An Unusual Case of Refractory Pemphigoid Gestationis with Neonatal Involvement: An Intricate Therapeutic Challenge

Dear Editor, Pemphigoid gestationis (PG) is a rare autoimmune blistering disorder of pregnancy. Although postpartum resolution is common, some patients present with persistent or refractory disease. We report a therapeutically challenging case of PG in a primigravida, notable for steroid resistance, postpartum persistence, rare head and neck involvement, and neonatal manifestations. This case highlights the importance of early recognition, objective disease monitoring, and escalation to second-line therapies. A 23-year-old woman at 35 weeks of gestation presented with a pruritic vesiculobullous eruption on the abdomen, periumbilical area, limbs, and genital region. She had been previously treated with methylprednisolone 48 mg/day and clobetasol propionate, 0.05% cream for four weeks at another center with minimal improvement. Clinical, examination revealed widespread tense bullae exceeding 2 cm, erythematous plaques, and with rare head-neck involvement [Figure 1]. Laboratory investigations demonstrated eosinophilia (7%) and markedly elevated anti-BP180 IgG titers (92 U/mL; normal