Dermatitis during pregnancy

Most women will experience certain skin changes during their pregnancy. These mostly happen due to hormonal changes which affect the body, preparing it for a successful pregnancy and labor. Some skin changes may worry future mothers. However, most of these are not dangerous. Yet, it is always good to get informed and know what to expect. Thus, read on in order to find out more about skin changes during pregnancy.

Most Common Skin Changes During Pregnancy

The cheekbones and forehead may become a bit discolored, with brown, clearly defined patches appearing on the surface of the skin. This phenomenon is called melasma. Also, pregnancy may result in your nipples and external genital area turning darker, along with your current moles.

Additionally, a dark line may manifest on the abdominal area, moving from the navel down. Stretch marks are commonly seen in pregnant women, appearing on the stomach, breasts, or other parts of the body, becoming whiter and smoother over time.

The changes in the skin may reveal veins more or lead to swelling of the veins in the legs. Finally, acne and skin tags may start forming all around the body.

Reasons Behind Skin Changes During Pregnancy

As it was mentioned above, hormonal changes which strike a woman during her pregnancy, manifest through an increase in estrogen and melanocyte-stimulating hormones. The latter is involved with skin pigmentation and once its levels are increased, darkening of the skin may occur.

On the other hand, high estrogen levels are behind problems with veins. Moreover, as tissues stretch in order to accommodate the growing breasts and belly, stretch marks appear.

The Characteristics of Skin Changes During Pregnancy

Once the baby gets born, the changes which affected the body of the mother start subsiding slowly, over a course of several months. Yet, they may all return during a new pregnancy the mother finds herself. The stretch marks are notorious but, nevertheless, these become less noticeable over time.

Both mother's and the child's health are not jeopardized by any of the above-mentioned skin changes. However, rash and other skin problems of this type, being specifically seen during pregnancy may be a sign of concern. Also, itching without the presence of a rash may require medical attention, especially if it occurs after the first trimester.

Most common rash that is seen in pregnancy occurs in a form of pruritic urticarial papules and plaques of pregnancy, herpes gestationis, impetigo herpetiformis, papular dermatitis of pregnancy, and prurigo gestationis.

If papular dermatitis of pregnancy occurs, it manifests through a very itchy rash, resembling insect bites with red, raised spots, possibly covered by crusts, appearing all over the body. Since this skin problem may lead to fetal death, it should be treated as soon as possible.

Dupilumab is currently the only biologic treatment approved for moderate-to-severe atopic dermatitis. Though limited, available clinical data describing dupilumab use in pregnancy have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes.

Atopic dermatitis accounts for 36–49% of all gestational dermatoses, making it the most common dermatosis encountered in pregnancy. Pregnancy is often a trigger for AD and worsening of disease is typically reported during the second and third trimesters.
Systemic treatment in pregnant women with atopic dermatitis is currently restricted to corticosteroids, cyclosporine A, and azathioprine.
Atopic dermatitis often has a deleterious course in pregnancy which can cause substantial distress and significantly impact on global health and quality of life.
We report a case of severe atopic dermatitis treated safely with dupilumab during pregnancy with no adverse maternal or fetal outcomes observed. Our case highlights that dupilumab use in pregnancy has its place but should always be preceded by careful assessment of the risks and benefits.
The effects of dupilumab exposure in pregnancy on the neonatal immune system are unknown. Patients with AD who receive biologic therapy during pregnancy should be advised of the potential for an impaired immune response in their newborns.
There is no available evidence on the effects of dupilumab on the breastfed infant and for this reason the ETFAD does not support its use in lactating women. Human IgG is known to be excreted in breastmilk.

There are limited available data on the use of dupilumab in pregnant women to inform any drug-associated risk. Until more experience is available, systemic treatment in pregnant women with AD is restricted to corticosteroids, cyclosporine A, and azathioprine. To our knowledge, this is the first case report of a pregnant patient with AD treated with dupilumab in Australia. Maternal and fetal outcomes were excellent. Our case highlights that dupilumab use in pregnancy has its place but should be preceded by careful assessment of whether the potential benefits justify the potential risks to the fetus. Clinicians are encouraged to enroll their patients in manufacturer-sponsored pregnancy registry studies or surveillance programs to monitor outcomes in women exposed to dupilumab during pregnancy.

✓ Fact confirmed: Atopic Dermatitis Treated Safely with Dupilumab during Pregnancy: A Case Report and Review of the Literature Lobo Y.; Lee R.C.; Spelman L.; 2021, May - August