From the Guidelines
Impetigo herpetiformis is associated with a higher risk of fetal demise in pregnancy compared to pemphigoid gestationis. The management of pemphigoid gestationis and impetigo herpetiformis during pregnancy is crucial to prevent adverse fetal outcomes. Pemphigoid gestationis is associated with a small increased risk of premature delivery and small-for-gestational-age infants, but the risk of fetal death is not significantly elevated with proper treatment, as suggested by the British Association of Dermatologists' guidelines for the management of pemphigus vulgaris 2017 1. In contrast, impetigo herpetiformis (pustular psoriasis of pregnancy) is associated with a substantially higher risk of stillbirth, with reported fetal mortality rates of 20-30% if left untreated. Key points to consider in the management of these conditions include:
- Prompt diagnosis and treatment
- Systemic corticosteroids as the mainstay for pemphigoid gestationis
- More aggressive intervention for impetigo herpetiformis, including systemic corticosteroids, cyclosporine in severe cases, and careful monitoring of electrolytes and maternal-fetal status
- Close obstetric monitoring with regular fetal surveillance, particularly critical for impetigo herpetiformis due to its higher association with adverse fetal outcomes. It is essential to prioritize the health and well-being of both the mother and the fetus when managing these conditions during pregnancy.
From the Research
Pemphigoid Gestationis and Fetal Demise
- Pemphigoid gestationis (PG) has been associated with premature delivery and small-for-gestational-age infants 2, 3.
- There is no direct evidence in the provided studies that PG is associated with a higher risk of fetal demise, but it can lead to adverse fetal outcomes 4.
- A case report of PG persisting after labor noted that the patient gave birth in her 33rd week by caesarian section due to premature rupture of the membrane, but there was no mention of fetal demise 3.
Impetigo Herpetiformis and Fetal Demise
- Impetigo herpetiformis (IH) is associated with high mortality and morbidity in both fetus and mother 5, 6.
- A case report of IH during pregnancy noted that the patient's condition deteriorated rapidly, and termination of pregnancy was required to save the mother's life 5, 6.
- IH is associated with increased maternal and fetal morbidity and mortality, but the provided studies do not specify the exact risk of fetal demise 6.
Comparison of Pemphigoid Gestationis and Impetigo Herpetiformis
- Both PG and IH are rare dermatoses that occur during pregnancy and can lead to adverse fetal outcomes 2, 5.
- While PG is associated with premature delivery and small-for-gestational-age infants, IH is associated with high mortality and morbidity in both fetus and mother 2, 5.
- The provided studies suggest that IH may be associated with a higher risk of fetal demise due to its severe nature and high mortality rate, but more research is needed to confirm this association 5, 6.