Immunosuppressive and Immunomodulating Therapy for Atopic Dermatitis in Pregnancy: An Appraisal of the Literature
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REVIEW
Immunosuppressive and Immunomodulating Therapy for Atopic Dermatitis in Pregnancy: An Appraisal of the Literature Sofine Heilskov . Mette S. Deleuran . Christian Vestergaard
Received: August 25, 2020 / Published online: November 2, 2020 Ó The Author(s) 2020
ABSTRACT The aim of this appraisal of the literature is to elucidate the effects of immunosuppressive and immunomodulating agents used to treat atopic dermatitis (AD) on risk factors for fertility, pregnancy, and breastfeeding. Negative side effects of the psychological and physical stresses associated to AD flairs and uncontrolled AD are discussed, in order to evaluate the consequences of abstaining from treatment. Research on pregnancies in Danish women suggests a tendency towards an increased use of topical steroids and ultraviolet light therapy during pregnancy, compared to before conception, confirming the need for these patients to receive treatment, as well as decreased use of systemic treatments, suggesting a tendency towards undertreatment in this patient population. It is important that effective treatment be provided to pregnant women with AD. Here we present an appraisal of current knowledge on treatments for AD and the risks of exposure for the fetus and breastfed infant. Since little is
S. Heilskov M. S. Deleuran C. Vestergaard (&) Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark e-mail: [email protected]
known about the association between AD, pregnancy, and systemic treatment, we generalize conclusions based on studies on treatments of pregnant women who have undergone organ transplantation and who have inflammatory bowel disease, rheumatic disease, and autoimmune disease. The majority of recommendations are therefore based on a low or very low quality of evidence according to the GRADE system. The selected studies reflect the authors’ assessment regarding originality and importance in the context of this appraisal. It is always the treating doctor’s responsibility to stay updated on current literature when treating patients, especially pregnant patients.
Keywords: Atopic dermatitis; Azathioprine; Calcineurin inhibitors; Corticosteroids; Crisaborole; Dupilumab; Methotrexate; Mycophenolate mofetil; Pregnancy; Ultraviolet light therapy
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Key Summary Points Atopic dermatitis in pregnancy is common. It is important to offer effective treatment to pregnant women with moderate to severe atopic dermatitis. Optimization of treatment prior to conception and effective adjustment of treatment throughout pregnancy is important. Systemic treatment for pregnant patients whose condition is not adequately managed with topical treatment and ultraviolet light therapy is the task of a specialist. Initialization of therapy must take into account the costs of the treatment and the benefits to both mother and child.
DIGITAL FEATURES This article is published with digital features to facilitate understanding of the article. To view digital features for this article go to https://doi. org/10.6084/m9.figshare.13032833.
INTRODUCTI
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