Russian Journal of Skin and Venereal DiseasesRussian Journal of Skin and Venereal Diseases1560-95882412-9097Eco-Vector7896110.17816/dv78961Research ArticleBullous pemphigoid of pregnancy: clinical picture, diagnostics, treatmentSnarskayaElena S.<p>MD, Dr. Sci. (Med.), Professor</p>snarskaya-dok@mail.ruhttps://orcid.org/0000-0002-7968-7663KocherginNikolay G.<p>MD, Dr. Sci. (Med.), Professor</p>nkocha@yandex.ruhttps://orcid.org/0000-0001-7136-4053GalaktionovaEugenia V.<p>Student</p>galaktionova.doc@gmail.comhttps://orcid.org/0000-0001-5851-9153VovdenkoKsenia A.vovdenkoksenia@ya.ruhttps://orcid.org/0000-0003-1415-3940I.M. Sechenov First Moscow State Medical University (Sechenov University)150720212443954032408202102122021Copyright © 2021, Eco-Vector2021<p>Pregnancy is a particular period in womans life. It accompanies with plenty of adaptation changes include many on skin. Pathological morphofunctional changes form a group of pregnancy-specific dermatoses.</p>
<p>The clinical case of bullous pemphigoid of pregnancy is presented in the article. The disease occurs during pregnancy or postpartum period. The incidence is estimated to be approximately 1 in 60,000 pregnancies. Clinically, PG is characterized by intense pruritus and polymorphic skin eruptions. Skin lesions develop including erythematous patches and plaques, followed by urticarial rash and blisters. Diagnosis of the disease is based on the features of the clinical picture, complex data of pathomorphological and immunological research methods, including direct or indirect immunofluorescence, enzyme-linked immunosorbent assay (ELISA), immunohistochemical determination of a fragment of the complement component C4d and determination of serum antibodies to BP180.</p>
<p>The most effective treatment is systemic glucocorticosteroids in combination with topical steroids and/or antihistamines. Timely diagnosing and prescribing appropriate medication are highly important in preventing intrauterine fetal suffering.</p>bullous pemphigoid of pregnancygestation pemphigoidpregnancy-specific dermatosesclinical picturediagnosticstreatmentбуллёзный пемфигоид беременныхспецифический дерматоз беременныхклиникадиагностикалечение[Kochergin N, Nikitina E, Tsykin A. Some features of dermatoses of pregnant women. Doctor. 2010;(1):51–55. (In Russ).]][Khachikyan KM, Karapetyan SV. A look at the problem of specific dermatoses of pregnant women (part one). Clinical Dermatology and Venereology. 2014;12(6):82–86. (In Russ). doi: 10.17116/klinderma2014682-86][Panicker VV, Riyaz N, Balachandran PK. A clinical study of cutaneous changes in pregnancy. J Epidemiol Glob Health. 2017;7(1):63–70. doi: 10.1016/j.jegh.2016.10][Lehrhoff S, Pomeranz MK. Specific dermatoses of pregnancy and their treatment. Dermatol Ther. 2013;26(4):274–284. doi: 10.1111/dth.12078][Daneshpazhooh M, Chams-Davatchi C, Payandemehr P, et al. Spectrum of autoimmune bullous diseases in Iran: a 10-year review. Int J Dermatol. 2012;51(1):35–41. doi: 10.1111/j.1365-4632.2011.04946.x][Singla A, Shree S, Mehta S. Pregnancy with pemphigoid gestationis: a rare entity. J Clin Diagn Res. 2016;10(7):QD06–QD07. doi: 10.7860/JCDR/2016/19491.8215][Sävervall C, Sand FL, Thomsen SF. Pemphigoid gestationis: current. Clin Cosmet Investig Dermatol. 2017;10:441–449. doi: 10.2147/CCID.S128144][Hallaji Z, Mortazavi H, Ashtari S, et al. Pemphigoid gestationis: Clinical and histologic features of twenty-three patients. Int J Womens Dermatol. 2016;3(2):86–90. doi: 10.1016/j.ijwd.2016.11.004][Huilaja L, Mäkikallio K, Sormunen R, et al. Gestational pemphigoid: placental morphology and function. Acta Derm Venereol. 2013;93(1):33–38. doi: 10.2340/00015555-1370][Olisova OY, Snarskaya ES, Vladimirov VV, et al. Bullous pemphigoid of pregnant women. Russian Journal of Skin and Venereal Diseases. 2014;17(5):17–21. (In Russ).][Sävervall C, Sand F, Thomsen S. Dermatological diseases associated with pregnancy: pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. Dermatol Res Pract. 2015;2015:979635. doi: 10.1155/2015/979635][Theocharidis G, Connelly JT. Minor collagens of the skin with not so minor functions. J Anat. 2019;235(2):418–429. doi: 10.1111/joa.12584][Roth MM. Pregnancy dermatoses: diagnosis, management, and controversies. Am J Clin Dermatol. 2011;12(1):25–41. doi: 10.2165/11532010-000000000-00000][Chander R, Garg T, Kakkar S, Jain A. Specific pregnancy dermatoses in 1430 females from Northern India. J Dermatol Case Rep. 2011;5(4):69–73. doi: 10.3315/jdcr.2011.1080][Genovese G, Derlino F, Berti E, Marzano AV. Treatment of autoimmune bullous diseases during pregnancy and lactation: a review focusing on pemphigus and pemphigoid gestationis. Front Pharmacol. 2020;11:583354. doi: 10.3389/fphar.2020.583354][Thomas S, Rajan U, George S, George M. Postpartum pemphigoid gestationis. Indian J Dermatol. 2012;57(2):146–148. doi: 10.4103/0019-5154.94291][Huilaja L, Mäkikallio K, Tasanen K. Gestational pemphigoid. Orphanet J Rare Dis. 2014;9:136. doi: 10.1186/s13023-014-0136-2][Cohen S, Strowd LC, Pichardo RO. Pemphigoid gestationis: a case series and review of the literature. J Dermatol Treat. 2018;29(8):815–818. doi: 10.1080/09546634.2018][Olbrich M, Künstner A, Witte M, et al. Genetics and omics analysis of autoimmune skin blistering diseases. Front Immunol. 2019;10:2327. doi: 10.3389/fimmu.2019.02327][Lipozenčić J, Ljubojevic S, Bukvić-Mokos Z. Pemphigoid gestationis. Clin Dermatol. 2012;30(1):51–55. doi: 10.1016/j.clindermatol.2011.03.009][Snarskaya E, Olisova O, Makatsariya A, et al. Skin pathologies in pregnancy. J Perinat Med. 2019;47(4):371–380. doi: 10.1515/jpm-2018-0338][Degtyarev DO, Yanchevskaya EYu, Mesnyankina OA, et al. Herpes of pregnant women: clinical case. Russian Journal of Skin and Venereal Diseases. 2014;17(6):41–43. (In Russ). doi: 10.17816/dv36932][Thomas RM, Colon A, Motaparthi K. Rituximab in autoimmune pemphigoid diseases: Indications, optimized regimens, and practice gaps. Clin Dermatol. 2020;38(3):384–396. doi: 10.1016/j.clindermatol.2019.07.023][Genovese G, Derlino F, Cerri A, et al. A systematic review of treatment options and clinical outcomes in pemphigoid gestationis. Front Med. 2020;7:604945. doi: 10.3389/fmed.2020.604945][Huilaja L, Mäkikallio K, Hannula-Jouppi K, et al. Cyclosporine treatment in severe gestational pemphigoid. Acta Derm Venereol. 2015;95(5):593–595. doi: 10.2340/00015555-2032]