Cyclosporine A

The ETFAD recommends that cyclosporine A be used off-label in women with AD who are pregnant or lactating if topical and UV treatments fail. 

Azathioprine

Azathioprine (AZA) may be used off-label to treat severe, uncontrolled AD in pregnant women when topical, UV, and other systemic therapies fail. However, ETFAD recommends avoiding the use of AZA during pregnancy since there are more effective alternatives. If AZA is to be continued during pregnancy, ETFAD recommends reducing the dosage to 50%. After conception, the use of AZA to treat AD should not be initiated.

Mycophenolate Mofetil

Mycophenolate mofetil (MMF) is contraindicated in pregnant women with AD and in men with AD 3 months before conception. MMF is secreted in breast milk and is not recommended for treating AD during lactation. The ETFAD recommends against using MMF in women who are pregnant, lactating, or planning to become pregnant.

Dupilumab

The ETFAD recommends against using dupilumab in women with AD who are pregnant or lactating due to lack of experience and scientific data.

Oral Antihistamines

Oral antihistamines in pregnant women with AD should only be used if clinically indicated. Loratadine should be used due to the large clinical experience with this treatment, and sedating antihistamines should only be used after carefully weighing the benefits and risks.

Treatment of AD in Men Planning to Father a Child

Men with AD who may father a child can safely use topical treatments and SCS without concern as long as general guidelines are followed. Cyclosporine A may also be used at the time of conception when other treatments fail or are contraindicated.

Men with AD who are treated using MMF are advised to use condoms during, and for at least 90 days after stopping, MMF therapy to reduce the risk for teratogenicity. Methotrexate should be paused 3 months before conception to reduce the risk for birth malformation. AZA should only be used in severe cases of AD when other therapies have failed or are contraindicated.

Unplanned Pregnancy During Systemic Treatment

The ETFAD recommends that women of childbearing age use contraceptive treatment when beginning treatment with methotrexate and MMF to reduce the risk for pregnancy- and fetal-related complications. Women with AD who get pregnant are recommended to stop systemic treatment immediately and intensify topical treatment.

Reference

Vestergaard C, Wollenberg A, Barbarot S, et al. European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period [published online June 23, 2019]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.15709

This article originally appeared on Dermatology Advisor