⚕️ FREE MSRA PODCAST – Pemphigoid Gestationis
🎧 A clear, high-yield breakdown of this rare autoimmune blistering condition in pregnancy – perfect for exam prep and clinical diagnosis confidence.

🧠 Key Learning Points

📌 Definition
• Pemphigoid Gestationis (PG) is a rare autoimmune subepidermal blistering disorder that occurs during pregnancy, usually in the 2nd or 3rd trimester.
• It involves IgG1 autoantibodies attacking the basement membrane zone of the skin.

📌 Causes & Risk Factors
• Pregnancy-related immune shifts (autoimmune trigger)
• Linked to hydatidiform mole or choriocarcinoma
• HLA-DR3 and HLA-DR4 associations
• Family or personal history of autoimmune disease
🧠 Mnemonic: “GHOST” – Gestation, HLA-DR3/4, Onset late, Skin attack, Thyroid risk

📌 Pathophysiology
• IgG1 antibodies bind to antigens in the lamina lucida → activate complement (C3)
• Leads to inflammation and dermal-epidermal separation
• Creates subepidermal bullae
• Shares antigenic similarities with bullous pemphigoid

📌 Symptoms
• Severe pruritus – hallmark feature, often before rash
• Begins with urticarial plaques (esp. periumbilical) → evolves into tense blisters
• Spares face, palms, soles, and mucosa in most cases
• Often worsens postpartum, but resolves over weeks/months
• May recur with future pregnancies, OCPs or menstruation

📌 Differential Diagnosis
• PUPPP (more common, lacks blisters)
• Bullous pemphigoid
• Linear IgA dermatosis
• Dermatitis herpetiformis
• Pruritic folliculitis of pregnancy
• Erythema multiforme

📌 Diagnosis
• Clinical picture + skin biopsy (from lesion edge)
• Direct immunofluorescence (DIF): linear C3 deposits at basement membrane
• Indirect immunofluorescence (IDIF): circulating IgG autoantibodies (PG factor)
• HLA-typing (supportive, not diagnostic)
🧠 Tip: DIF = deposits in skin, IDIF = antibodies in blood

📌 Management
• Oral corticosteroids (prednisolone 0.5–1 mg/kg/day) – mainstay
• Antihistamines – symptomatic relief for pruritus
• Emollients for skin comfort
• Severe/resistant cases: consider plasmapheresis or immunoadsorption
• Multidisciplinary care: dermatologist + obstetrician + paediatrician

📌 Complications
• Preterm labour (~20%)
• Small-for-gestational-age (SGA) infants
• Neonatal blisters (5–10%): transient, due to maternal IgG crossing placenta
• Psychological distress, sleep disruption from pruritus

📌 Prognosis
• Self-limiting postpartum, but may recur in future pregnancies or hormonal shifts
• Increased lifelong risk of autoimmune disease (e.g. Graves’, Hashimoto’s, Pernicious anaemia)
• Important for long-term autoimmune screening and counselling

📎 More MSRA Resources for Pemphigoid Gestationis
📝 Revision Notes:
https://www.passthemsra.com/topic/pemphigoid-gestationis-revision-notes/
🧠 Flashcards:
https://www.passthemsra.com/topic/pemphigoid-gestationis-flashcards/
💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/pemphigoid-gestationis-accordion-qa-notes/
🚀 Rapid Quiz:
https://www.passthemsra.com/topic/pemphigoid-gestationis-rapid-quiz/
🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/pemphigoid-gestationis/
🎓 Full Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/

🎓 This episode is part of the Dermatology for the MSRA course
Explore full revision guides, flashcards, quizzes, and more at:
👉 https://www.passthemsra.com

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