Abstract：
Treating atopic dermatitis (AD) in pregnant or breastfeeding women, and in women and men with AD aspiring to be parents is difficult and characterized by uncertainty, as evidence to inform decision-making on systemic anti-inflammatory treatment is limited. This project mapped consensus across dermatologists, obstetricians and patients in Northwestern Europe to build practical advice for managing AD with systemic anti-inflammatory treatment in men and women of reproductive age. Twenty-one individuals (sixteen dermatologists, two obstetricians and three patients) participated in a two-round Delphi process. Full consensus was reached on 32 statements, partial consensus on four statements and no consensus on four statements. Cyclosporine A was the first-choice long-term systemic AD treatment for women preconception, during pregnancy and when breastfeeding, with short-course prednisolone for flare management. No consensus was reached on second-choice systemics preconception or during pregnancy, although during breastfeeding dupilumab and azathioprine were deemed suitable. It may be appropriate to discuss continuing an existing systemic AD medication with a woman if it provides good disease control and its benefits in pregnancy outweigh its risks. Janus kinase (JAK) inhibitors, methotrexate and mycophenolate mofetil should be avoided by women during preconception, pregnancy and breastfeeding, with medication-specific washout periods advised. For men preconception: cyclosporine A, azathioprine, dupilumab and corticosteroids are appropriate; a 3-month washout prior to conception is desirable for methotrexate and mycophenolate mofetil; there was no consensus on JAK inhibitors. Patient and clinician education on appropriate (and inappropriate) AD treatments for use in pregnancy is vital. A shared-care framework for interdisciplinary management of AD patients is advocated and outlined. This consensus provides interdisciplinary clinical guidance to clinicians who care for patients with AD before, during and after pregnancy. While systemic AD medications are used uncommonly in this patient group, considerations in this article may help patients with severe refractory AD.
摘要：
治疗孕妇或哺乳期妇女的特应性皮炎（AD），在女性和男性与AD渴望成为父母是困难的，以不确定性为特征，作为决定全身抗炎治疗的证据是有限的.这个项目绘制了皮肤科医生的共识，欧洲西北部的产科医生和患者为生育年龄的男性和女性进行全身性抗炎治疗以管理AD提供实用建议。21个人(16名皮肤科医生，两名产科医生和三名患者）参加了两轮Delphi过程。就32项声明达成了充分共识,对四项声明部分达成共识，对四项声明未达成共识。环孢菌素A是孕前妇女长期全身性AD治疗的首选药物，在怀孕期间和母乳喂养时，短期强的松龙用于耀斑管理。在第二选择系统的概念前或怀孕期间没有达成共识，尽管在母乳喂养期间，dupilumab和硫唑嘌呤被认为是合适的。如果女性提供良好的疾病控制，并且其在怀孕期间的益处超过其风险，则讨论继续使用现有的全身性AD药物可能是适当的。Janus激酶（JAK）抑制剂，女性在孕前应避免使用甲氨蝶呤和霉酚酸酯，怀孕和母乳喂养，建议使用特定药物清除期。男性先入为主:环孢素A,硫唑嘌呤，dupilumab和皮质类固醇是合适的;甲氨蝶呤和霉酚酸酯在受孕前需要3个月的洗脱;JAK抑制剂没有达成共识.患者和临床医生对妊娠中使用的适当（和不适当）AD治疗的教育至关重要。倡导并概述了用于AD患者跨学科管理的共享护理框架。这一共识为以前护理AD患者的临床医生提供了跨学科的临床指导，怀孕期间和之后。虽然全身性AD药物在该患者组中使用并不常见，本文中的考虑因素可能有助于重度难治性AD患者。
