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Table 1 Differential diagnostics of pregnancy associated pruritic dermatoses

From: Gestational pemphigoid

  Atopic eruption of pregnancy Polymorphic eruption of pregnancy Intrahepatic cholestasis of pregnancy Gestational pemphigoid
Estimated incidence Most common pregnancy associated dermatose. 1:5–1:20 1:160 1:50–1:5000 1:40000–1:50000
High-risk groups   Primigravidity   Multiparity
Multiple pregnancy
Skin manifestations Pruritus Pruritus (Nocturnal) pruritus Pruritus
Eczematous lesions Urticarial papules and plaques Secondary skin lesions due to scratcing Papules
Urticarial plaques
Target lesions
Blisters, vesicles
Papules Sparing of the umbilical region Jaundice  
Localization of skin manifestations Trunk Lower abdomen Extremities (palms and soles) Abdomen, umbilicus
Extensors of the extremities Striae   
Studies S-IgE levels may be elevated Negative DIF Elevated total serum bile acid levels Linear C3 (and IgG) positivity in DIF. BP180 ELISA
Symptom onset (trimester of pregnancy) I-II III III II-III
Parturition/Lactation Symptom resolution Symptom resolution Symptom resolution Flare-up in connection to delivery
Pregnancy complications No fetal risks No fetal risks Stillbirth Prematurity
    Fetal growth restriction
Newborn No harm to newborn No harm to newborn No harm to newborn Possibility for transient skin blistering
Recurrence No elevated risk for recurrence No elevated risk for recurrence Elevated risk for recurrence Recurrence is usual.
Activation of symptoms is possible during menstruation and hormonal contraceptive use
  1. S-IgE: serum immunoglobulin E; DIF: direct immunofluorescence microscopy; BP180-ELISA: bullous pemphigoid 180 ELISA.