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Pruritic Rash in Pregnancy

 

Am Fam Physician. 2017 Apr 1;95(7):453-454.

A 29-year-old woman (gravida 4, para 2) presented at 29 weeks' gestation with the sudden appearance of scattered periumbilical and lower extremity pruritic papules. Despite treatment with topical hydrocortisone valerate and oral diphenhydramine (Benadryl), the rash spread to her entire abdomen and all four extremities. Physical examination revealed ovoid plaques with targetoid features and erythematous nodules (Figures 1 and 2). Her face and mucous membranes were not affected.

The pruritus intensified, and her symptoms did not respond to an increased dose of topical or oral corticosteroids. Her medical and obstetric histories were unremarkable, including no history of similar rashes. She had no new exposures. A skin biopsy revealed prominent linear staining of the epidermal basement membrane for C3 and lesser staining for immunoglobulin G (IgG).

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Figure 1


Figure 1

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Figure 2


Figure 2

Question

Based on the patient's history, physical examination, and histologic findings, which one of the following is the most likely

Author disclosure: No relevant financial affiliations.

Address correspondence to James S. Studdiford, MD, at james.studdiford@jefferson.edu. Reprints are not available from the authors.

REFERENCES

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1. Bedocs PM, Kumar V, Mahon MJ. Pemphigoid gestationis: a rare case and review. Arch Gynecol Obstet. 2009;279(2):235–238....

2. Jenkins RE, Hern S, Black MM. Clinical features and management of 87 patients with pemphigoid gestationis. Clin Exp Dermatol. 1999;24(4):255–259.

3. Bergman H, Melamed N, Koren G. Pruritus in pregnancy: treatment of dermatoses unique to pregnancy. Can Fam Physician. 2013;59(12):1290–1294.

4. Chi CC, Wang SH, Charles-Holmes R, et al. Pemphigoid gestationis: early onset and blister formation are associated with adverse pregnancy outcomes. Br J Dermatol. 2009;160(6):1222–1228.

5. Huilaja L, Mäkikallio K, Tasanen K. Gestational pemphigoid. Orphanet J Rare Dis. 2014;9:136.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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