Monday, August 5, 2013

Pemphigus in pregnancy

- Presents with clusters of vesicles and bullae and is associated with other auto-immune diseases and HLA-B8 and DR3  
- Starts within umbilicus and spreads to involve limbs, palms and soles  
- May improve in later pregnancy but 50-75% experience exacerbation within 24-48 hours of delivery
- 5% of neonates may develop bullous lesions  
- Possible increased risk of adverse perinatal outcome - fetal growth and well-being should be monitored
- Treatment is with topical corticosteroids and oral anti-histamines or oral prednisolone in severe cases in pregnancy although methotrexate and azathioprine are used in non-pregnant.

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