{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T10:14:52Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 19.8, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a0951b-aaef-7b51-b51e-7ae0bee3b518\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: herpes gestationis\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 043: 1", "usd": 0.0, "recall": true }, "codex": { "seconds": 79.5, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a0951b-aaf2-7d11-9794-6bf70d6ec0ee\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: herpes gestationis\nRegistry id: vr.tr.herpes-gestationis\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this en" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:39:52+00:00", "fields": [ "agent_conduct", "ethics", "owners" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:33+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q8280", "registryId": "vr.tr.herpes-gestationis", "name": "herpes gestationis", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q8280/", "model": { "registry_id": "vr.tr.herpes-gestationis", "name": "herpes gestationis", "purpose": "Enable an agent to recognise suspected herpes gestationis, assess diagnostic certainty and disease activity, and support coordinated dermatological and obstetric decisions.", "definition": "Herpes gestationis, now usually called pemphigoid gestationis, is a rare pregnancy-associated autoimmune blistering disease in which antibodies targeting the skin's basement membrane, principally BP180, cause intensely itchy inflammatory lesions and subepidermal blisters during pregnancy or the postpartum period.", "scope_statement": "This model owns the pregnancy-associated autoimmune blistering condition pemphigoid gestationis, historically called herpes gestationis, under registry identity vr.tr.herpes-gestationis in XCT / XCT.STA, including its postpartum course and recurrences.", "in_scope": [ "Condition identity and distinction from infectious herpes and other pregnancy eruptions", "Clinical presentation and immunopathological diagnostic evidence", "Maternal skin activity, symptom burden and complications", "Pregnancy timing, postpartum persistence and recurrent episodes", "Condition-specific treatment assessment and maternal-fetal coordination" ], "out_of_scope": [ "Herpes simplex and varicella-zoster infections as separate diseases", "Bullous pemphigoid outside the gestational disease context", "Polymorphic eruption of pregnancy and other alternative diagnoses", "General pregnancy management and independent obstetric disorders", "Drug pharmacology and prescribing protocols", "Independent neonatal blistering disorders" ], "distinguishing_features": [ "The historical word 'herpes' does not establish viral infection; the condition belongs to autoimmune blistering disease. [DermNet](https://dermnetnz.org/topics/pemphigoid-gestationis)", "Pruritic plaques beginning around the umbilicus and evolving into tense blisters support recognition, although early disease may lack blisters. [EADV](https://eadv.org/wp-content/uploads/2023/04/EADV-Pregnancy-TF_-Pemphigoid-Gestationis-PG.pdf)", "Linear C3 deposition at the dermoepidermal junction on direct immunofluorescence supports the diagnosis and helps distinguish it from polymorphic eruption of pregnancy. [DermNet](https://dermnetnz.org/topics/pemphigoid-gestationis)", "Pregnancy-associated onset and a compatible course distinguish gestational pemphigoid from other pemphigoid presentations; antibody results require clinical context. [StatPearls](https://www.ncbi.nlm.nih.gov/books/NBK470287/)", "A flare around delivery or recurrence with later pregnancies supports the longitudinal pattern without being a required diagnostic feature. [EADV](https://eadv.org/wp-content/uploads/2023/04/EADV-Pregnancy-TF_-Pemphigoid-Gestationis-PG.pdf)" ], "characteristics": [ { "name": "Diagnostic certainty", "kind": "state", "unit_or_values": "suspected | supported | specialist-confirmed | reconsidered; dated evidence", "why_it_matters": "Prevents a suggestive pregnancy rash from being treated as a confirmed autoimmune diagnosis." }, { "name": "Reproductive timing", "kind": "measurement", "unit_or_values": "gestational weeks and days, or days since delivery", "why_it_matters": "Locates onset, investigations and activity changes within the pregnancy and postpartum course." }, { "name": "Lesion phenotype and distribution", "kind": "category", "unit_or_values": "urticarial plaques | vesicles | tense bullae | erosions; affected sites and umbilical involvement", "why_it_matters": "Supports recognition and identifies atypical presentations requiring reassessment." }, { "name": "Skin activity", "kind": "measurement", "unit_or_values": "new blisters per day and affected body surface area percentage; dated method", "why_it_matters": "Separates continuing lesion formation from healing residual lesions." }, { "name": "Itch burden", "kind": "measurement", "unit_or_values": "0-10 reported intensity with recall period; sleep disruption recorded separately", "why_it_matters": "Captures suffering that lesion extent alone may miss." }, { "name": "Immunopathology", "kind": "category", "unit_or_values": "direct immunofluorescence pattern, histology findings, specimen site and adequacy", "why_it_matters": "Makes the diagnostic interpretation traceable to the actual specimen and report." }, { "name": "BP180 antibody result", "kind": "measurement", "unit_or_values": "laboratory-reported titre or concentration, assay units and reference interval", "why_it_matters": "Records supportive serology without assuming different assays are interchangeable." }, { "name": "Episode relationship", "kind": "relation", "unit_or_values": "linked pregnancy, delivery, previous episode and possible hormonal exposure", "why_it_matters": "Distinguishes persistent disease from a later recurrence." }, { "name": "Treatment response", "kind": "state", "unit_or_values": "unassessed | improving | controlled on treatment | flaring | persistent despite treatment", "why_it_matters": "Connects observed activity to treatment exposure and review decisions." } ], "affordances": [ "Assemble a diagnostic evidence summary for dermatology review.", "Identify missing or discordant evidence before accepting the diagnosis.", "Track itch, new blister formation and healing through pregnancy and postpartum follow-up.", "Prepare a coordinated dermatology, obstetric and neonatal handover.", "Compare documented treatment response with adverse effects and reproductive context.", "Preserve recurrence history for future pregnancy and contraception counselling." ], "agent_conduct": { "may": [ "Explain pemphigoid gestationis and why it is not related to the herpes virus, citing medical sources.", "Advise a pregnant person with a blistering itchy rash to contact their maternity team." ], "must_not": [ "Diagnose the condition or rule it out from a description or photo.", "Recommend steroids or other drugs during pregnancy.", "Imply the condition is a sexually transmitted infection.", "Share a person's pregnancy or diagnosis without consent." ], "requires_human": [ "Any decision on treatment during pregnancy or after birth." ] }, "ethics": { "considerations": [ "The old name causes needless shame by suggesting a sexual infection.", "Treatment in pregnancy affects both the mother and the baby." ], "affected_parties": [ "Pregnant people", "Newborns", "Maternity clinicians" ] }, "owners": { "steward": "Nobody owns the condition; clinicians answer for each patient's care.", "master_systems": [] }, "what_it_is_for": [ "Pemphigoid gestationis is encountered in dermatological and obstetric care during pregnancy or after childbirth.", "Recognising the condition supports assessment of maternal skin disease, diagnostic confirmation and coordinated pregnancy monitoring." ], "standards_and_regulation": [ "The World Health Organization classifies herpes gestationis under ICD-10 code O26.4." ], "visual_identification": [ "Intensely itchy, raised red plaques often begin around the navel before spreading across the trunk and limbs.", "Tense fluid-filled blisters can develop on inflamed skin, helping distinguish established disease from pregnancy eruptions without blisters.", "The face and mucous membranes are usually spared, but appearance alone cannot confirm the diagnosis." ], "failure_modes_and_hazards": [ "Severe itching and blistering can disrupt sleep and damage the skin barrier.", "Damaged skin can develop secondary infection.", "Affected pregnancies have increased risks of preterm birth and impaired fetal growth.", "Maternal antibodies can occasionally cause temporary blistering in the newborn." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q8280: herpes gestationis", "url": "https://www.wikidata.org/wiki/Q8280", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Gestational pemphigoid", "url": "https://en.wikipedia.org/wiki/Gestational_pemphigoid", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "identity-and-disease-boundaries", "name": "Identity and disease boundaries", "description": "Anchor the historical registry name to the clinical disease and its nearest alternatives.", "rationale": "The name invites confusion with viral herpes, while early lesions overlap with other pregnancy eruptions.", "layers": [ { "id": "historical-name-and-concept", "name": "Historical name and concept", "description": "Preserve registry identity while making clinical terminology explicit.", "findings": [ { "id": "pemphigoid-gestationis-equivalence", "name": "Pemphigoid gestationis equivalence", "description": "Herpes gestationis is a historical synonym of pemphigoid gestationis. [DermNet](https://dermnetnz.org/topics/pemphigoid-gestationis)", "questions": [ { "text": "Does the originating record use herpes gestationis to mean pemphigoid gestationis?", "kind": "definition", "id": "pemphigoid-gestationis-equivalence-q01" }, { "text": "Does an existing Vercy publication already own this concept and require a registry link?", "kind": "boundary", "id": "pemphigoid-gestationis-equivalence-q02" } ] } ] }, { "id": "pregnancy-rash-differential", "name": "Pregnancy rash differential", "description": "Make competing explanations and discriminatory evidence explicit.", "findings": [ { "id": "alternative-diagnoses", "name": "Alternative diagnoses", "description": "Record why polymorphic eruption of pregnancy, other pemphigoid disorders or infection remain plausible or have been excluded.", "questions": [ { "text": "Which clinical and laboratory observations distinguish this episode from polymorphic eruption of pregnancy?", "kind": "boundary", "id": "alternative-diagnoses-q01" }, { "text": "Which atypical features require investigation for infection or another blistering disorder?", "kind": "action", "id": "alternative-diagnoses-q02" } ] } ] } ] }, { "id": "diagnostic-evidence", "name": "Diagnostic evidence", "description": "Connect the observed eruption to tissue and circulating-antibody evidence.", "rationale": "An early nonbullous eruption cannot be classified reliably by appearance alone.", "layers": [ { "id": "clinical-evolution", "name": "Clinical evolution", "description": "Reconstruct the sequence from itch to visible lesions.", "findings": [ { "id": "onset-and-distribution", "name": "Onset and distribution", "description": "Record first symptoms, initial sites, umbilical involvement and subsequent blister formation.", "questions": [ { "text": "When did itch, plaques and the first blisters appear relative to gestation or delivery?", "kind": "measurement", "id": "onset-and-distribution-q01" }, { "text": "Which sites are involved, spared or atypical, and who documented the examination?", "kind": "provenance", "id": "onset-and-distribution-q02" } ] } ] }, { "id": "tissue-and-serology", "name": "Tissue and serology", "description": "Retain specimen-level evidence and interpretation limits.", "findings": [ { "id": "immunological-support", "name": "Immunological support", "description": "Capture histology, direct immunofluorescence and BP180 serology with sampling details rather than a single positive-test flag.", "questions": [ { "text": "What did histology and direct immunofluorescence show, and were specimen site and handling appropriate?", "kind": "provenance", "id": "immunological-support-q01" }, { "text": "What BP180 assay, result and reference interval were reported, and how did the specialist interpret discordant findings?", "kind": "measurement", "id": "immunological-support-q02" } ] } ] } ] }, { "id": "maternal-activity-and-course", "name": "Maternal activity and course", "description": "Represent current skin burden and changes across reproductive events.", "rationale": "Symptom control, lesion healing and durable remission are different states.", "layers": [ { "id": "active-skin-burden", "name": "Active skin burden", "description": "Measure new disease activity separately from accumulated skin damage.", "findings": [ { "id": "activity-and-complications", "name": "Activity and complications", "description": "Track new blisters, erosions, itch, sleep loss and assessed secondary infection.", "questions": [ { "text": "How many new blisters developed during the stated interval, and how extensive are active lesions?", "kind": "measurement", "id": "activity-and-complications-q01" }, { "text": "Do itch, sleep loss, painful erosions or suspected infection warrant earlier clinical review?", "kind": "action", "id": "activity-and-complications-q02" } ] } ] }, { "id": "postpartum-and-recurrence", "name": "Postpartum and recurrence", "description": "Link activity changes to delivery and subsequent reproductive history.", "findings": [ { "id": "episode-continuity", "name": "Episode continuity", "description": "Record delivery-associated flares, persistent postpartum activity, remission and later recurrence as distinct events.", "questions": [ { "text": "Did activity resolve, persist or flare after delivery, and was treatment still being used?", "kind": "measurement", "id": "episode-continuity-q01" }, { "text": "What evidence separates a new recurrence from uninterrupted disease or a different eruption?", "kind": "boundary", "id": "episode-continuity-q02" } ] } ] } ] }, { "id": "pregnancy-and-neonatal-interface", "name": "Pregnancy and neonatal interface", "description": "Link maternal disease to obstetric surveillance and newborn assessment.", "rationale": "The disease is associated with prematurity, impaired fetal growth and occasional transient neonatal blistering. [EADV](https://eadv.org/wp-content/uploads/2023/04/EADV-Pregnancy-TF_-Pemphigoid-Gestationis-PG.pdf)", "layers": [ { "id": "obstetric-surveillance", "name": "Obstetric surveillance", "description": "Record the pregnancy-specific monitoring plan and its responsible clinician.", "findings": [ { "id": "growth-and-delivery-assessment", "name": "Growth and delivery assessment", "description": "Link disease onset and activity to documented fetal growth assessments and delivery outcomes without asserting individual causation.", "questions": [ { "text": "What growth measurements and gestational dating support the obstetric assessment?", "kind": "measurement", "id": "growth-and-delivery-assessment-q01" }, { "text": "What surveillance and escalation plan has the obstetric team agreed in light of disease activity?", "kind": "action", "id": "growth-and-delivery-assessment-q02" } ] } ] }, { "id": "newborn-handover", "name": "Newborn handover", "description": "Keep maternal disease and neonatal findings linked but separately assessed.", "findings": [ { "id": "neonatal-skin-assessment", "name": "Neonatal skin assessment", "description": "Record newborn skin findings and their clinical interpretation rather than automatically assigning the maternal diagnosis.", "questions": [ { "text": "Has the neonatal team received the maternal diagnosis, supporting evidence and treatment history?", "kind": "action", "id": "neonatal-skin-assessment-q01" }, { "text": "If the newborn has blisters, what assessment distinguishes transferred-antibody effects from infection or another disorder?", "kind": "boundary", "id": "neonatal-skin-assessment-q02" } ] } ] } ] }, { "id": "treatment-and-follow-up-decisions", "name": "Treatment and follow-up decisions", "description": "Connect clinician-selected interventions to activity, reproductive context and observed response.", "rationale": "Treatment decisions must account for maternal control alongside pregnancy and lactation considerations.", "layers": [ { "id": "treatment-selection-and-response", "name": "Treatment selection and response", "description": "Document why a treatment was chosen and whether its intended effects occurred.", "findings": [ { "id": "exposure-response-assessment", "name": "Exposure-response assessment", "description": "Record topical or systemic treatment, exposure dates, adherence, response and adverse effects for specialist review.", "questions": [ { "text": "What activity and symptom burden justified the selected treatment at this reproductive stage?", "kind": "action", "id": "exposure-response-assessment-q01" }, { "text": "After the documented exposure, did new blister formation and itch improve, and what adverse effects were assessed?", "kind": "measurement", "id": "exposure-response-assessment-q02" } ] } ] }, { "id": "reassessment-and-future-planning", "name": "Reassessment and future planning", "description": "Preserve a plan for unresolved disease and later reproductive decisions.", "findings": [ { "id": "review-and-recurrence-plan", "name": "Review and recurrence plan", "description": "Record follow-up ownership, clinician-directed treatment changes and counselling needs.", "questions": [ { "text": "What findings trigger diagnostic reconsideration, treatment escalation or review of a taper?", "kind": "action", "id": "review-and-recurrence-plan-q01" }, { "text": "What previous recurrence or suspected hormonal association should inform future pregnancy and contraception counselling?", "kind": "action", "id": "review-and-recurrence-plan-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This description is based on recall; no sources were consulted.", "Check the applicable national ICD modification before using O26.4 for clinical coding.", "Precise incidence, pregnancy-outcome risks and antibody-test thresholds require verification in appropriate clinical sources." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of herpes gestationis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "O26.4", "note": "WHO category titled 'Herpes gestationis'; national modifications may require additional characters." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of herpes gestationis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Recognised in dermatology and obstetrics when assessing intensely itchy eruptions arising during pregnancy or after delivery.", "Diagnosis is supported by direct immunofluorescence of perilesional skin showing linear complement C3 deposition along the basement membrane zone, sometimes with IgG.", "Serum testing for antibodies against BP180 supports diagnosis and can help monitor disease activity.", "Recognition informs obstetric monitoring and counselling about recurrence in subsequent pregnancies." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of herpes gestationis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "The historical name can misleadingly suggest herpesvirus infection; this is an autoimmune disease and is not contagious.", "Early lesions may be mistaken for polymorphic eruption of pregnancy before characteristic blisters develop.", "Disease may flare around delivery and recur in later pregnancies.", "Affected pregnancies have increased risks of preterm delivery and fetal growth restriction.", "Transferred maternal antibodies occasionally cause transient blistering in the newborn." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of herpes gestationis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Bullous pemphigoid", "difference": "Shares basement-membrane autoimmunity, including BP180 targeting, but typically affects older adults without the characteristic pregnancy association." }, { "name": "Polymorphic eruption of pregnancy", "difference": "Usually begins in abdominal stretch marks and spares the umbilicus; pemphigoid gestationis commonly involves the umbilicus and has characteristic positive direct immunofluorescence." }, { "name": "Dermatitis herpetiformis", "difference": "A gluten-associated blistering disease characterised by granular IgA deposition in dermal papillae rather than the linear C3 pattern typical of pemphigoid gestationis." }, { "name": "Herpes simplex infection", "difference": "Caused by herpes simplex virus and distinguishable by viral testing; pemphigoid gestationis is caused by autoantibodies." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of herpes gestationis this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which diagnostic criteria should the model adopt for suspected disease with negative or discordant immunofluorescence and serology?", "Which activity measure and response thresholds are sufficiently validated specifically for pemphigoid gestationis?", "How reliably do onset timing, blister burden and BP180 titres predict obstetric outcomes and justify different surveillance intensity?", "What evidence supports treatment choices for refractory disease during pregnancy and lactation?", "How should persistent postpartum disease and rare presentations associated with trophoblastic disease be bounded against other pemphigoid models?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 15, "questions": 25 } }