Herpes gestationis: Clinical features of immunologically proved cases J.
A. CARRUTHERS,
F.R.C.P.(C.)
Landon, England Clinical features of eight immunopathologically proved cases of herpes gestationis (HG) are presented. They are compared with those of an earlier, clinically defined series. The important features of the disease are identical in the two groups, particularly the worsening with subsequent pregnancies, absence of intervening HG-free pregnancies, and the exacerbation with delivery and estrogens. The immunopathologic investigations are a reliable, diagnostic aid in differentiating HG from other dermatoses of pregnancy with which it may, at times, be confused. (AM. J. 0BSTET. GYNECOL. 131: 865, 1978.)
HER PES GESTA TIONI S (HG) is a pruritic, bullous disease of pregnancy. The typical case develops widespread pruritis and bullae (Fig. 1) during pregnancy or in the first 72 hours of the puerperium. This usuaiiy occurs in the first or second pregnancy and recurs with subsequent pregnancies. generaiiy in a more severe form. A similar eruption has been described in infants born of affected mothers and aiso in patients with hydatidiform mole and choriocarcinoma. Pruritus and pruritic skin eruptions are common during pregnancy. The typical case of HG can readily be differentiated from among these but many cases are not so easily diagnosed. Because of the inevitability of recurrence of HG with future pregnancies and its tendency to be increasingly severe, it is important to differentiate this condition from other similar eruptions. 1n 1973, Provost and Tomasi 4 described new immunopathologic findings in HG. They described complement deposition at the dermoepidermaljunction of the patient's periiesionai skin. and aiso a circuiaiing factor capable of fixing complement at the same site in normal human skin (Fig. 2). A number of smaii series have been reported by a few workers confirming these findings and that, among the pruntiC builous dermatoses of pregnancv, they are specific for HG. Since 1973. we have cunfirrned the diagnosis of HG in eight patients who have had a total of 14 affected
From St. John\ Hospital for Di1eases of the Skin. Rneivedfor publication December 27, 1977. Accepted February J-1, 1978. Rejn-int requests: Dr.]. A. Carruthers, Division of Dermatology, Department of Medicine, Faculty of Medicine, The University of British Columbia, 865 W. 1Oth Az•c .. Var1rouver, B. C., Canada V5Z I L7. 0002-937R/78108131-0865$00.30/0
©
1978 The C. V. Mosby Co.
pregnancies. Because the condition is being redefined by these immunopathologic findings. it seems of value to compare the clinical findings in our cases with those of an eariier, dinicaiiv defined series.-· Patients
Four of these patients were seen at St. John's Hospital and their clinical and immunopathologic features have been reported elsewhere. 1 All of th('se four patients showed complement deposition
A. CARRUTHERS,
F.R.C.P.(C.)
Landon, England Clinical features of eight immunopathologically proved cases of herpes gestationis (HG) are presented. They are compared with those of an earlier, clinically defined series. The important features of the disease are identical in the two groups, particularly the worsening with subsequent pregnancies, absence of intervening HG-free pregnancies, and the exacerbation with delivery and estrogens. The immunopathologic investigations are a reliable, diagnostic aid in differentiating HG from other dermatoses of pregnancy with which it may, at times, be confused. (AM. J. 0BSTET. GYNECOL. 131: 865, 1978.)
HER PES GESTA TIONI S (HG) is a pruritic, bullous disease of pregnancy. The typical case develops widespread pruritis and bullae (Fig. 1) during pregnancy or in the first 72 hours of the puerperium. This usuaiiy occurs in the first or second pregnancy and recurs with subsequent pregnancies. generaiiy in a more severe form. A similar eruption has been described in infants born of affected mothers and aiso in patients with hydatidiform mole and choriocarcinoma. Pruritus and pruritic skin eruptions are common during pregnancy. The typical case of HG can readily be differentiated from among these but many cases are not so easily diagnosed. Because of the inevitability of recurrence of HG with future pregnancies and its tendency to be increasingly severe, it is important to differentiate this condition from other similar eruptions. 1n 1973, Provost and Tomasi 4 described new immunopathologic findings in HG. They described complement deposition at the dermoepidermaljunction of the patient's periiesionai skin. and aiso a circuiaiing factor capable of fixing complement at the same site in normal human skin (Fig. 2). A number of smaii series have been reported by a few workers confirming these findings and that, among the pruntiC builous dermatoses of pregnancv, they are specific for HG. Since 1973. we have cunfirrned the diagnosis of HG in eight patients who have had a total of 14 affected
From St. John\ Hospital for Di1eases of the Skin. Rneivedfor publication December 27, 1977. Accepted February J-1, 1978. Rejn-int requests: Dr.]. A. Carruthers, Division of Dermatology, Department of Medicine, Faculty of Medicine, The University of British Columbia, 865 W. 1Oth Az•c .. Var1rouver, B. C., Canada V5Z I L7. 0002-937R/78108131-0865$00.30/0
©
1978 The C. V. Mosby Co.
pregnancies. Because the condition is being redefined by these immunopathologic findings. it seems of value to compare the clinical findings in our cases with those of an eariier, dinicaiiv defined series.-· Patients
Four of these patients were seen at St. John's Hospital and their clinical and immunopathologic features have been reported elsewhere. 1 All of th('se four patients showed complement deposition
