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妊娠期和哺乳期化脓性汗腺炎的治疗:应对挑战

Hidradenitis Suppurativa Treatment During Pregnancy and Lactation: Navigating Challenges.

作者信息

Özbek Laşin, Güldan Mustafa, Alpsoy Erkan, Vural Seçil

机构信息

School of Medicine, Koç University, Istanbul, Turkey.

Department of Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Turkey.

出版信息

Int J Dermatol. 2025 Jan 31. doi: 10.1111/ijd.17672.

Abstract

Hidradenitis suppurativa (HS), or acne inversa, is a chronic inflammatory skin condition primarily affecting skin folds such as the axilla, groins, and the inframammary, perineal, and perianal regions. It is characterized by painful abscesses, sinus tracts, and scarring. Predominantly affecting young adults, particularly females, HS often emerges during reproductive age, and flares are widely reported during pregnancy and postpartum, underscoring the need to consider management strategies tailored to pregnant or lactating individuals. Moreover, the chronic and relapsing nature of HS, along with challenges related to the safety and compliance of medication use during pregnancy and lactation, as well as various comorbidities and psychological distress, significantly complicate its management in pregnant or lactating women. Treatment options, including topical clindamycin, oral clindamycin-rifampicin, adalimumab, metformin, antiseptic washes, and certolizumab pegol, have accumulated evidence supporting their relative safety in pregnant and lactating women. While certolizumab pegol has shown promising safety data among biologics, it requires more efficacy data in HS. Conversely, while newly approved HS medications such as secukinumab and bimekizumab show promise for the general population, further research is necessary to evaluate their safety profiles in pregnant and breastfeeding individuals. The scant research available on HS in pregnant and lactating women, also shown by our systematic literature review, highlights the need for a comprehensive investigation into the safety, efficacy, and suitability of management strategies.

摘要

化脓性汗腺炎(HS),又称反向性痤疮,是一种慢性炎症性皮肤病,主要影响皮肤褶皱部位,如腋窝、腹股沟以及乳房下、会阴和肛周区域。其特征为疼痛性脓肿、窦道和瘢痕形成。HS主要影响年轻成年人,尤其是女性,常在育龄期发病,且广泛报道在孕期和产后病情会加重,这凸显了需要考虑针对孕妇或哺乳期女性量身定制管理策略的必要性。此外,HS的慢性和复发性本质,以及孕期和哺乳期用药的安全性和依从性相关挑战,再加上各种合并症和心理困扰,使得其在孕妇或哺乳期女性中的管理显著复杂化。治疗选择包括外用克林霉素、口服克林霉素 - 利福平、阿达木单抗、二甲双胍、抗菌洗剂和赛妥珠单抗,已有证据支持它们在孕妇和哺乳期女性中的相对安全性。虽然赛妥珠单抗在生物制剂中显示出有前景的安全性数据,但在HS中还需要更多疗效数据。相反,虽然新批准的HS药物如司库奇尤单抗和比美吉珠单抗对一般人群显示出前景,但有必要进一步研究以评估它们在孕妇和哺乳期女性中的安全性。我们的系统文献综述也表明,关于孕妇和哺乳期女性HS的研究很少,这凸显了对管理策略的安全性、有效性和适用性进行全面调查的必要性。

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