Snap Shot A 26-year-old G1P0 female at 36 weeks gestation presents to her obstetrician with a 2 day history of abrupt onset of extremely pruritic and urticarial papules and blisters on the abdomen and trunk. She states that the itching has got so bad that it is interfering with her every day life. Introduction Pruritic blistering dermatologic disorder unique to pregnancy NOT associated with past or present herpes infection onset T2-postpartum characterized by severe pruritis lesions are erythematous papules, vesicles, and bullae distribution abdomen extremities generalized Epidemiology US incidence 1:50,000-60,000 pregnancies Mechanism and pathophysiology autoimmune bullous dermatosis pathophysiology antibodies against hemidesmosomal proteins undetermined trigger Associated conditions other autoimmune diseases such as Hashimoto's thyroiditis Grave's disease pernicious anemia Prognosis increased incidence of fetal morbitity and mortality increased risk of low amniotic fluid preterm labor IUGR maternal development of Grave's disease Presentation Symptoms pruritic papules and pustules characteristically periumbilical Physical exam inspection erythematous urticarial patches and plaques progress to tense vesicles and blisters Evaluation Labs some labs may be elevated IgG ESR acute phase reactants antithyroid antibodies Diagnosis clinical presentation histoloigic findings of subdermal blister process direct immunofluorescence showing linear C3 deposition on basement membrane Treatment Overview goals relieve pruritis supress extensive blister formation treatment can be difficult and can take weeks to months to resolve Conservative tepid baths warm compresses Pharmacologic topical steroids and antihistamines indications mild cases systemic corticosteroids indications more severe cases