|LETTER TO EDITOR
|Year : 1995 | Volume
| Issue : 1 | Page : 58-59
Pemphigus vulgaris and pregnancy
RR Mittal, SP Singh
R R Mittal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mittal R R, Singh S P. Pemphigus vulgaris and pregnancy. Indian J Dermatol Venereol Leprol 1995;61:58-9
| To the Editor,|| |
Pemphigus vulgaris (PV) with pregnancy is extremely rare condition for west but it is seen occasionally in our patients as Indians suffer from PV at younger age. Infants of mother with PV are likely to have been exposed in utero to maternal IgG pemphigus antibodies by transplacental transfer.
A case of neonatal pemphigus vulgaris was reported where diagnosis was confirmed by immunofluorescent studies and skin lesions healed within 2 weeks as the level of maternal antibodies decreased. Transplacental transfer of antibodies leads to 23% still birth rate. Neonatal PV is the manifestation of autoimmune disease of the mother and is likely to disappear within few weeks of birth. No obvious correlation seems to exist between severity of disease in the mother and neonatal outcome. Two cases of pregnancy in PV were reported from India.
Five years back, one 17 years female was admitted and diagnosed histopathologically as a case of PV. She was treated with systemic steroids and remained well with maintenance doses of prednisolone 10mg daily for 2½ years. She was married at the age of 20 years and delivered a full term normal female child weighing 3.5 Kg at the age of 21½ year in a rural hospital. She is well controlled with 10mg prednisolone daily after her delivery. Pregnancy and delivery were uneventful and she did not need higher dosage of prednisolone during pregnancy, delivery or after delivery.
Histopathologically proved PV in 16-20 years, uneducated or partially educated females, who are unable to earn their livelihood, is not very rare in Punjab. 4-6 such new cases are admitted every year in dermatovenereology ward. Either they are already married or get married sometime after the control of their disease as their parents cannot keep grown up unmarried girls for a long period in spite of counselling. I have been observing pregnancy and its outcome in such cases of PV for the last many years. Most of the well controlled cases delivered normal babies, sometimes preterm low weight babies or still births were observed. Young females who are maintained with 10mg prednisolone daily for 2 years before conceiving usually do well during pregnancy and delivery. Pregnancy did not worsen the PV in mothers and no side effects of systemic steroids were seen in the neonates. Out of such well controlled cases, 4 cases of PV who delivered in our institution were given 4ml of dexamethasone intramuscularly during delivery. No extra steroids were given in the above patient in the rural hospital. I have gained confidence that young females with PV, who have well controlled disease at least 2 years prior to conception, can hope to get one or two normal babies. Therefore young females of PV should be treated only with systemic steroids rather than combination of steroids and cytotoxic drugs.
| References|| |
|1.||Avalos E, Patel H, Anhalt GJ, et al. Autoimmune injury of squamous epithelium by pemphigus antibodies. Br J Dermatol 1984;111:359-65. [PUBMED] |
|2.||Merlob P, Metzker A, Hazaz B, et al. Neonatal pemphigus. Pediatrics 1986;78:1102-5. [PUBMED] |
|3.||Stores JS, Galen WK, Nesbitt LT, et al. Neonatal pemphigus vulgaris. J Am Acad Dermatol 1982;6:929-32. |
|4.||Banerjee K, Banerjee R. Pemphigus vulgaris and pregnancy. Ind J Dermatol Venereol Leprol 1994;60:82-4. |