Treatment of Autoimmune Bullous Diseases During Pregnancy and Lactation: A Review Focusing on Pemphigus and Pemphigoid Gestationis

Abstract

Pregnancy may induce the onset or exacerbation of autoimmune bullous diseases such as pemphigus or pemphigoid gestationis. A shift toward T helper (Th) 2 immune response and the influence of hormonal changes have been evoked as possible triggering factors. Therapeutic management of this setting of patients may represent a challenge, mainly due to safety concerns of some immunosuppressive drugs during pregnancy and lactation. In this narrative review, we provided a comprehensive overview of the therapeutic management of autoimmune bullous diseases in pregnant and breastfeeding women, focusing on pemphigus and pemphigoid gestationis.

Non‐biologic immunosuppressive drugs for inflammatory and autoimmune skin diseases

“…91 The same applies for topical application of steroids, in which non-fluorinated agents should be preferred. 92,93 Glucocorticoids are present in breast milk only in very low concentrations. However, it is recommended to avoid breastfeeding shortly after drug intake.…”

“…On the other hand, fluorinated agents (betamethasone/dexamethasone) can cross the placenta and lead to fetal abnormalities 91 . The same applies for topical application of steroids, in which non‐fluorinated agents should be preferred 92,93 . Glucocorticoids are present in breast milk only in very low concentrations.…”

Nicht‐Biologika‐Immunsuppressiva bei entzündlichen und autoimmunen Hautkrankheiten

“…Andererseits können fluorierte Wirkstoffe (Betamethason/Dexamethason) die Plazenta passieren und zu fötalen Anomalien führen 91 . Das Gleiche gilt für die topische Anwendung von Steroiden, bei der nichtfluorierte Wirkstoffe bevorzugt werden sollten 92,93 . Glukokortikoide sind in der Muttermilch nur in sehr geringen Konzentrationen vorhanden.…”

Burden of pemphigus vulgaris with a particular focus on women: A review

“…CSs are considered the treatment of choice in PV in this period. 46 , 47 CSs can be used alone or combined with other immunosuppressive drugs such as AZT, IVIg, or plasmapheresis in refractory disease. 46 Data regarding paternal exposure to immunosuppressive agents are limited.…”