How do you get rid of pemphigoid gestationis ?

 PEMPHIGOID GESTATIONIS  [ PG ] :



Pemphigoid gestationis (PG) is a rare, itchy skin eruption that usually happens in the second or third trimester of pregnancy. It often begins with the appearance of very itchy red bumps or blisters on your abdomen and trunk, though it can show up on other parts of your body.

PG is caused by your immune system mistakenly attacking your own skin. It usually goes away on its own within days or weeks after delivery. In rare cases, it can last longer. Pemphigoid gestationis used to be known as herpes gestationis, but it’s now understood that it has no connection to the herpes virus. There are also other types of pemphigus  or pemphigoid skin eruptions, not related to pregnancy.

Pemphigus refers to a blister or pustule, and gestationis means “of pregnancy” in Latin.

WHAT ARE THE SIGNS AND SYMPTOMS OF PEMPHIGOID GESTATIONIS ?

PG, red bumps appear around the belly button and spread to other parts of the body within a few days or weeks. Your face, scalp, palms, and soles of the feet are usually not affected. After two to four weeks, the bumps turn into large, red, fluid-filled blisters. These bumps can also be called bulla. They can be extremely uncomfortable.



Instead of blisters or bulla, some people develop raised red patches called plaques. The PG blisters may shrink or go away on their own near the end of your pregnancy, but 75 - 80 % of women with PG experience a flare-up around the time of delivery.

PG can recur during menstruation or in subsequent pregnancies. Use of oral contraceptives may also bring on another attack. In rare cases — about 1 in every 100,000 births — PG can appear in newborns.

WHAT ARE THE CAUSES OF PEMPHIGOID GESTATIONIS ?

Pemphigoid gestationis is now understood to be an autoimmune disease. That means that your immune system begins to attack parts of your own body. In PG, the cells that come under attack are those of the placenta. Placental tissue contains cells from both parents. The cells that have derived from the father may contain molecules that are recognized as foreign by the mother’s immune system. This causes the mother’s immune system to mobilize against them.

Paternal cells are present in every pregnancy, but autoimmune diseases like PG only occur in some cases. It’s not completely understood why the maternal immune system reacts in this way in some cases, and not in others.The MHC II-class molecules are responsible for the sticking together of your layers of skin. Once your immune system begins to attack them, it can result in the blisters and plaque that are a main symptom of PG.



PEMPHIGOID GESTATIONIS DIAGNOSIS :

PG, they may refer you to a dermatologist for a skin biopsy. This involves applying a local anesthetic or freezing spray to a small area of skin and cutting away a tiny sample to be sent to the laboratory.

If the lab finds the signs of pemphigoid under the microscope, they’ll do a further test known as an immunofluorescence analysis that can confirm PG.

Your doctor will also take blood samples to determine the levels of the pemphigoid antigen Collagen XVII/BP180 in the blood. This may help them to assess the disease activity.

HOW TO TREAT PEMPHIGOID GESTATIONIS ?

Symptoms are mild, your doctor may prescribe anti-itch creams known as topical corticosteroids. These calm the skin by reducing the level of immune system activity at the site of the blisters.

Over-the-counter allergy drugs (antihistamines) can also be helpful. These include the non-drowsy products:

  • cetirizine (Zyrtec)
  • fexofenadine (Allegra)
  • loratadine (Claritin)

Diphenhydramine (Benadryl) induces drowsiness and is best taken at night. It then serves as a sleep aid in addition to its properties as an itch reliever.

All of these are available over the counter. Generic versions are equivalent in activity to the brand names, and often considerably less expensive.

Always speak to your doctor before taking any medications, even over-the-counter products, during pregnancy.

Home remedies

Your doctor may also suggest home remedies to fight the itch and discomfort of a mild case of PG. These can include:

  • keeping the skin cool with ice or cold compresses
  • staying in a cool or air-conditioned environment
  • bathing in Epsom salt  or oatmeal preparations
  • wearing cool cotton clothing

More severe cases

When itching and irritation are more severe, your doctor will likely prescribe oral corticosteroids. As these drugs act by reducing the activity of the immune system, the minimal effective dose must always be used.

Your doctor will take into account the effects on both you and your baby, and keep the dosage and duration of treatment to a minimum.

Immunosuppressive drugs such as azathioprine or cyclosporine may also be used to help reduce the itch and discomfort. Careful monitoring for side effects is needed. This may include:

  • checking blood pressure once or twice a week for the first month of use
  • monitoring kidney function with blood and urine tests
  • monitoring liver function, uric acid, and fasting lipid levels

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