title: Treatment of dermatologic connective tissue disease and autoimmune blistering disorders in pregnancy.
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.
authors.affiliation: Division of Dermatology, Philadelphia Veteran's Affairs Medical Center, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Inbal
authors.initials: I
authors.lastname: Braunstein
authors.forename: Victoria
authors.initials: V
authors.lastname: Werth
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000628:therapy*; D001379:Azathioprine / Q000627:therapeutic use; D001768:Blister / Q000628:therapy*; D065095:Calcineurin Inhibitors; D003240:Connective Tissue Diseases / Q000628:therapy*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D010789:Phototherapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D012871:Skin Diseases / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D006886:Hydroxychloroquine; D001379:Azathioprine
keywords: autoimmune skin disease; blistering disease; blistering disorders; cutaneous lupus erythematosus; dermatomyositis; lactation; morphea; pemphigoid gestationis; pemphigus foliaceus; pemphigus vulgaris; pregnancy; rheumatic skin disease