Review Question - QID 103472

The classic presentation of herpes gestationis (now more commonly called pemphigoid gestationis) is a vesicular rash involving the periumbilical region.

Herpes gestationis is not caused by a herpes virus but instead is an autoimmune phenomenon, similar to the bullous diseases. The rash can present as papules, vesicles, plaques or urticaria. Typically it occurs during the second half of pregnancy, but has also been reported to erupt postpartum. The condition is benign and not associated with any adverse outcomes for the mother or fetus. Treatment is typically oral corticosteroids if the mother is seeking symptomatic relief.

Tunzi et al. describe some of the major pregnancy-specific skin conditions which include pruritic urticarial papules and plaques of pregnancy, prurigo of pregnancy, intrahepatic cholestasis of pregnancy, pemphigoid gestationis, impetigo herpetiformis, and pruritic folliculitis of pregnancy. The majority of skin conditions resolve postpartum and require only symptomatic treatment.

Lipozencic et al. detail the specifics of diagnosing pemphigoid gestationis, which includes the presence of subepidermal vesicles on routine histologic examination and the linear deposition of C3 and IgG along the basement membrane of perilesional skin. Detection of C3 and IgG is accomplished by immunoflourescence microscopy.

Illustration A shows a typical example of herpes gestationis. Note the vesicular nature and anatomic distribution.

Incorrect Answers
Answer 1: This is a description of cholestasis of pregnancy.
Answer 2: This is a description of pruritic urticarial papules and plaques of pregnancy (PUPPP).
Answer 3: This is a description of oral herpes.
Answer 4: This is a description of genital herpes.