoid Gestationis Clinical Presentation." Medscape. Dec. 5, 2013 (May 19, 2015) http://emedicine.medscape.com/article/1063499-clinical
- Huilaja, Laura; Kaarin Makikallio and Kaisa Tasanen. "Gestational pemphigoid." Orphanet Journal of Rare Diseases. Sept. 2, 2014 (May 19, 2015) http://www.ojrd.com/content/9/1/136
- Lardenoije, Celine MJG; Marije van de Water, Helena JMM Mertens, Ed TCM Gondrie. "Pemphigoid gestationis." BMJ Case Reports. Feb. 8, 2011 (May 21, 2015) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062810/
- Roddick, Julie. "Autoimmune Disease." 2015 (May 19, 2015) http://www.healthline.com/health/autoimmune-disorders
- The Sun. "Woman's odd rash is allergic reaction to pregnancy." Fox News. Dec. 13, 2012 (May 19, 2015) http://www.foxnews.com/health/2012/12/13/woman-odd-rash-is-allergic-reaction-to-pregnancy/