Pemphigoid Gestationis: Symptoms, Diagnosis, and Treatment

Intense itching during pregnancy can be miserable, and a rash that starts around the belly button or develops into blisters can be alarming. One uncommon cause is pemphigoid gestationis (PG), an autoimmune skin condition that usually begins in the second or third trimester but can also start shortly after delivery. It is not an infection, even though an older name—“herpes gestationis”—can sound as if it were caused by herpes.

Most pregnancies affected by PG do not have a serious outcome, but the condition has been linked with a higher chance of preterm delivery or a baby who is smaller than expected, particularly when the skin disease is more severe. A maternity clinician and dermatologist can help confirm the diagnosis, control symptoms, and decide what pregnancy monitoring is appropriate.

What is pemphigoid gestationis?

Pemphigoid gestationis is a rare autoimmune blistering disease associated with pregnancy and the postpartum period. The immune system makes antibodies that target BP180, also called collagen XVII, a protein near the junction between the epidermis and the layer below it. Damage at this junction can create a raised, hive-like rash and, in some cases, tense fluid-filled blisters.

The exact immune trigger is not fully understood. BP180 is also present in placental tissue, and pregnancy-related immune changes may contribute to the response. PG is not caused by poor hygiene, food, or contact with another person. It is not herpesvirus infection. The older term “herpes gestationis” described the appearance of blisters, not their cause.

PG most often appears during the second or third trimester, but onset can occur earlier in pregnancy or soon after delivery. The condition may intensify around labor or flare in the first weeks after birth. It can occur in a first pregnancy or in someone who has had previous pregnancies. The rash usually improves after pregnancy, though some people need treatment for weeks or months postpartum.

Although PG is usually limited to the skin, itching and visible lesions can substantially affect sleep, comfort, and daily life. A clinician should assess new pregnancy rashes rather than assume they are routine stretching or a harmless allergy. Several pregnancy-specific conditions look similar early on but have different causes and follow-up needs.

Symptoms and how the rash may change

Itching is often the first symptom. The initial rash may look like red bumps, raised patches, or hives around the belly button. Over several days or weeks it can spread across the abdomen, trunk, buttocks, arms, or legs. In some people, large tense blisters appear on top of inflamed plaques. Blister fluid is usually clear but can be blood-tinged.

The rash often starts around the navel, which is a useful clue. The face, scalp, mouth, and genital mucosa are not usually affected. Palms and soles are often spared early, but blisters can involve them later. Skin can be very itchy and tender, and scratching may create open areas that can become infected.

Some people have an itchy rash without obvious blisters. Others notice the rash progressing rapidly. PG can flare near delivery and again after birth. A postpartum flare does not necessarily mean the treatment failed, but the maternity and dermatology teams should know so that they can adjust care.

Skin lesions generally heal without scars, although dark or light marks can remain temporarily. Scarring, pus, fever, or increasing pain may signal infection or another diagnosis and should be discussed with a clinician.

How PG differs from other pregnancy rashes

Several skin conditions can cause itching during pregnancy. The differences are not always obvious in the early stages, so a clinician may need to examine the rash, ask when it began, and order skin or blood tests.

Polymorphic eruption of pregnancy (PUPPP)

Polymorphic eruption of pregnancy—also called PUPPP—often begins late in pregnancy within stretch marks on the abdomen and tends to spare the navel. It can be intensely itchy, but it usually does not produce the tense blisters that can occur in PG. The mother's and baby's care needs are generally different, which is why a rash around the navel or a blistering rash should be assessed.

Intrahepatic cholestasis of pregnancy

Cholestasis can cause significant itching without a primary rash. It often affects the palms and soles, though itching may become generalized; scratch marks can appear later. Because cholestasis can affect pregnancy outcomes, severe itch—especially on palms or soles without a clear rash—should be reported to the maternity team promptly. Blood tests, including bile acids and liver tests, may be needed. Do not assume that all pregnancy itching is a skin allergy.

Atopic eruption and other causes

Atopic eruption of pregnancy may resemble eczema or small itchy bumps, often in someone with a personal history of eczema or atopy. Other possibilities include contact dermatitis, urticaria, infections, medication reactions, and less common blistering diseases. A new rash with blisters, fever, facial swelling, or mucosal symptoms needs prompt evaluation.

How pemphigoid gestationis is diagnosed

A clinician considers the timing, location, itch, and appearance of the rash. If the presentation is typical, examination may strongly suggest PG. Early disease can look like other pregnancy rashes, however, so testing is often used to confirm the diagnosis and guide pregnancy monitoring.

Skin biopsy and direct immunofluorescence

A small sample from an active lesion may be sent for routine microscopy, which can show inflammation and a split beneath the epidermis. A second sample of nearby skin may be examined with direct immunofluorescence (DIF), a test for antibodies and complement deposited in tissue. PG typically shows a linear band of complement C3 along the basement membrane zone; IgG may also be present.

Blood tests can look for circulating antibodies, especially antibodies against BP180 (collagen XVII). Results are interpreted with the clinical pattern because no single test should be used without context. The dermatologist and obstetric clinician may coordinate results, especially if the rash is widespread or blistering.

Pregnancy and fetal monitoring

Most babies are unaffected, but PG has been associated with a higher risk of preterm delivery or a baby who is small for gestational age. The risk appears to be greater when disease is more severe; published estimates differ because the condition is rare and studies include different patient groups. This association does not mean that an adverse outcome is inevitable.

Antibodies can cross the placenta. A small number of newborns develop temporary itchy bumps or blisters that usually resolve as maternal antibodies clear. The maternity team can help plan newborn assessment if needed. A dermatologist and obstetric clinician—sometimes a maternal-fetal medicine specialist—can decide whether additional fetal growth monitoring is appropriate.

PG usually affects the mother's skin rather than directly causing organ damage in the pregnant person. Still, a new rash should be evaluated to rule out other diagnoses, and severe itching without a primary rash needs a separate assessment for cholestasis. Attend prenatal visits and follow the plan from the maternity team.

Treatment during pregnancy and after birth

Treatment aims to reduce itch and inflammation, prevent new blisters, protect open skin, and support the health of both pregnant person and baby. The plan should be made with a clinician who knows the pregnancy history and disease severity. Do not start a prescription, herbal product, or over-the-counter treatment during pregnancy without checking with the maternity team or prescriber.

Mild or localized symptoms

For limited disease, clinicians may recommend moisturizers, gentle skin care, and a topical corticosteroid applied to affected areas. The strength, amount, body area, and duration matter in pregnancy. A maternity clinician or dermatologist can select the lowest effective approach and explain when to stop or review it.

An oral antihistamine may be considered for itch if appropriate during pregnancy. The choice should be checked with a clinician or pharmacist, especially if there are other medicines or health conditions. Avoid sedating products if they affect alertness or if the care team advises against them.

More extensive blistering

If the rash is widespread, blistering, or not controlled with local treatment, an oral corticosteroid may be considered. The prescriber balances disease control with pregnancy and maternal risks, uses a tailored plan, and monitors response. Do not adjust the dose or taper without instructions. Some people need a treatment change or continued care after delivery because a postpartum flare can occur.

Other immune-suppressing treatments may be considered in exceptional or refractory cases, especially after delivery, but their risks and benefits depend on pregnancy stage, breastfeeding, disease severity, and available alternatives. Medication guidance can change, so the obstetrician, dermatologist, and pharmacist should review the exact drug rather than relying on an online list.

Blister and itch care at home

Keep the skin comfortable with fragrance-free moisturizers or emollient washes if recommended. Wear loose, soft clothing and try to reduce friction over active areas. If a blister opens, gentle cleansing and a non-adherent dressing may protect the skin; ask the care team what to use and how often to change it.

Call the clinician if a lesion becomes increasingly painful, warm, swollen, foul-smelling, or produces pus, or if fever develops. Avoid picking blisters, using harsh antiseptics, or applying leftover steroid or antibiotic creams without advice. Skin infection may need separate evaluation and treatment.

Write down changes in itch, rash location, blisters, sleep, and any medication use. If symptoms worsen around delivery, tell both the obstetric and dermatology teams. A postpartum plan can help manage flares and decide when treatment can be reduced.

What to expect after delivery

PG often improves after birth, but the rash may flare during labor or in the first days postpartum. Many cases settle over weeks or months; a smaller group has more prolonged disease. The care team can explain whether to continue treatment, what to do if blisters return, and whether any follow-up is needed for the newborn.

PG can recur in a later pregnancy and may start earlier than it did the first time. Some people notice flares with menstruation or hormonal contraception after pregnancy. Mention a prior diagnosis to the obstetrician or dermatologist before or early in a future pregnancy so that itching or a rash can be assessed promptly.

Transferred maternal antibodies can cause a temporary rash in a small number of newborns. This is different from a viral infection. If the baby develops blisters or a rash, contact the pediatrician; symptoms usually resolve as maternal antibodies clear, but the baby should be assessed.

Some people with PG also have autoimmune thyroid disease. A clinician may ask about thyroid symptoms or other autoimmune history and decide whether further evaluation is warranted. Do not assume that every postpartum symptom is related to PG; discuss new concerns with a healthcare professional.

When to contact your maternity team

Contact the maternity team or clinician promptly for a new itchy rash that begins near the navel, any tense blisters, widespread itching, or a rash that is rapidly changing. Mention whether the palms or soles itch and whether there is an obvious rash. If itching is severe but there is no primary rash—especially on palms or soles—ask about same-day assessment for cholestasis.

Call for advice if lesions become infected, painful, or widespread, or if you develop fever or feel unwell. Contact your maternity unit urgently for reduced fetal movement or any pregnancy warning sign described in your prenatal care instructions. Use emergency services for breathing difficulty, fainting, severe allergic symptoms, or severe illness.

At an appointment, useful questions include: “Could this be PG or another pregnancy rash?” “Do I need a skin biopsy or BP180 test?” “Should I have bile-acid or liver tests?” “What treatment is appropriate at this stage of pregnancy?” and “What is the plan for delivery and the weeks after birth?”

Frequently asked questions

References and further reading

• European Academy of Dermatology and Venereology. Pemphigoid gestationis: patient information leaflet. Skin Diseases in Pregnancy Task Force. 2024.
• DermNet. Pemphigoid gestationis: features, diagnosis, complications, treatment, and outcome.
• Merck Manual Professional Edition. Pemphigoid gestationis. Reviewed March 2024.
• Preuß SL, et al. Pemphigoid gestationis is associated with an increased risk for adverse pregnancy outcomes: a large-scale propensity-matched retrospective cohort study. 2024.
• A systematic review of treatment options and clinical outcomes in pemphigoid gestationis. 2020.
• StatPearls. Pemphigoid gestationis: diagnosis and management.

Medical information notice: This article is for general education and does not replace prenatal care, diagnosis, or individualized treatment. Contact your maternity team for new blisters, severe itching, or pregnancy concerns. Seek urgent help for breathing difficulty or severe illness.