Pemphigoid gestationis without blisters

Background and Objective: Pemphigoid gestationis (PG) is a rare pregnancy-a ssociated autoimmune bullous disease characterized by autoantibodies to the 180 kD bullous pemphigoid antigen (BP180). The clinical spectrum of PG is polymorphic and for diagnostic purposes,a skin biopsy is usually taken demo nstrating the deposition of autoantibodies. Patients and Methods: From 2 patients, skin biopsies were obtained for hist opathologic and immunofluorescence studies. Circulating autoantibodies were characterized by immunoblotting and ELISA using a recombinant form of the immunodominant BP180 NC16 A domain. Results: The 2 PG patients described here did not show blisters but complai ned about severe itching. In the first case, PG presented in the first trim ester of the second pregnancy as an erythema-multiforme-like disease. The s econd patient developed urticarial plaques a few days after delivery. PG wa s diagnosed by the detection of autoantibodies against recombinant BP180 NC 16 A by immunoblot and ELISA analysis and confirmed by linear deposits of C 3 at the cutaneous basement membrane zone on direct immunofluorecence micro scopy. Skin lesions healed with oral prednisolon. Conclusions: In our two patients, nonbullous PG could be diagnosed by serol ogical tests. Immunmoblotting and ELISA might be sensitive and specific too ls when screening sera of patients with pruritic skin lesions in pregnancy for the presence of autoantibodies to BP180. In some cases,these newer tech niques may make a skin biopsy unnecessary.