Abstract
Pregnancy may induce the onset or exacerbation of autoimmune bullous diseases such as pemphigus or pemphigoid gestationis. A shift toward T helper (Th) 2 immune response and the influence of hormonal changes have been evoked as possible triggering factors. Therapeutic management of this setting of patients may represent a challenge, mainly due to safety concerns of some immunosuppressive drugs during pregnancy and lactation. In this narrative review, we provided a comprehensive overview of the therapeutic management of autoimmune bullous diseases in pregnant and breastfeeding women, focusing on pemphigus and pemphigoid gestationis.
Highlights
Autoimmune bullous diseases (AIBDs) represent a group of mucocutaneous disorders that encompass different conditions hallmarked by autoreactive antibodies directed against epithelial adhesion molecules (Egami et al, 2020)
Based on the localization of the blister, AIBDs are distinguished into two different categories: (i) AIBDs with intraepithelial cleavage, which belong to the pemphigus group (Kridin, 2018), including pemphigus vulgaris (PV) and pemphigus foliaceus (PF), and (ii) AIBDs with subepithelial detachment, which comprise diseases of the pemphigoid group (Amber et al, 2018) such as bullous pemphigoid (BP), pemphigoid gestationis (PG), mucous membrane pemphigoid (MMP), linear IgA bullous dermatosis (LABD), and epidermolysis bullosa acquisita (EBA)
Given that neonatal health is closely linked to the control of the underlying maternal AIBD, the issues related to the management of these disorders during pregnancy and lactation take on remarkable importance, often requiring a close interaction
Summary
Autoimmune bullous diseases (AIBDs) represent a group of mucocutaneous disorders that encompass different conditions hallmarked by autoreactive antibodies directed against epithelial adhesion molecules (Egami et al, 2020). Based on the localization of the blister, AIBDs are distinguished into two different categories: (i) AIBDs with intraepithelial cleavage, which belong to the pemphigus group (Kridin, 2018), including pemphigus vulgaris (PV) and pemphigus foliaceus (PF), and (ii) AIBDs with subepithelial detachment, which comprise diseases of the pemphigoid group (Amber et al, 2018) such as bullous pemphigoid (BP), pemphigoid gestationis (PG), mucous membrane pemphigoid (MMP), linear IgA bullous dermatosis (LABD), and epidermolysis bullosa acquisita (EBA) Among all these entities, PG and PV are those which involve more commonly women of childbearing potential (Feliciani et al, 2019). On the other hand, achieving disease control can be hindered by pregnancy-associated hormonal changes and pregnancy complications (preeclampsia, gestational diabetes, intrauterine growth restrictions, and preterm birth) Both in pemphigus and PG, maternal autoantibodies can be transferred to the newborn determining the occurrence of neonatal blistering lesions. We have striven to provide a comprehensive overview of the management of AIBDs during pregnancy and lactation, focusing on pemphigus and PG, merging our experience with data extrapolated by case series and reviews
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