Contributed equally to this manuscript.
Glucocorticosteroid-resistant pemphigoid gestationis: Successful treatment with adjuvant immunoadsorption
Article first published online: 2 OCT 2011
© 2011 Japanese Dermatological Association
The Journal of Dermatology
Volume 39, Issue 2, pages 168–171, February 2012
How to Cite
WESTERMANN, L., HÜGEL, R., MEIER, M., WEICHENTHAL, M., ZILLIKENS, D., GLÄSER, R. and SCHMIDT, E. (2012), Glucocorticosteroid-resistant pemphigoid gestationis: Successful treatment with adjuvant immunoadsorption. The Journal of Dermatology, 39: 168–171. doi: 10.1111/j.1346-8138.2011.01376.x
- Issue published online: 24 JAN 2012
- Article first published online: 2 OCT 2011
- Received 27 November 2011; accepted 7 July 2011.
A 40-year old prima para presented with multiple urticaria-like plaques and severe pruritus 2 weeks prior to giving birth by cesarean section. Three days after birth, the disease flared up and tense blisters appeared on hands, lower arms and feet. Based on the clinical presentation, direct immunofluorescence microscopy, complement binding test and detection of high levels of circulating anti-BP180 antibodies, the diagnosis of pemphigoid gestationis was established. Despite treatment with class IV topical corticosteroid and prednisolone p.o. up to 60 mg/day, both skin lesions and severe pruritus progressed accompanied by increasing anti-BP180 antibody serum levels. In order to continue breast feeding, the prednisolone dose could not be further increased and 10 immunoadsorptions over 4 weeks were performed. During this period, skin lesions cleared rapidly, pruritus subsided and BP180-specific serum autoantibodies decreased by 99.5% allowing the reduction of prednisolone to 7.5 mg/day. We conclude that immunoadsorption is an effective and safe adjuvant therapeutic option for severe pemphigoid gestationis.