A large percentage of patients with immune-mediated inflammatory diseases (IMIDs) are women of childbearing age. Pregnancy is a complex physiological scenario and causes significant endocrine and immunological changes. Pregnancy can trigger a worsening of IMIDs and, bidirectionally, disease flares are associated with worse pregnancy outcomes. This highlights the importance of achieving adequate control of IMIDs before conception and during pregnancy. When choosing pharmacological therapy in pregnant women with IMIDs, it is important to be aware of all available options and their potential impact on the mother and fetus. The aim of this review is to highlight the influence of pregnancy on the clinical evolution and prognosis of the most common cutaneous, rheumatological, and gastroenterological IMIDs. In addition, we provide an updated review of the different systemic and topical therapies used for the treatment of common dermatoses (such as atopic dermatitis, psoriasis, and hidradenitis suppurativa) and their safety profile during pregnancy and lactation.

Immune-mediated inflammatory diseases (IMIDs) are chronic and disabling diseases that share common inflammatory and immunological dysregulation. The association between IMIDs and the risk of cancer remains debatable. Inflammation is a double-edged sword for cancer as it can help destroy malignant cells but it can also promote the development of some cancers. The following review aims to provide a summary of the associations of neoplasms and the most common IMIDs and the possible relationship of the indirect risk caused by their chronic therapy. The risk of developing neoplasm is higher globally in patients with IMID, with different risk profiles and tumor types depending on the inflammatory pathology. Overall, lymphoproliferative disorders are the most common cancer in IMID patients. Nowadays, data available on the safety of the drugs used in IMID patients showed no increased risk of neoplasms in general, although more studies are needed.

Despite the advances in medical treatment of Crohn’s disease (CD), most of the patients require one or more surgical bowel resections during their life for complicated disease. Surgery for CD has gone through progressive technical refinement over time. Minimally invasive surgery and bowel-sparing techniques have been validated with regard to surgical trauma reduction, and their role has been clearly defined in the current guidelines. Nevertheless, continuous technology advancement has further expanded the surgical tools with single-access and robotic-assisted surgery. With the aim of further reducing the impact of surgery, the concept of “strategic surgery” has been explored. On the one hand, patients’ optimization before surgery has the potential to reduce post-operative complications. On the other, early intervention for the uncomplicated disease before medical therapy escalation has been demonstrated equally reliable with respect to biologics in terms of quality of life and advantageous in terms of health-care costs. Ultimately, a better comprehension of the pathological mechanisms underlying the disease is the key to radically changing the surgical management of both abdominal and perianal CDs. In fact, novel surgical strategies aiming at reducing disease recurrence which take into account the anastomotic configuration and the role of the mesentery as an active player in the disease process have been pursued in the past decade. The purpose of this review is to describe the recent innovations in the surgical treatment of CD focusing on their potential impact on the short- and long-term outcomes.

Despite recent advances in Crohn’s disease (CD) therapy, with ever-new treatments available, there is still a relevant percentage of patients with refractory disease who do not achieve adequate clinical response and are not amenable to intestinal surgery. A joint consensus of the European societies for blood and marrow transplantation and inflammatory bowel disease has recognized the therapeutic role of autologous hematopoietic stem cell (HSCs) transplantation in this cluster of patients. The therapy produces a reset of patients’ immune system and the subsequent recovery of more self-tolerant inflammatory cells. In several case series and prospective clinical trials, this treatment was demonstrated to be able to induce clinical remission and heal mucosal damage, although providing only a temporary improvement. The use of deep immunosuppression as part of transplanting protocols represents the major limitation of this technique as causes a high adverse event rate, including mortality of up to 2%. Many new protocols have been assessed and are under investigation with the intent to reduce complications. The present review summarizes evidence of the efficacy and safety of autologous HSCs transplantation in refractory CD.

Paradoxical reactions are defined as adverse effects that manifest as a de novo appearance or the exacerbation of a condition that commonly responds to a certain class of drug. A well-known example of paradoxical reaction is the debut of psoriatic eruptions when patients undergo anti-tumor necrosis factor-alpha (TNF-α) therapy for inflammatory bowel disease. Initially, they were described as isolated events among patients who received the aforementioned drug agents for inflammatory rheumatic diseases. Later, paradoxical reactions have been reported in association with other conditions as psoriasis and inflammatory bowel disease and different biologic drugs or classes. Furthermore, paradoxical reactions have been reported with other biologics than TNF-α inhibitors, such as ustekinumab and IL-17 and IL-23 inhibitors. Sometimes, differentiating a true paradoxical reaction from a disease flare caused by efficacy loss can be challenging. The hypothesis concerning its pathophysiology consists in an imbalance of the immunity and inflammatory mechanisms and cells implied (cytokines, lym-phocytes…). These reactions may hinder proper patient management and result in catastrophic consequences. Thus, close surveillance and early recognition of these drug class effects is crucial.

Biologics have completely changed the treatment (and life) of patients with inflammatory bowel disease (IBD). After the first ones, anti-tumor necrosis factor (TNF) biologics, two new biologics, with other therapeutic targets, are now in routine use in our patients, and some others are in different stages of research. They share many aspects, but differ in others, so their efficacy and safety may be different. Having predictors of efficacy and safety in a particular patient are one of the greatest challenges in IBD therapy, but we are far from achieving it. In any case, safety is key, especially in drugs used as maintenance therapy in a chronic disease such as IBD. Although biologics are generally safe when are used correctly, it is essential to be aware of their potential adverse events and their particularities in different situations. To minimize them, it is essential to use them in the ideal patient, to choose the right biologic at the right time, to carry out a series of prior measures before start them, and, finally, to monitor the treatment correctly. We will discuss the differences between biologics, essentially anti-TNF versus ustekinumab versus vedolizumab, in terms of adverse events as well as their particularities of use. Having the knowledge of their contraindications, use in special populations, the steps before start, and how to monitoring them is essential. Although sometimes there are alternatives to biologics such as "the new small molecules, " they are not the purpose of this review.

Idiopathic inflammatory myopathies (IIMs), also known as autoimmune myositis, are a rare group of autoimmune disorders with a heterogenoeous spectrum of muscular and extramuscular involvement. IIM can be classified into several subgroups: dermatomyositis (DM), including clinically amyopathic DM, antisynthetase syndrome (ASS), immune-mediated necrotizing myopathy, inclusion body myositis, polymyositis, and overlap myositis (OM). Skin disease is a defining feature of DM, also present in AAS and OM. Lesions of DM are very varied but many share common histological features that are very useful for an early diagnosis of IIM when cutaneous involvement precedes other symptoms. Although the characteristic signs of DM are heliotrope rash, Gottron’s papules, and Gottron’s sign, there are a multitude of other cutaneous findings that can suggest a diagnosis of DM. Myositis-specific autoantibodies an myositis-associated autoantibodies have been identified in IIM. The former is only present in IIM and the latter can occur not only in IIM but also in other autoimmune disorders such as systemic lupus erythematosus, Sjögren syndrome, or systemic sclerosis. Myositis autoantibodies identify different clinical phenotypes, so they are very valuable in improving diagnosis and classification of IIM patients. This article first discusses the cutaneous findings of DM and then two particular phenotypes, MDA-5 DM, and AAS. Finally, OM according to myositis-associated autoantibodies is reviewed.

Immune-mediated inflammatory diseases (IMIDs) are a group of chronic and, up to date, incurable disorders affecting 5-7% of the Western population that share common pathophysiologic mechanisms. IMIDs may generate long-term disability as well as a significant reduction quality of life, causing a high socio-sanitary impact. Approximately, 20% of patients diagnosed with IMID suffer from at least another coexisting IMID and other comorbidities are also frequent, which has a significant impact on their therapeutic management. Moreover, the transversality and the associated complexity of caring for these patients make its multidisciplinary management necessary and represent a challenge for the traditional structure of health-care services. In this context, IMID multidisciplinary units emerge as a new collaborative care model that could provide an optimal framework for sharing clinical decisions between different specialists involved in the care of these patients. Some of the main goals of this multidisciplinary model should be the early diagnosis of concomitant IMIDs, the optimization of the treatment and the improvement the quality of care. For this purpose, shared decision about the most appropriate care plan and a multidisciplinary consultation must be warranted. In addition, IMIDs units should offer supporting programs such as those rely on the prevention of potentially avoidable transmissible diseases, neoplasms related to immunosuppression, and cardiovascular disease; resources of psychological support; and programs of transition from pediatric to adult healthcare.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting areas with a high density of apocrine glands and characterized by subcutaneous nodules that may evolve into fistulas with pus secretion. Progressor and aggressive profiles will require the use of immunomodulatory therapies to fight against their disease outcomes. Various options have been proposed to treat HS. Unfortunately, no therapy has been fully successful. Methods: The aim of this review is to investigate all current knowledge on biologic and small molecule options for HS management. A systematic literature research using the words "biologic, " "small molecule, " "therapy, " and "HS" was performed in PubMed/Medline and Scopus/ Embase databases. A search of the clinicaltrials.gov website for interventional recruiting and completed trials including the term "HS" was also performed up to August 2021. Results: At present, tumor necrosis factor TNF alfa blockers are considered the first therapeutic option based on clinical trials results and real-world evidence. However, new therapeutic options based on alternative pathway blockage, including interleukin (IL)-17, Complement and IL-23, seem to offer future alternatives for this condition. Conclusions: Several future studies and clinical trials are necessary to gain new knowledge about HS and to properly treat this complex condition. At present, IL-17 blockers such as secukinumab and bimekizumab represent the most promising alternative therapies for those patients who do not respond to adalimumab.

An increased risk of infections has been observed in dermatological patients with immune-mediated inflammatory diseases under immunosuppressive treatments. Some of these treatments (Interleukin [IL]-23 and IL-17 inhibitors) present a better and safer profile than others (methotrexate, cyclosporine or anti-tumor necrosis factor). The appearance of the coronavirus disease- 19 (COVID-19) pandemic has raised serious doubts about their continuation, because they may increase the susceptibility to infections or even worsen the course of SARS-CoV-2 infection itself. Therefore, preventive measures, such as adequate vaccination schedules, are crucial to properly manage these patients. In this review, we discuss the evidence on immunosuppressive treatment in different autoimmune skin diseases, their risk of infections, preventive measures associated to the vaccination status and their impact on patients during COVID-19 infection. Articles reviewed were obtained through searches of relevant databases (PUBMED, MEDLINE, ETHERIA).