Skin nontumor

Vesiculobullous and acantholytic reaction patterns

Pemphigoid gestationis

Last author update: 1 July 2011
Last staff update: 17 November 2021

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PubMed Search: Pemphigoid gestationis [title]

Mowafak Hamodat, M.B.Ch.B., M.Sc.
Page views in 2022: 1,821
Page views in 2023 to date: 211
Cite this page: Hamodat M. Pemphigoid gestationis. website. Accessed February 3rd, 2023.
Definition / general
  • Rare, self limiting, autoimmune, subepidermal bullous disease, occurring during or soon after pregnancy or in women taking oral contraceptives
  • Formerly called herpes gestationis due to herpetiform nature of blisters but disease is NOT related to herpes infection
  • Called pruritus gravidarum when occurs without significant cutaneous stigmata
  • Occurs in 1 per 50,000 pregnancies
  • Rarely complicates hydatidiform mole and gestational choriocarcinoma
  • Rarely present in postpartum period
  • May follow a change in sexual partner
  • Pruritic lesions of abdomen, chest, back and extremities
  • Due to circulating autoantibodies against placental collagen XVII (BP180, BPAG2) a hemidesmosomal transmembrane protein and less frequently BP230 (J Cell Biochem 1999;72:356)
Clinical features
  • Usually urticarial papules, also blisters and rash
  • Usually resolves within weeks to months after delivery
  • Tends to recur with subsequent pregnancy
  • Associated with premature delivery, small for gestational age infants
Prognostic factors
Case reports
Clinical images

Contributed by Mark R. Wick, M.D.

Breast skin

Images hosted on other servers:

36 year old woman at 24 weeks gestation

Annular erythematous-edematous lesions

Exudative and erythematous lesions

Various images

Microscopic (histologic) description
  • Similar to bullous pemphigoid - subepidermal blister, with eosinophils in lumen
  • Marked edema in papillary dermis
  • Perivascular infiltrate consists of lymphocytes, histiocytes and large numbers of eosinophils
  • Eosinophilic spongiosis may be seen
Microscopic (histologic) images

Contributed by Mark R. Wick, M.D.

Breast skin

Collagen IV stain

IgG stain

Images hosted on other servers:

H&E and C3

H&E, subepidermal bulla with eosinophils

Perivascular infiltrate of lymphocytes and eosinophils

Linear C3 staining

Positive stains
Differential diagnosis
  • Pruritic urticarial papules of pregnancy: typically begins in stretch mark areas of abdomen and usually ends within 2 weeks after delivery; no antibody deposition
  • Pregnancy prurigo: usually develops in the third trimester of pregnancy, presents with pruritic papules and nodules; histologic changes are those of low grade nonspecific spongiotic dermatitis
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