PEMPHIGOID GESTATIONIS: A PREGNANCY DISEASE OR A FAMILY DISEASE?

Background: Pemphigoid Gestationis is an autoimmune bullous disease that appears around 20 weeks of pregnancy, occurring in 1 of 40,000 pregnancies. Although usually solved spontaneously at the end of pregnancy, acute exacerbations may occur during delivery or immediately postpartum, with hormone therapy or menstrual cycles. Usualy begins with urticarial lesions that develop into blisters that extend to entire body, except face, palms and soles. Immunofluorescence technique makes a definitive diagnosis and treatment is based on corticosteroid therapy. Case report: 29 years old pregnant, without any relevant previous disease, with normal ultrasound scans and analysis of pregnancy. Around 30 weeks of pregnancy, emerged a maculopapular rash with itching and polycyclic lesions in armpits, groin and upper body. She was observed by a dermatologist who diagnosed a polymorphic eruption of pregnancy. Due to the progressive worsening of lesions it was performed a skin biopsy that was inconclusive, but immunofluorescence technique reveled Pemphigoid Gestationis. Despite high doses of systemic corticosteroids therapy, there were severe exacerbations during pregnancy and childbirth. She kept getting worse during menstrual cycle in postpartum, so she began goserelin treatment monthly for 1 year. Conclusion: The Pemphigoid Gestationis makes differential diagnoses with other specific pregnancy skin diseases. In addition to diagnostic and therapeutic challenges, this case also represents a challenge to her family doctor, who plays an important role in monitoring all the family problems: the inability of breastfeeding and taking care of the newborn, the impact of overloading the husband, the cushingoid look, multiple secondary effects of medication and the iatrogenic menopause.