Features of modern treatment of atopic dermatitis in gravidas: A literature review

Authors

  • N.V. Bespalova
  • A.V Gorkovets
  • D.V. Zubkov НАО "Медицинский университет Караганды"
  • M.R. Izmailovich
  • Zh.T. Amirbekova
  • O.Y. Dedova
  • А.А. Knaus
  • G.S. Turdunova

DOI:

https://doi.org/10.37800/RM.1.2023.126-135

Keywords:

atopic dermatitis (AD), pregnancy, pathogenesis, treatment, emollients

Abstract

Relevance: Currently, there is an increase in the incidence of atopic dermatitis (AD), not only in the general population of the Republic of Kazakhstan but also among pregnant women. The course of blood pressure during pregnancy has several features and is also accompanied by negative consequences for both the pregnant woman and the fetus. Clinical manifestations of blood pressure adversely affect the entire gestation period, and the presence of itching increases the emotional lability of the pregnant woman. The lack of timely diagnosis and adequate management of blood pressure issues result in serious consequences that progress as infectious complications, eventually leading to septic complications.
The study aimed to review domestic and foreign experiences in treating atopic dermatitis during pregnancy.
Materials and methods: The literature review includes an analysis of foreign scientific publications from the scientific electronic databases Elsevier, PubMed, Web of Science, and Google Scholar, as well as research results presented in domestic publications over the past decade.
Results: The article discusses the issues of the pathogenesis of blood pressure, the influence of pregnancy on the dynamics of the process, and recommendations adopted in the international community for the treatment of blood pressure. Today, atopic dermatitis is one of the main allergic diseases of pregnant women, the clinical manifestations of which significantly worsen the course of the gestational period. The drugs used in this clinical practice to combat blood pressure have been little studied in the field of safe effects on the body of pregnant women, fetal organogenesis, and lactation period. There is a limited amount of research in this area. Ethical restrictions reduce the possibility of clinical trials of drugs on pregnant women, which does not fully assess the impact on the course of pregnancy and lactation.
Conclusion: Untreated, unresponsive to the therapy of blood pressure outside of gestation, or exacerbations of atopy during pregnancy are dangerous for the health of both mother and baby. When choosing a treatment strategy for AD, the attending physician should inform women of reproductive age about the potential impact of the prescribed therapy on pregnancy and fertility. BP therapy should be prescribed individually for each pregnant woman, taking into account extragenital features and anamnesis.

References

Шперлинг Н.В., Шперлинг И.А. Комплексная терапия атопического дерматита у беременных // Клиническая дерматология и венерология. – 2020. – №19(6). – С. 847-854 [Shperling N.V., Shperling I.A. Kompleksnaya terapiya atopicheskogo dermatita u beremennyh // Klinicheskaya dermatologiya i venerologiya. – 2020. – Vol. 19(6). – P. 847-854 (in Russ.)]. https://www.mediasphera.ru/issues/klinicheskaya-dermatologiya-i-venerologiya/2020/6/1199728492020061847

Левашова С.В., Эткина Е.И., Гурьева Л.Л., Бабенко Л.И., Бикташева А.Р., Орлова Н.А., Фазылова А.А., Сакаева Г.Д., Данилова Л.Я., Якутина С.Е. Мутации гена филаггрина как фактор нарушения регуляции эпидермального барьера у детей // Лечащий врач. – 2016. – №1. – С. 24-27 [Levasheva S.V., Etkina E.I., Gur’eva L.L., Babenkova L.I., Biktasheva A.R., Orlova N.A., Fazylova A.A., Sakaeva G.D., Danilova L.Ya., Yakuta S.E. Mutasii gena filaggrina kak factor narusheniya regulyatsii epidermalnogo bar’era u detey // Lechashiy vrach. – 2016. – №1. – S. 24-27 (in Russ.)]. https://www.lvrach.ru/2016/01/15436375

White S., Philips R., Neill M.M., Kelly E. Pregnancy-specific skin disorders // Skin Ther. Let. – 2014. – Vol. 19(5). – P. 7-9. https://www.skintherapyletter.com/dermatology/skin-disorders/

Монахов К.Н., Холодилова Н.А. Особенности ведения пациенток с обострением атопического дерматита на фоне беременности // Фарматека. – 2018. – №1. – С. 47-51 [Monaxov K.N., Xolodilova N.A. Osobennosti vedeniya pacientok s obostreniem atopicheskogo dermatita na fone beremennosti // Farmateka. – 2018. – №1. – S. 47-51 (in Russ.)]. https://pharmateca.ru/ru/archive/article/36146.

Передкова Е.В., Себекина О.В. Влияние беременности на течение аллергических заболеваний // Эффективная фармакотерапия. – 2019. – №15(37). – С. 18-26 [Peredkova E.V., Sebekina O.V. Vliyanie beremennosti na techenie allergicheskix zabolevanij // E’ffektivnaya farmakoterapiya. – 2019. – №15(37). – S. 18-26. (in Russ.)]. https://umedp.ru/articles/vliyanie_beremennosti_na_techenie_allergicheskikh_zabolevaniy.html

Кандрашкина Ю.А., Орлова Е.А. Нейроиммунные изменения при атопическом дерматите во время беременности // Молекулярная медицина. – 2022. – №3. – С. 41-46 [Kandrashkina Yu.A., Orlova E.A. Nejroimmunnye izmeneniya pri atopicheskom dermatite vo vremya beremennosti // Molekulyarnaya medicina. – 2022. – №3. – S. 41-46 (in Russ.)]. https://cyberleninka.ru/article/n/neyroimmunnye-izmeneniya-pri-atopicheskom-dermatite-vo-vremya-beremennosti

Бобко С.И., Цыкин А.А. Кожный зуд: современное состояние проблемы // Русский медицинский журнал. Дерма-тология. – 2016. – №1. – С. 606-612 [Bobko S.I., Cykin A.A. Kozhnyj zud: sovremennoe sostoyanie problemy // Russkij medicinskij zhurnal. Dermatologiya. – 2016. – №1. – S. 606-612 (in Russ.)]. https://www.rmj.ru/articles/dermatologiya/Koghnyy_zud_sovremennoe_sostoyanie_problemy/

D’Erme A.M., Bos J.D. Katsambas A.D., Lotti T.M., Dessinioti C., D’Erme A.M. Atopic Dermatitis // In: European Handbook of Dermatological Treatments. – 3rd ed. – Berlin, Heidelberg: Springer-Verlag, 2015. – ISBN: 3662451387 9. Cevikbas F., Wang X., Akiyama T. A sensory neuron-expressed IL-31 receptor mediates T helper cell-dependent itch: Involvement of TRPV1 and TRPA1 // J. Allergy Clin. Immunol. – 2014. – Vol. 133 (2). – P. 448-460. https://doi.org/10.1016/j.jaci.2013.10.048

Imai Y. Interleukin-33 in atopic dermatitis // J. Dermatol. Sci. – 2019. – Vol. 96(1). – P. 2-7. https://doi.org/10.1016/j. jdermsci.2019.08.006.

Mu Z., Zhao Y., Liu X., Chang C., Zhang J. Molecular biology of atopic dermatitis. Clin Rev // Allergy Immunol. – 2014. – Vol. 47 (2). – P. 193-218. https://doi.org/10.1007/s12016014-8415-1.

Klein S.L., Flanagan K.L. Sex differences in immune responses Nat. Rev // Immunol. –2016. – Vol. 16. – P. 626-638. https://doi.org/10.1038/nri.2016.90

Grobe W., Peng W., Jallam.P., Yu C.F., Novak N. Androgens have an anti-inflammatory effect on human basophils in vitro // J. Allergy. – 2020. – Vol 75. – P. 992-994. https://doi.org/10.1111/all.14131

Mor G., Aldo P, Alvero A.B. The unique immunological and microbial aspects of pregnancy Nat Rev // Immunol. – 2017. – Vol. 17. – P. 469-482. https://doi.org/10.1038/nri.2017.64

Balakirski G., Novak N. Atopic dermatitis and pregnancy // Journal of Allergy and Clinical Immunology. – 2022. – Vol. 49(4). – P. 1185-1194. https://doi.org/10.1016/j.jaci.2022.01.010.

Sanders K.M., Akiyama T. The vicious cycle of itch and anxiety // Neurosci. Biobehav. Rev. – 2018. – Vol. 87. – P. 17-26. https://doi.org/10.1016/j.neubiorev.2018.01.009

Гуцуляк С.А. Атопический дерматит у детей: учебное пособие // ФГБОУ ВО ИГМУ Минздрава России, кафедра педиатрии. – Иркутск, ИГМУ. – 2019. – C. 72. [Guculyak S.A. Atopicheskij dermatit u detej: uchebnoe posobie // FGBOU VO IGMU Minzdrava Rossii, kafedra pediatrii. – Irkutsk. IGMU. – 2019. – S. 72. (in Russ.)]. https://www.twirpx.com/file/3715386/

Heilskov S., Deleuran M.S., Vestergaard C. Immunosuppressive and Immunomodulating Therapy for Atopic Dermatitis in Pregnancy: An appraisal of the literature // Dermatol. Ther. – 2020. – Vol. 10(6). – P. 1215-1228. https://doi.org/10.1007/s13555-020-00457-w

Wollenberg A., Oranje A., Deleuran M., Simon D., Szalai Z., Kunz B. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients // J. Eur. Acad. Dermatol. Venereol. – 2016. – Vol. 30. – P. 729-747. https://doi.org/10.1111/jdv.13599

McClanahan D., Wong A., Kezic S., Samrao A., Hajar T., Hill E., Simpson E.L. A randomized controlled trial of an emollient with ceramide and filaggrin-associated amino acids for the primary prevention of atopic dermatitis in high-risk infants // J. Eur. Acad. Dermatol. Venereol. – 2019. – Vol. 33(11). – P. 2087-2094. https://doi.org/10.1111/jdv.15786.

Lin T.K., Man M.Q., Abuabara K., Wakefield J.S., Sheu H.M., Tsai J.C., Lee C.H., Elias P.M. By protecting against cutaneous inflammation, epidermal pigmentation provided an additional advantage for ancestral humans // Evol. Appl. – 2019. – Vol. 2412(10). – P. 1960-1970. https://doi.org/10.1111/eva.12858.

Погонченкова И.Э., Рассулова М.А., Хан М.А., Лян Н.А., Филатова Т.А., Бокова И.А. Современные технолоии меди-цинской реабилитации детей с атопическим дерматитом // Доктор.ру – 2016. – №12-2(129). – С. 44-48 [Pogochenkova I.E., Rassulova M.A., Khan M.A., Lyan M.A., Filatova T.A., Bokova I.A. Sovremennye tehnologii medicinskoy reabilitasii detey s atopicheskim dermatitom // Doctor.ru. – 2016. – №12-2(129). – S. 44-48 (in Russ.)]. https://elibrary.ru/item.asp?id=27656537

Vestergaard C., Wollenberg A., Barbarot S., Christen-Zaech S., Deleuran M., Spuls P. European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period // J. Eur. Acad. Dermatol. Venereol. – 2019. – Vol. 33. – P. 1644-1659. https://doi.org/10.1111/jdv.15709.

Chi C.C., Kirtschig G., Alerer W. Updated evidence-based (S2e) European Dermatology Forum guideline on topical corticosteroids in pregnancy // J. Eur. Acad. Dermatol. Venereol. – 2017. – Vol. 31(5). – P. 761-773. https://doi.org/10.1111/jdv.14101

Hamann C.R., Egeberg A., Wollenberg A., Gislason G., Skov L., Thyssen J.P. Pregnancy complications, treatment characteristics and birth outcomes in women with atopic dermatitis in Denmark // J. Eur. Acad. Dermatol. Venereol. – 2019. – Vol. 33(3). – P. 577-587. https://doi.org/10.1111/jdv.15256

Meltzer E.O., Ratner P.H., McGraw T. Oral Phenylephrine HCl for Nasal Congestion in Seasonal Allergic Rhinitis: A Randomized, Open-label, Placebo-controlled Study // J. Allergy Clin. Immunol Pract. – 2015. – Vol. 3. – P. 702. https://doi.org/10.1016/j.jaip.2015.05.007.

Bay Bjørn A., Ehrenstein V., Hundborg H.H., Nohr E.A., Sørensen H.T., Nørgaard M. Use of corticosteroids in early pregnancy is not associated with risk of oral clefts and other congenital malformations in offspring // Am. J. Ther. – 2014. – Vol. 21(2). – P. 73-80. https://doi.org/10.1097/MJT.0b013e3182491e02.

MacDonald K., Norman W.V., Popescu O. New anomalies due to methotrexate and misoprostol exposure in early pregnancy // Int. J. Gynaecol. Obstet. – 2013. – Vol. 122(3). – P. 267-268. https://doi.org/10.1016/j.ijgo.2013.03.026

Götestam Skorpen C., Hoeltzenbein M., Tincani A., Fischer-Betz R., Elefant E., Chambers C., Østensen M. The EULAR points to consider for use of antirheumatic drugs before pregnancy and during pregnancy and lactation // Ann. Rheum. Dis. – 2016. – Vol. 75(5). – P. 795-810. https://doi.org/10.1136/annrheumdis-2015-208840.

Garritsen F.M., Den Broek M.PH., Zuilen A.D., Fidder H.H., De Bruin-Weller M.S., Spuls P.I. Pregnancy and fetal outcomes after paternal exposure to azathioprine, methotrexate or mycophenolic acid: a critically appraised topic // Br. J. Dermatol. – 2017. – Vol. 176(4). – P. 866-877. https://doi.org/10.1111/bjd.15320

Akbari M., Shah S., Velayos F.S., Mahadevan U., Cheifetz A.S. Systematic Review and Meta-analysis on the Effects of Thiopurines on Birth Outcomes from Female and Male Patients with Inflammatory Bowel Disease // Inflamm. Bowel Dis. – 2013. – Vol. 19(1). – P. 15-22. https://doi.org/10.1002/ibd.22948

Fabbrocini G., Napolitano M., Megna M. Treatment of atopic dermatitis with biologic drugs // Dermatol. Ther. – 2018. – Vol. 8(4). – P. 527-538. https://doi.org/10.1007%2Fs13555-018-0258-x

Lou H., Lu J., Choi E.B. Expression of IL-22 in the skin causes Th2-biased immunity, epidermal barrier dysfunction, and pruritus via stimulating epithelial Th2 cytokines and the GRP pathway // J. Immunol. – 2017. – Vol. 198(7). – P. 2543-2555. https://doi.org/10.4049/jimmunol.1600126

Silverberg J.I., Yosipovitch G., Simpson E.L. Dupilumab treatment results in early and sustained improvements in itch in adolescents and adults with moderate to severe atopic dermatitis: Analysis of the randomized phase 3 studies SOLO 1 and SOLO 2, AD ADOL, and CHRONOS // J. Am. Acad. Dermatol. – 2020. – Vol. 82(6). – P. 1328-1336. https://doi.org/10.1016/j.jaad.2020.02.060

Glickman J.W., Han J, Garcet S., Krueger J.G., Pavel A.B., Guttman-Yassky E. Improving evaluation of drugs in atopic dermatitis by combining clinical and molecular measures // J. Allergy Clin. Immunol. Pract. – 2020. – Vol. 8(10). – P. 3622-3625. https://doi.org/10.1016/j.jaip.2020.07.015

Hamilton J.D., Su arez-Farinas M., Dhingra N. Dupilumab improves the molecular signature in skin of patients with moderate-to-severe atopic dermatitis // J. Allergy Clin. Immunol. – 2014. – Vol. 134(6) – P. 1293-1300. https://doi.org/10.1016/j.jaci.2014.10.013

European Medicines Agency. Dupixent (dupilumab): Summary of product characteristics // www.ema.europa.eu/en/medicines/human/EPAR/dupixent. Last update: 22.02.2023

Kage P., Simon J.C., Treudler R. A case of atopic eczema treated safely with dupilumab during pregnancy and lactation // J. Eur. Acad. Dermatol. Venereol. – 2020. – Vol. 34(6). – P. e256-e257. https://doi.org/10.1111/jdv.16235.

Wollenberg A., Howell M.D., Guttman-Yassky E. Treatment of atopic dermatitis with tralokinumab, an anti-IL-13 mAb // J. Allergy Clin. Immunol. – 2019. – Vol. 143(1). – P. 135-141. https://doi.org/10.1016/j.jaci.2018.05.029

Panettieri R.A. Jr., Wang M., Braddock M., Bowen K., Colice G. Tralokinumab for the treatment of severe, uncontrolled asthma: the ATMOSPHERE clinical development program // Immunotherapy. – 2018. – Vol. 10(6). – P. 473-490. https://doi.org/10.2217/imt-2017-0191

Bao L., Zhang H., Chan L.S. The involvement of the JAK-STAT signaling pathway in chronic inflammatory skin disease atopic dermatitis // JAKSTAT. – 2013. – Vol. 2. – P. e24137. https://doi.org/10.4161/jkst.24137

He H., Guttman-Yassky E. JAK Inhibitors for Atopic Dermatitis: An Update // J. Clin. Dermatol. – 2019. – Vol. 20(2). – P. 181-192. https://doi.org/10.1007/s40257-018-0413-2.

Erratum in: He H, Guttman-Yassky E. Am J Clin Dermatol. – 2019. – Vol. 20(2). – P. 193. https://doi.org/10.1007/s40257-019-00421-1.

Simpson E.L., Lacour J.P., Spelman L., Galimberti R., Eichenfield L.F., Bissonnette R., King B.A., Thyssen J.P., Silverberg J.I., Bieber T., Kabashima K., Tsunemi Y., Costanzo A., Guttman-Yassky E., Beck L.A., Janes J.M., DeLozier A.M., Gamalo M., Brinker D.R., Cardillo T., Nunes F.P., Paller A.S., Wollenberg A., Reich K. Baricitinib in patients with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids: results from two randomized monotherapy phase III trials // Br. J. Dermatol. – 2020. – Vol. 183. – P. 242-255. https://doi.org/10.1111/bjd.18898

Reich K., Kabashima K., Peris K. Efficacy and Safety of Baricitinib Combined With Topical Corticosteroids for Treatment of Moderate to Severe Atopic Dermatitis: A Randomized Clinical Trial // JAMA Dermatol. – 2020. – Vol. 156(12). – P. 1333-1343. https://doi.org/10.1001/jamadermatol.2020.3260

European Medicines Agency. Olumiant (baricitinib) E.U. summary of product characteristics (Annex I) // www.ema.europa.eu/en/documents/product-information/olumiant-epar-product-information_en.pdf. Last update: 29.06.2022

Costanzo G., Firinu D., Losa F., Deidda M., Barca M.P., Del Giacco S. Baricitinib exposure during pregnancy in rheumatoid arthritis // Ther. Adv. Musculoskelet. Dis. – 2020. – Art. ID: 12. https://doi.org/10.1177/1759720X19899296

Napolitano M., Fabbrocini G., Cinelli E., Stingeni L., Patruno C. Profile of Baricitinib and Its Potential in the Treatment of Moderate to Severe Atopic Dermatitis: A Short Review on the Emerging Clinical Evidence // J. Asthma Allergy. – 2020. – Vol. 13. – P. 89-94. https://doi.org/10.2147%2FJAA.S206387

European Medicines Agency. Rinvoq (Upadacitinib) E.U. summary of product characteristics (Annex I) // www.ema.europa.eu/en/documents/product-information/rinvoq-epar-product-information_en.pdf. Last update: 12.07.2022

Downloads

Published

2023-03-31

How to Cite

[1]
Bespalova Н., Gorkovets А., Zubkov Д. , Izmailovich М., Amirbekova Ж. , Dedova О., Knaus А. and Turdunova Г. 2023. Features of modern treatment of atopic dermatitis in gravidas: A literature review. Reproductive Medicine (Central Asia). 1(54) (Mar. 2023), 126–135. DOI:https://doi.org/10.37800/RM.1.2023.126-135.

Issue

No. 1(54) (2023): Reproductive medicine

Section

Статьи

License

The articles published in this Journal are licensed under the CC BY-NC-ND 4.0 (Creative Commons Attribution – Non-Commercial – No Derivatives 4.0 International) license, which provides for their non-commercial use only. Under this license, users have the right to copy and distribute the material in copyright but are not permitted to modify or use it for commercial purposes. Full details on the licensing are available at https://creativecommons.org/licenses/by-nc-nd/4.0/.