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Deleuran M, Dézfoulian B, Elberling J, Knutar I, Lapeere H, Lossius AH, Schuttelaar MLA, Stockman A, Wikström E, Bradley M, de Bruin-Weller M, Gutermuth J, Mandelin JM, Schmidt MC, Thyssen JP, Vestergaard C. Systemic anti-inflammatory treatment of atopic dermatitis during conception, pregnancy and breastfeeding: Interdisciplinary expert consensus in Northern Europe. J Eur Acad Dermatol Venereol 2024; 38:31-41. [PMID: 37818828 DOI: 10.1111/jdv.19512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/09/2023] [Indexed: 10/13/2023]
Abstract
Treating atopic dermatitis (AD) in pregnant or breastfeeding women, and in women and men with AD aspiring to be parents is difficult and characterized by uncertainty, as evidence to inform decision-making on systemic anti-inflammatory treatment is limited. This project mapped consensus across dermatologists, obstetricians and patients in Northwestern Europe to build practical advice for managing AD with systemic anti-inflammatory treatment in men and women of reproductive age. Twenty-one individuals (sixteen dermatologists, two obstetricians and three patients) participated in a two-round Delphi process. Full consensus was reached on 32 statements, partial consensus on four statements and no consensus on four statements. Cyclosporine A was the first-choice long-term systemic AD treatment for women preconception, during pregnancy and when breastfeeding, with short-course prednisolone for flare management. No consensus was reached on second-choice systemics preconception or during pregnancy, although during breastfeeding dupilumab and azathioprine were deemed suitable. It may be appropriate to discuss continuing an existing systemic AD medication with a woman if it provides good disease control and its benefits in pregnancy outweigh its risks. Janus kinase (JAK) inhibitors, methotrexate and mycophenolate mofetil should be avoided by women during preconception, pregnancy and breastfeeding, with medication-specific washout periods advised. For men preconception: cyclosporine A, azathioprine, dupilumab and corticosteroids are appropriate; a 3-month washout prior to conception is desirable for methotrexate and mycophenolate mofetil; there was no consensus on JAK inhibitors. Patient and clinician education on appropriate (and inappropriate) AD treatments for use in pregnancy is vital. A shared-care framework for interdisciplinary management of AD patients is advocated and outlined. This consensus provides interdisciplinary clinical guidance to clinicians who care for patients with AD before, during and after pregnancy. While systemic AD medications are used uncommonly in this patient group, considerations in this article may help patients with severe refractory AD.
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Affiliation(s)
- M Deleuran
- Department of Dermatology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - B Dézfoulian
- Dermatology Department, Liège University Hospital, Liège, Belgium
| | - J Elberling
- Department of Dermatology and Allergy, Department of Clinical Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - I Knutar
- Department of Dermatology, Vaasa Central Hospital, Vaasa, Finland
| | - H Lapeere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - A H Lossius
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - M L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Stockman
- Department of Dermatology, AZ Delta, Torhout, Belgium
| | - E Wikström
- Dermatology Health Clinic, Oulu, Finland
| | - M Bradley
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
| | - M de Bruin-Weller
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Gutermuth
- Vrije Universiteit Brussel (VUB), SKIN Research Group, Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - J M Mandelin
- Department of Dermatology, Helsinki University Central Hospital, Helsinki, Finland
| | - M C Schmidt
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - J P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, Copenhagen, Denmark
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Alcantara-Luna S, Ruiz-Villaverde R, Domínguez-Cruz J, Galán-Gutiérrez M, Navarro-Triviño F, Pereyra-Rodriguez JJ, Armario-Hita JC. Validation of a Questionnaire to Assess the Perception of Women with Atopic Dermatitis in Family Planning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710753. [PMID: 36078468 PMCID: PMC9517831 DOI: 10.3390/ijerph191710753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Atopic dermatitis (AD) is a highly frequent chronic inflammatory skin disease. It is important to know how women with AD approach family planning together with their disease. The aim of the present research is to develop and validate a questionnaire for women diagnosed with AD in order to measure their level of desire and gestational information. MATERIALS AND METHODS A multicenter cross-sectional study was conducted. Women between 18 and 45 years old with mild, moderate, and severe forms of the disease were included and disease-free controls. An exploratory factorial analysis of the primary components and varimax rotation was used to measure the validity of the construct. Cronbach's α was used to measure the reliability of the individual scales and the global questionnaire. RESULTS In total, 150 valid questionnaires were included. The final questionnaire consisted of 23 items that converged on six factors. The six scales had adequate reliability: "Pregnancy" (Cronbach's alpha = 0.95), "Conception" (Cronbach's alpha = 0.93), "Concern-information" (Cronbach's alpha = 0.82), "Breastfeeding" (Cronbach's alpha = 0.81), "Sexual life" (Cronbach's alpha = 0.79), and "Family planning" (Cronbach's alpha = 0.67). The total Cronbach's alpha of the questionnaire was 0.94. DISCUSSION This questionnaire is the first specific measurement instrument developed for women with AD of childbearing age that has demonstrated adequate levels of reliability and construct validity. We consider it useful and valuable to study aspects such as family planning in this patient profile, and that can influence their decision to have offspring.
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Affiliation(s)
- Sara Alcantara-Luna
- Dermatology Department, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Ricardo Ruiz-Villaverde
- Dermatology Department, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016 Granda, Spain
| | - Javier Domínguez-Cruz
- Dermatology Department, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Manuel Galán-Gutiérrez
- Dermatology Department, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain
| | - Francisco Navarro-Triviño
- Dermatology Department, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016 Granda, Spain
| | - Jose-Juan Pereyra-Rodriguez
- Dermatology Department, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
- Correspondence:
| | - Jose-Carlos Armario-Hita
- Dermatology Department, Hospital Universitario de Puerto Real, Calle Romería, 7, 11510 Puerto Real, Spain
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Lim MM, Kirchhof MG. Breast Psoriasis as a Special Site for Biologic Coverage in Women of Childbearing Age. J Cutan Med Surg 2022; 26:432-433. [DOI: 10.1177/12034754221083972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Megan M. Lim
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Mark G. Kirchhof
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
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De Simone C, Calabrese L, Balato A, Cannavò SP, Dattola A, Esposito M, Fargnoli MC, Giuffrida R, Hansel K, Musumeci ML, Napolitano M, Offidani A, Parodi A, Patrizi A, Peris K, Radi G, Venturini M, Prignano F. Psoriasis and its management in women of childbearing age: tools to increase awareness in dermatologists and patients. GIORN ITAL DERMAT V 2021; 155:434-440. [PMID: 33050681 DOI: 10.23736/s0392-0488.20.06748-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psoriasis is a common, chronic inflammatory disease with a multifactorial pathogenesis. Mean age at presentation of psoriasis is 28 years in women, which is almost the height of fertility age. Since women of childbearing potential represent a significant proportion of psoriatic patients, the impact of psoriasis and its treatment on fertility, pregnancy, and breastfeeding should be highlighted for a proper management. Therefore, when approaching to a psoriatic woman of childbearing age, Healthcare Providers should be adequately informed and ready to provide the patients with answers to the most frequently asked questions. The Italian Society of Dermatology and Venereology (SIDeMaST) has fostered a Task Force named "Psoriasis in Women of Childbearing Age" which is composed by a group of Italian female dermatologists with a high expertise in psoriasis treatment. The aims of the Task Force are to increase awareness of the disease and its treatment in patients of childbearing age among both dermatologists and women affected by psoriasis and to encourage counselling on family planning. With the aim of providing a real support for the proper management of the delicate journey to motherhood, the Italian Task Force has published two different informative booklets addressed to patients and dermatologists which focus on the main issues regarding psoriasis in women of childbearing age.
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Affiliation(s)
- Clara De Simone
- Section of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy - .,Section of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy -
| | - Laura Calabrese
- Section of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Section of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Anna Balato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Serafinella P Cannavò
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Maria Esposito
- Unit of Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria C Fargnoli
- Unit of Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roberta Giuffrida
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Maria L Musumeci
- Dermatology Clinic, G. Rodolico Hospital, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Catania, Italy
| | - Maddalena Napolitano
- Vincenzo Tiberio Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Annamaria Offidani
- Unit of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Aurora Parodi
- Department of Health Sciences (DiSSal), San Martino IRCCS Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Annalisa Patrizi
- Unit of Dermatology, Department of Specialty, Diagnostic, and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Ketty Peris
- Section of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Section of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Giulia Radi
- Unit of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Marina Venturini
- Department of Dermatology, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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Johansen CB, Laurberg TB, Egeberg A, Jensen UFA, Hansen AL, Skov L, Kristensen LE, Thomsen SF, Schreiber K. Awareness and Expectations Surrounding Family Planning and Pregnancy Among Danish Patients with Chronic Inflammatory Disease of the Skin or Joints: Results from an Online Survey. Rheumatol Ther 2021; 8:1419-1433. [PMID: 34392489 PMCID: PMC8380620 DOI: 10.1007/s40744-021-00348-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patients with chronic inflammatory diseases (CIDs) may encounter challenges in their family planning journey. Here, we report on the access to family planning and pregnancy (FPP) information and the concerns among patients in Denmark with CIDs. Methods Patients aged 18–50 years with CIDs participated in an online survey. Patients were recruited through patient advocacy groups and were asked to report information on their diagnosis, concerns related to FPP and perceptions of access to FPP information. Descriptive statistics were applied. Results Of the eligible respondents, 368 had rheumatological diagnoses (rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis or axial spondyloarthritis; mean age 40 years; 83% women, 17% men) and 95 had dermatological diagnoses (psoriasis or psoriatic arthritis; mean age 38 years; 67% women, 33% men). Approximately 70% of all patients reported seeking FPP information from patient advocacy groups; 57% of both cohorts used the internet as information sources; and 73% and 42% of rheumatological and dermatological cohorts used their hospital and specialist doctor, respectively. Despite this, 58% and 67% of patients with rheumatological and dermatological diagnoses reported limited or no access to FPP information, with > 70% of dermatological patients of early/mid-reproductive age reporting a lack of access to this information. Overall, 68% of patients with rheumatological and 73% with dermatological diagnoses had biological children, amongst whom 24% and 18%, respectively, indicated their disease affected the number of children they ultimately decided to have. The most frequent FPP concerns among patients who did not want any/more biological children were disease worsening, heredity and taking care of the child. Conclusions Despite awareness of available sources of FPP information, patients expressed experiencing a feeling of limited access to information and having concerns that affect key decisions regarding FPP. The results of this survey highlight a need for improved and more standardised FPP information for patients with CIDs in Denmark. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00348-2.
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Affiliation(s)
- Cæcilie B Johansen
- Department of Dermatology and Venereology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
| | - Trine B Laurberg
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Venereology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | | | | | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars E Kristensen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Simon F Thomsen
- Department of Dermatology and Venereology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
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Simionescu AA, Danciu BM, Stanescu AMA. State-of-the-Art Review of Pregnancy-Related Psoriasis. ACTA ACUST UNITED AC 2021; 57:medicina57080804. [PMID: 34441010 PMCID: PMC8402069 DOI: 10.3390/medicina57080804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/14/2022]
Abstract
Psoriasis is a chronic immunologic disease involving inflammation that can target internal organs, the skin, and joints. The peak incidence occurs between the age of 30 and 40 years, which overlaps with the typical reproductive period of women. Because of comorbidities that can accompany psoriasis, including metabolic syndrome, cardiovascular involvement, and major depressive disorders, the condition is a complex one. The role of hormones during pregnancy in the lesion dynamics of psoriasis is unclear, and it is important to resolve the implications of this pathology during pregnancy are. Furthermore, treating pregnant women who have psoriasis represents a challenge as most drugs generally prescribed for this pathology are contraindicated in pregnancy because of teratogenic effects. This review covers the state of the art in psoriasis associated with pregnancy. Careful pregnancy monitoring in moderate-to-severe psoriasis vulgaris is required given the high risk of related complications in pregnancy, including pregnancy-induced hypertensive disorders, low birth weight for gestational age, and gestational diabetes. Topical corticosteroids are safe during pregnancy but effective only for localised forms of psoriasis. Monoclonal antibodies targeting cytokines specifically upregulated in psoriasis, such as ustekinumab (IL-12/23 inhibitor), secukinumab (IL-17 inhibitor) can be effective for the severe form of psoriasis during pregnancy. A multidisciplinary team must choose optimal treatment, taking into account fetal and maternal risks and benefits.
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Affiliation(s)
- Anca Angela Simionescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: (A.A.S.); (A.M.A.S.)
| | - Bianca Mihaela Danciu
- Department of Obstetrics, Gynecology and Neonatology, “Dr. Alfred Rusescu” National Institute for Maternal and Child Health, 127715 Bucharest, Romania;
| | - Ana Maria Alexandra Stanescu
- Department of Family Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: (A.A.S.); (A.M.A.S.)
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