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Herpes Gestationis

From: angel forseth (angel_forseth@und.nodak.edu)
Thu, 17 Oct 2002 11:04:09 -0500 (CDT)

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Hi, my name is Angel and I am currently enrolled at the University of North Dakota. Recently I was at clinical on the Family Birthing Center and I was assigned to take care of women with a rash that they were not quite sure it was. By the end of clinical the doctors’ diagnosis was herpes gestationis. This was the first case Altru has seen in seven years. According to Cunningham et al, (1989), herpes gestationis (HG) is a serious but rare dermatological disease that is peculiar to pregnancy. It is a pruritic blistering eruptions with lesions that vary from erythematous and edematous papules to large, tense bullae. Unlike herpes simplex virus, herpes gestationis is not a viral induced illness. Common sites it may involve are the extremities and the abdomen, but it may morphological change and develop in the small intestinal mucosa. The incidence of HG in many books is around 1:3000. It is usually appears in the second and third trimester, but may vary from 9 weeks gestation to 1-2 weeks postpartum. Some common signs and symptoms one may see are fever, hot and cold sensation, headache, malaise, nausea, and pruritus. Gleicher (1985), states how we get HG is that IgG autoantibody is directed against a component of the basement membrane in dermal—epidermal junction. “The IgG binds the antigen in the basement membrane and fixes complement of both the classical and alternative pathways. When basilar necrosis is widespread, blister formation at the dermal—epidermal junction is seen (Gleicher, 1989, 1151).” How HG is diagnosed and confirmed is when immunoreactants by indirect immunofluorescence bind to the epidermal side of split skin specimens with the finding of the with or without the IgG along the basement membrane zone of the skin (Buttino et al, 1998). Usually HG is treated with mild topical steroids or systemic steroids if the case is more severe. This is done to prevent risk for fetal complications. There is debating information on the fetal morbidity and mortality with some studies reporting increased incidence of stillbirths, spontaneous abortions, and prematurity and others showing no increased risk, according the Barron & Lindheimer, (2000). Some studies did show a significant increase in the in low birth weight and “small-for-date” infants and others showed no difference. Gleicher, (1985) states that HG can pass through the placenta and cause blisters on the fetus/newborn also. With my case, the doctor induced the pregnant women at 36 weeks to prevent any complication which could have happened with the baby. So, I was wondering if anybody else has seen or heard of this diagnosis and can add to my knowledge base on it, about the etiology, treatments, and nursing interventions used.

Barron, W.M., & Lindheimer, W.M. (2000). Medical disorders during pregnancy

( 3rd ed.).Philadelphia: Mosby.

Buttino, L., Elkayam, U., Evans, M.I., Galbraith, R.M., Gall, S.A., & Sibai,

B.A. (1998).Principles & practice of medical therapy in pregnancy

(3rd ed.). Connecticut: Appleton & Lance.

Cunningham, G.F., MacDonald, P.C.,& Gant, N.F. (1989) Williams obstetrics. San

Mateo, California: Appleton & Lance.

Gleicher, N. (1985). Principles of medical therapy in pregnancy. New York:

Book Company.

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Angel Forseth

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