Pemphigoid gestationis presenting with active disease during an ongoing pregnancy requires a treatment approach that accounts for fetal safety alongside disease control. This protocol applies specifically to the active-disease, in-pregnancy setting — not to post-partum or post-abortion presentations.

Clinical scenario Pemphigoid gestationis with active disease during pregnancy (not in the post-partum or post-abortion period). Treatment decisions in this setting must balance maternal disease activity with the safety constraints of the ongoing pregnancy.

The structured protocol for this situation includes an immunosuppressant option requiring specific haematological monitoring — with particular vigilance expected during the later stages of pregnancy. The complete treatment selection criteria, sequencing, and monitoring requirements are detailed in the full protocol.

Full regimen, selection criteria, and monitoring parameters available via the link below.

References

DOI: 10.3389/fmed.2020.604945

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.

Azathioprine (monitor for leukopenia, particularly in the last trimester)

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Treatment of Gestational Pemphigoid with Active Disease During Pregnancy

References