Section of Dermatology, Department of Health Sciences (DISSAL), San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy.
Section of Dermatology, Department of Health Sciences (DISSAL), San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy -
G Ital Dermatol Venereol. 2019 Jun;154(3):299-304. doi: 10.23736/S0392-0488.18.06212-0. Epub 2018 Oct 29.
Autoimmune skin diseases can occur in pregnancy, and the treatment is often required to control both maternal disease and fetal outcomes. Moreover, the control of mother's diseases and fetal health is a challenge for dermatologists because of the teratogenic effects of many drugs. So it is important to know exactly which drugs can be administrated in the different stages of pregnancy. Authors reviewing the literature and relying on daily dermatological experience agree that during pregnancy effective drug treatment of autoimmune diseases is possible with reasonable safety for the fetus/child and lactation. During pregnancy and lactation patients with autoimmune disorders should be evaluated carefully, and the benefit-risk of continued therapy should be reassessed. The points to consider presented in this review show that, despite limitations, effective drug treatment of autoimmune diseases is possible with reasonable safety for the fetus/child during pregnancy and lactation. Prior to conception it is necessary to explain to the patients what the risks of pregnancy are. It is preferred to avoid a pregnancy in active disease and replace treatment with an allowed therapy. During pregnancy it is necessary to avoid treatment with mycophenolate mofetil, cyclophosphamide and methotrexate. In some very particular cases, as life saver drug, cyclosporine and rituximab can be used. Finally, some drugs can be used monitoring the patient, in particular, systemic corticosteroid at low dosage, dapsone, azathioprine, iloprost and sildenafil.
自身免疫性皮肤病可在妊娠期间发生，通常需要治疗来控制母体疾病和胎儿结局。此外，由于许多药物具有致畸作用，控制母体疾病和胎儿健康对皮肤科医生来说是一个挑战。因此，确切了解哪些药物可在妊娠的不同阶段使用非常重要。作者查阅文献并依靠日常皮肤科经验，认为在妊娠期间对自身免疫性疾病进行有效药物治疗是可能的，对胎儿/儿童和哺乳期具有合理的安全性。妊娠和哺乳期自身免疫性疾病患者应仔细评估，并重新评估继续治疗的获益风险。本综述中提出的注意点表明，尽管存在局限性，但在妊娠和哺乳期对胎儿/儿童进行有效药物治疗具有合理的安全性。在受孕前，有必要向患者解释妊娠的风险。最好避免在疾病活动期怀孕，并改用允许的治疗方法。在妊娠期间，必须避免使用霉酚酸酯、环磷酰胺和甲氨蝶呤。在某些非常特殊的情况下，环孢素和利妥昔单抗可用作救命药物。最后，一些药物可以在监测患者的情况下使用，特别是低剂量全身皮质类固醇、达普松、硫唑嘌呤、伊洛前列素和西地那非。
