This protocol addresses pemphigoid gestationis presenting with active disease during pregnancy — specifically excluding the post-partum and post-abortion periods. Managing this condition during pregnancy requires a careful approach that balances disease control with safety for both the patient and the developing fetus.
Active pemphigoid gestationis in a pregnant patient (not post-partum, not post-abortion). The treatment strategy in this setting is shaped by the need to control active disease while remaining appropriate for use during pregnancy.
Management in this setting centres on topical therapy as the preferred first-choice intervention. An additional agent may be considered specifically to address itch. The full selection criteria, sequence, and clinical decision points are detailed in the complete protocol.
DOI: 10.3389/fmed.2020.604945
In analogy to bullous pemphigoid, high potency topical corticosteroids are proposed as first-choice treatment both in mild disease and in moderate-to-severe PG.
Even there is proven evidence, oral antihistamines can be used for itch management.
In case of failure/contraindication/side effects of systemic corticosteroids, we suggest to consider during pregnancy intravenous immunoglobulin therapy and, as second step, conventional immunosuppressants/immunomodulating agents such as dapsone or azathioprine, which are the last choice, which can be used safely during pregnancy as inferred from many studies involving patients with other diseases treated with these agents.
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