Effectiveness and safety of off-label dupilumab use for the treatment of pemphigoid gestationis: a new case report.

Abstract

Pemphigoid gestationis (PG) is a very rare autoimmune disorder that typically occurs during the second and third trimesters of pregnancy. It is characterised by intense pruritus, erythematous plaques and vesicles, primarily affecting the abdomen and extremities. The exact cause remains unclear, but type 2 inflammation and antibodies against the collagen protein BP180 are implicated. Diagnosis is confirmed through clinical findings and specific tests. Traditional treatments include topical and systemic corticosteroids, but they can have significant side effects.This case report discusses a 38-year-old woman with PG in her second pregnancy, who experienced the disorder in her first pregnancy with severe symptoms and was treated with corticosteroids and intravenous immunoglobulins but developed serious side effects. In her current pregnancy, dupilumab was introduced at week 30 (off-label use), leading to significant symptom improvement within a week.This case supports the potential of dupilumab as a first-line treatment for severe PG, demonstrating safety and efficacy for both mother and baby.