LAUSR

Gestational pemphigoid (PG) is a rare autoimmune bullous disease that affects women during pregnancy and is characterized by the appearance of plaques, erythematous papules, and/or highly pruritic blisters that usually first appear in the periumbilical area. PG occurs in the second or third trimester of pregnancy or during the puerperal period, and can cause fetal complications such as low weight, malformations, and preterm birth. PG should be differentiated from other dermatoses of pregnancy. Biopsy for conventional histology is of little use in this regard. Diagnosis is established using direct or indirect immunofluorescence or antigen detection techniques (mainly enzyme-linked immunosorbent assay [ELISA], although immunoblot and immunoprecipitation can also be used). Treatment selection is complicated owing to the limited number of safety studies performed in pregnant women. Most systemic corticosteroids are considered safe, even though their potential adverse effects include teratogenic effects (orofacial anomalies), risk of miscarriage, and antepartum fetal death. Although the majority of cases respond adequately to systemic corticosteroids, in some cases adjuvant therapies are required to attenuate clinical signs and reduce the corticosteroid dose and treatment duration. We present 4 cases of PG that were refractory to corticosteroids and required treatment with intravenous immunoglobulin (IVIG) therapy.