The use of dupilumab in severe atopic dermatitis during pregnancy: a case report

Stoica

et al. 2022

Life

Dupilumab is the only available biological treatment for moderate-to-severe atopic dermatitis (AD). Even so, limited clinical data regarding its safety profile are available. Interactions with other drugs and the adverse effects of Dupilumab on patients with multiple comorbidities, such as chronic heart disease, diabetes, chronic kidney disease, etc., are not known yet. Moreover, there have been described cases of cutaneous lymphomas induced by Dupilumab. Therefore, the clinician that wants to start treatment for moderate-to-severe atopic dermatitis, which does not respond to conventional drugs, might be reluctant to choose biologic agents such as Dupilumab. In this paper, we reported a case of severe atopic dermatitis with multiple comorbidities in which the patient was successfully treated with Dupilumab despite numerous underlying conditions. We also conducted a review of the current literature on the safety profile of Dupilumab in special categories of patients with comorbidities, such as heart, kidney, and liver disease, oncologic conditions, and during pregnancy.

Section: Discussionmentioning

confidence: 99%

Atopic Dermatitis with Multiple Comorbidities Treated with Dupilumab. A Case Report and Review of the Literature Regarding the Safety of Dupilumab

Stoica

et al. 2022

Life

“…30 There are several case reports and data from the European Medicines Agency 140,141 which have shown favourable outcomes with no signals for adverse fetal outcomes in patients treated with DUP during pregnancy. 127,[142][143][144] A study of a large global pharmacovigilance database found that no pregnancy, puerperium or perinatal adverse drug reactions were associated with the use of DUP based on 36 reports. 145 The ERS/TSANZ task force has classified DUP as possibly safe during pregnancy and lactation.…”

Section: Tuberculosis (Tb)mentioning

confidence: 99%

“…When exposed to a surrogate antibody against IL‐4Rα, there were no significant adverse morphological, functional or immunological developmental effects observed in the offspring of cynomolgus monkeys 30 . There are several case reports and data from the European Medicines Agency 140,141 which have shown favourable outcomes with no signals for adverse fetal outcomes in patients treated with DUP during pregnancy 127,142–144 . A study of a large global pharmacovigilance database found that no pregnancy, puerperium or perinatal adverse drug reactions were associated with the use of DUP based on 36 reports 145 .…”

Section: Data Summariesmentioning

confidence: 99%

Expert consensus on the systemic treatment of atopic dermatitis in special populations

Adam

Gooderham

Beecker

et al. 2023

Acad Dermatol Venereol

With the increasing number of options for the treatment of moderate-to-severe atopic dermatitis, clinicians need guidance on a practical approach to selecting a systemic agent for specific patient populations. We convened an expert panel consisting of 12 members to conduct a literature review and summarize relevant data related to six scenarios of clinical interest: comorbid asthma, ocular surface disease, history of cancer, past and ongoing infections of interest (including herpes simplex virus, herpes zoster, hepatitis B, and tuberculosis), pregnancy and lactation, and the elderly. We performed a literature search and examined each clinical scenario with | 1143 ADAM et al.

“…17,18 Labs are required when a comprehensive history and physical examination have failed to resolve diagnostic uncertainty. 19 Physiological skin changes, skin illnesses influenced by pregnancy, and particular dermatoses of pregnancy are the three groups into which the dermatoses of pregnancy fall. Pregnancyrelated inflammatory dermatoses are categorized into four subgroups.…”

Section: Introductionmentioning

confidence: 99%

Clinical Patterns and Frequency of Dermatological Manifestations Associated with Pregnancy

Imtiaz¹,

Ilyas²,

Sabir³

et al. 2023

PJMHS

Introduction: Pregnancy is a physiological state of women which is associated with intricate endocrinological, immunological, metabolic & vascular changes. So pregnancy makes a woman susceptible to various changes in skin & appendages. Alteration to the immune state of the pregnant women is necessary to allow mother to tolerate genetically different tissue during pregnancy. Decrease in cell mediated immunity in normal pregnancy is mainly responsible for the higher frequency and severity of certain infectious diseases. Some of which can also be transmitted to the baby during child birth. Moreover there are marked changes in the levels of sex hormones particularly oestrogen & progesterone and this can lead to profound changes in skin. Objective: To find the prevalence of dermatological manifestations in pregnant patients presenting in a tertiary care hospital Study Design: Descriptive/Cross-sectional Study Setting: The study was done in the Dermatology unit DHQ Hospital Faisalabad. Duration of Study: The study was carried out from 1st October 2016 to 10th March 2017 Subjects and methods: 185 pregnant women presenting at any gestational age in dermatology department and patients referred from Gynae department with dermatological complaints were included in the study. Patients with pre-existing medical conditions such as hypertension and diabetes were excluded. Complete history and clinical features of the patients were accessed and relevant investigations were done to support the diagnosis. Final diagnosis was made on basis of history, clinical examination and laboratory confirmation of disease as per operational definition. LFT’s for intrahepatic cholestasis of pregnancy was done from DHQ laboratory and sample for skin biopsy for pemphigoid gestationis were sent to pathology laboratory FMU. All the data was recorded in a well-structured questionnaire. Results: Age range in this study was from 18 to 40 years with mean age of 30.129±3.26 years and mean duration of disease was 5.864±1.79 week. Majority of the women were with 2nd trimester of pregnancy (67%). 60% of women had no occupation. Striae Gravidarum was seen in 48.1%, Linea Nigra 45.9%, Melasma 25.4%, Hirsutism 16.2%, Palmer Erythema 8.1%, Atopic eruption of Pregnancy 11.9%, Polymorphic eruption of Pregnancy 3.2%, Intrahepatic Cholestasis of Pregnancy 1.6%, Pemphigoid gestationis 1.1%, Acne Vulgaris 9.7%, Vulvovaginal candidosis 8.1%, Urticaria 6.5% and Scabies was 5.4%. Practical Implication: We set out to investigate the prevalence of dermatological manifestations during pregnancy, as well as other clinical characteristics affecting pregnant women in Pakistan. Conclusion: If infections during pregnancy are diagnosed at the earliest stage it may prevent morbidity during and after antenatal period. Keywords: Pregnancy; Dermatological manifestations; Frequency, Clinical Patterns, Pemphigoid Gestationis, Acne Vulgaris, Vulvovaginal Candidosis,