M. Daboubi, T. Maaita, M. Al-Ruhaibeh

Fig. 1. Pruritic urticarial lesions developing a periumbilical
pattern on the abdomen
Fig. 2. Annular erythema on the fore arm
Fig. 3. Dense peri-vascular dermal lymphohistiocytic
infiltrate and esinophils
antenatal clinic and the dermatology clinic as well
regularly every two weeks.
She delivered vaginally at 39 weeks a baby boy
weighing 3.150 kilograms who was healthy without
abnormalities or skin lesions. She had two very
small skin lesions at time of delivery.
The patient experienced a postpartum flare-up on
the third day while she was still in the hospital;
prednisolone dose was increased to 50mg per day
and she was discharged five days later on 40mg per
day. Later the dose was decreased gradually till it
was stopped at the 14 th week post partum.
It is important to notice that the first and the third
pregnancies were free of the disease.
Discussion
Herpes gestationis is one of the specific
dermatoses of pregnancy like Papular dermatitis of
pregnancy. It is characterized by intense pruritic
urticarial papules and plaques with the development
of tense vesicles and bullae, and it tends to recur
with subsequent pregnancies and with the use of the
Fig 4. Sub epidermal vesicle containing lymphohistiocytes
and esinophils
oral contraceptive pill. Herpes gestationis is clearly
hormonally modulated, since the rash flares
premenstrually, (3) however skipped or uninvolved
pregnancies occur in 8% of reported cases. (4,5) The
same occurred with our patient, which is important,
because this is very rare and explanation of why
skipped pregnancies occur remains uncertain. It is
not due to the mother and the fetus being compatible
at the DR locus (as there is an association of Herpes
gestationis with HLA DR3 and DR4 antigens), nor it
is due to a change in partner. (4)
It tends to occur any time from first trimester to
the immediate post partum period but mostly it
begins in the second or third trimester.
Exacerbation at the time of delivery or post partum
period occurs in 75% of the patients and most
patients recover within 14 weeks after delivery. (6)
Persistence up to 28 months post partum has been
frequently reported, (6,7) and exceptionally long
persistence for eight years has been reported in one
case. (6) Herpes gestationis occurs in pregnancy and
in trophoplastic tumors.
JOURNAL OF THE ROYAL MEDICAL SERVICES
Vol. 17 Supp No. 2 July 2010
95