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Treatment of dermatologic connective tissue disease and autoimmune blistering disorders in pregnancy

Authors

  • Inbal Braunstein,

    1. Division of Dermatology, Philadelphia Veteran's Affairs Medical Center, Philadelphia, Pennsylvania
    2. Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Victoria Werth

    Corresponding author
    1. Division of Dermatology, Philadelphia Veteran's Affairs Medical Center, Philadelphia, Pennsylvania
    • Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Conflict of Interest: Dr. Braunstein and Dr. Werth have no conflicts of interest to disclose. There was no funding provided for the production of this article.

Address correspondence and reprint requests to: Victoria Werth, MD, Professor of Dermatology, Department of Dermatology, PCAM, Suite 1-330S, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, or email: werth@mail.med.upenn.edu.

Abstract

Autoimmune skin disease occurs in pregnancy, and treatment is often required to control both maternal disease and fetal outcomes. Here we present the available safety data in pregnancy and lactation for medications used to treat autoimmune skin diseases, including cutaneous lupus erythematosus, dermatomyositis, morphea and systemic sclerosis, pemphigus vulgaris, pemphigus foliaceus, and pemphigoid gestationis. A PubMed search of the English-language literature using keywords, “pregnancy” “rheumatic disease,” and “connective tissue disease” was performed. Relevant articles found in the search and references were included. Reasonable evidence supports the careful and cautious use of topical steroids, topical calcineurin inhibitors, systemic corticosteroids, hydroxychloroquine, and azathioprine in pregnancy. Case reports or clinical experience suggest intravenous immunoglobulin, dapsone, phototherapy, rituximab, and plasmapheresis may be safe. Several treatment options exist for autoimmune skin disease in pregnancy and lactation, and should be considered when treating these patients.

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