A severe persistent case of recurrent pemphigoid gestationis successfully treated with minocycline and nicotinamide

Sir, We describe a patient with severe recurrent and persistent pemphigoid gestationis (PG) who showed excellent clinical response to minocycline and nicotinamide during the postpartum period. This 24‐year‐old Caucasian woman developed a severely pruritic papulo‐vesicular eruption in the 34th week of her first pregnancy (Fig. 1). Clinically she had PG and this was confirmed on immunofluorescence studies (Fig. 2) and histology. She was treated with prednisolone 40 mg daily. She developed Cushingoid habitus and despite systemic steroids, her rash persisted. Her PG ran an unusually protracted course but finally abated 18 months postpartum on a combination of systemic steroids, antihistamine and potent steroid ointment. PG recurred during her second pregnancy at 12 weeks' gestation. Despite being on prednisolone up to 20 mg daily, her PG was still active at 1 year postpartum. Minocycline 100 mg daily was started beginning 12 months postpartum. In addition, nicotinamide 1000 mg daily was added. She was reviewed in clinic at 15 months postpartum (3 months after commencement of minocycline and nicotinamide) and had no further blisters. At 21 months postpartum (6 months after starting minocycline and nicotinamide), she was off all treatment and remained in complete remission.