title: Management of pemphigus disease in pregnancy.
abstract: Pemphigus can cause complications during pregnancy and may cause serious harm to a fetus. For this study, a comprehensive review of common treatments of pemphigus and their adverse effects associated with pregnancy and male fertility was conducted. We concluded that a period of remission with minimal or no therapy before conception could significantly reduce the risk of the disease flaring up, at least in the first trimester. The period of remission causes a delay in the flare-up of the disease, which means lower cumulative doses and the prevention of possible congenital abnormalities caused by corticosteroid or immunosuppressant treatments. All common treatments of pemphigus-azathioprine, mycophenolate mofetil, and methotrexate-should be avoided during pregnancy. However, it appears that systemic corticosteroids in a safe dose with a topical form of corticosteroids may be used without serious risk. Due to the lack of data associated with rituximab therapy, it is recommended that this drug be avoided 12 months before conception. It appears that the safest treatment of pemphigus is intravenous immunoglobulin (IVIg), which may be more effective when used with topical corticosteroids. Due to the delayed effect of IVIg, it should be used some months prior to conception.
authors.affiliation: Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.|Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Soheil
authors.initials: S
authors.lastname: Tavakolpour
authors.affiliation: Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hajar Sadat
authors.initials: HS
authors.lastname: Mirsafaei
authors.affiliation: Medical biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
authors.forename: Saeid
authors.initials: S
authors.lastname: Delshad
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D047109:Fetal Development / Q000187:drug effects; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007248:Infertility, Male / Q000151:congenital / Q000517:prevention & control*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000627:therapeutic use; D010392:Pemphigus / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D012867:Skin / Q000473:pathology*
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D009173:Mycophenolic Acid; D001379:Azathioprine; D008727:Methotrexate
keywords: autoimmunity; corticosteroids; intravenous immunoglobulin; pemphigus; pregnancy