DP17 A very rare presentation of linear IgA disease during pregnancy

Abstract We present a very rare immunobullous dermatosis, linear IgA disease (LAD), that developed during pregnancy, to highlight its clinical features, management and important safety considerations for the neonate. During her first 32-year-old Japanese woman of 27 weeks’ gestation an intensely itchy blistering rash on limbs, trunk face without periumbilical predilection. The blisters were tense, clustering in annular configuration, with subsequent development erosions involving oral genital mucosae. Medications included pregnancy multivitamin only. A lesional skin biopsy revealed subepidermal blister containing neutrophils eosinophils. Direct immunofluorescence perilesional demonstrated deposition along basement membrane zone. Linear was diagnosed. Initial treatment consisted erythromycin daily clobetasol ointment. Owing inadequate symptom control progression, dapsone 50 mg initiated prompt improvement condition cessation new blistering. postpartum flare necessitated dose increase 75 daily. Her baby’s glucose-6-phosphate dehydrogenase (G6PD) level found be normal at birth. She proceeded breastfeed son, monitoring his haemoglobin normal. Although presentation initially raised possibility pemphigoid gestationis (PG), there no involvement, morphology conjunction mucosal involvement more suggestive LAD. results also helped distinguish LAD from PG. onset is unusual has been rarely reported (Ikkaku N, Tateishi Oda Y et al. immunoglobulin bullous dermatosis developing late pregnancy. J Dermatol 2017; 44:e44–5). Pre-existing typically improves although flares are recognized. Pemphigoid associated increased risk prematurity intrauterine growth restriction, but this not possibly due rarity. Both diagnosis mainstay treatment—dapsone—have potential implications As other diseases, transplacental transfer pathogenic antibodies may result transient, usually mild, neonatal can safely used breastfeeding, haemolysis methemoglobinaemia necessitates assessment G6PD Multidisciplinary input dermatology, obstetric paediatric teams crucial ensure appropriate counselling care affected mother baby.