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Evidence-Based Dermatology: Critically Appraised Topic
June 1, 2008

Do Safe and Effective Treatment Options Exist for Patients With Active Pemphigus Vulgaris Who Plan Conception and Pregnancy?

Author Affiliations
 

DAMIANOABENIMD, MPHROSAMARIACORONADSc, MDURBàGONZáLEZMD, PhDABRAR A.QURESHIMD, MPHHYWELWILLIAMSMSc, PhD, FRCP

Arch Dermatol. 2008;144(6):783-785. doi:10.1001/archderm.144.6.783

A 32-year-old woman with active pemphigus vulgaris (PV) who planned to conceive in the near future presented to our dermatology clinic to discuss pharmacologic management of her PV. At that time, she had stable but persistent oral disease while prescribed a regimen of prednisone, 7.5 mg/d; dapsone, 50 mg twice daily; and methotrexate, 25 mg/wk. The objective of this article is to evaluate available evidence regarding the safety and efficacy of steroid-sparing agents in PV during the peripartum period.

Pemphigus vulgaris in pregnancy is rare, with fewer than 40 cases documented in the literature.1 Avoidance of immunosuppressive medications in patients with PV during pregnancy has been recommended,2 but this cannot be achieved in many cases because inadequate treatment of PV can contribute to marked patient morbidity and mortality.3,4 Moreover, severe maternal disease and high serum antibody titers previously have been correlated with poor neonatal outcomes in a case series of 9 patients.5 As the first-line treatment for PV, prednisone has a well-established safety record in pregnancy,6,7 as well as a rapid onset of action and a high degree of physician comfort with use. Even though prednisone and its metabolites cross the placenta sparingly when compared with other, less frequently used corticosteroids (eg, dexamethasone and betamethasone7), high dosages can increase fetal risk for low birth weight, prematurity, infection, and adrenal insufficiency.6-8

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