Guidelines for managing skin disease during pregnancy

Mar 02, 2019, 12:00am

Treating chronic inflammatory skin conditions during pregnancy can be difficult because the therapies dermatologists prescribe can affect the unborn infant. See what insights this physician offers on managing chronic inflammatory skin conditions in pregnant patients.

Treating chronic inflammatory skin conditions during pregnancy carries a different set of guidelines. Dermatologists are treating the mother, but whatever therapies they prescribe can also have an effect on the unborn infant.

Consequently, the onus is on the dermatologist to discuss any therapies and potential side effects with any woman of child-bearing age despite whether she’s sexually active. As a rule, patients don’t initiate these conversations.

Jenny Murase, M.D., a dermatologist with the Palo Alto Foundation Medical Group, discussed some risk factors and guidance for dermatologists during the American Academy of Dermatology Spring Meeting in Washington, D.C.

“A key thing for dermatologist to understand is that 50 percent of pregnancies in the United States aren’t planned with a healthcare provider, meaning an ob/gyn, family practitioner, dermatologist, etc.,” she said. “So, that means the number of pregnancies planned with a dermatologist are a fraction of that 50 percent.”

Here are some guidelines she suggested:

ANTIHISTAMINES

Although antihistamines are largely considered safe during pregnancy for patients with chronic inflammatory skin conditions, she said, they should be avoided during the last month. During that time period, they can cause adverse effects:

• An oxytocin-like effect that prompts uterine contractions
• A increased rate of retrolental fibroblasts in premature infants exposed to antihistamines within 2 weeks of delivery
• Withdrawal symptoms, including tremors, irritability, poor feeding, and diarrhea

IMMUNOSUPPRESSION

If a patient is receiving immunosuppressive therapy, she should take extra precaution to avoid pregnancy.

For example, patients receiving mycophenolate mofetil should use at least two forms of contraception, including a barrier method, for at least 4 weeks prior to receiving treatment and for 6 weeks post-treatment. Additionally, women receiving azathioprine should not rely on an IUD alone for contraception.

STEROIDS

Whenever possible, steroid use should be strictly limited during pregnancy. Both betamethasone and dexamethasone can cross the placental barrier easily, putting the unborn infant at risk, she says. Topical prednisone is the preferred alternative because it doesn’t cross the placental barrier as efficiently.

“Even still, you are guaranteed side effects with prednisone,” she said, recommending prednisone be limited during pregnancy when possible. “You’ll gain weight, have gestational diabetes, you’ll have high blood pressure, fat redistribution, and bone loss. It’s not a situation where you can monitor to see if you get the side effects. You will get them.”

Murase also discussed cyclosporine and its safety as an oral systemic therapy. Research data indicates it presents no malformation risk, neurodevelopmental, immunologic, or nephrogenic defect risks.

Overall, Murase said, she hopes dermatologists remember three overall take-away messages:

  • Topical steroids and anti-histamines are largely safe in pregnancy

  • Biologics have mounting safety data around the safety of anti-TNF class drugs in pregnancy and breastfeeding

  • IgG, immunoglobulin G, is an excellent antibody choice for treating moderate-to-severe pemphigus cases

 

Reference:
F027 - Women’s Health Therapeutic Hotline. “Pearls in Managing Skin Disease in Pregnancy.” Jenny Murase, M.D., 1-4 p.m., March 1. American Academy of Dermatology Spring Meeting, Washington, D.C.