Systemic medications used in treatment of common dermatological conditions: Safety profile with respect to pregnancy, breast feeding and content in seminal fluid.

Systemic medications used in treatment of common dermatological conditions: Safety profile with respect to pregnancy, breast feeding and content in seminal fluid.

J Dermatolog Treat. 2017 Jan 16;:1-53

Authors: Brown SM, Aljefri KA, Waas R, Hampton PJ

Abstract
Prescribing for pregnant or lactating patients and male patients wishing to father children can be a difficult area for dermatologists. There is a lack of review articles of commonly used systemic medications in dermatology with respect to their effects on developing embryogenesis and their potential transfer across the placenta, in breast milk and in seminal fluid. This paper aims to provide an up to date summary of evidence to better equip dermatologists to inform patients about the effects of systemic medications commonly used in dermatology to treat conditions such as atopic dermatitis, psoriasis and acne, on current and future embryogenesis and fertility.
RESULTS/DISCUSSION: We have provided detailed evidence about the safety profile for the use of systemic medication used in the treatment of common dermatological conditions, such as atopic dermatitis, psoriasis and acne with respect to pregnancy, breastfeeding and spermatogenesis. The following medications are completely contraindicated in pregnancy: retinoids, methotrexate, mycophenolate and fumaric acid esters, whilst ciclosporin and hydroxychloroquine are considered safer options. Azathioprine and biologics have been considered on a case by case scenario. There is an association with impaired neonatal immunity and a possible VACTERL association with biologics. There is insufficient evidence to recommend ustekinumab. Dapsone should also be considered on a case by case basis as it is associated with haemolysis and hyperbilirubinaemia in the neonate. The following medications are contraindicated in breastfeeding: retinoids, methotrexate, mycophenolate, fumaric acid esters and ciclosporin. There is conflicting information about the use of azathioprine. Dapsone use during breastfeeding is associated with haemolysis and hyperbilirubinaemia in the neonate. The use of hydroxychloroquine is felt to be safe. The data associated with the use of biologic agents is limited, specific guidance for each biological medication is detailed in the relevant section. Methotrexate is completely contraindicated in male patients actively trying for children and needs to be suspended for at least 3 months prior to contraception. The following medications are felt to be low risk: biologics, ciclopsorin and retinoids, there are some concerns however regarding isotretinoin use in males when their female partner is already pregnant and recent advice recommends contraception. There is insufficient information regarding the use of mycophenolate, fumaric acid esters, azathioprine, hydroxychloroquine, dapsone and ustekinumab in order to consider their safety profile.

PMID: 28092212 [PubMed - as supplied by publisher]

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