Management of pyoderma gangrenosum during pregnancy and breastfeeding: a systematic review
Conflict of interest: Dr. Afsaneh Alavi has received consulting fees from Abbvie, BI, Kymera, InflaRx, Incyte, Novartis, and UCB, is an investigator for BI and Processa, and a board member of the HS Foundation. Dr. Noah Goldfarb was awarded grants from the HS Foundation and VA Health Care System, is a peer reviewer for UpToDate, has done consulting and advisory boards for Sonoma Biotherapeutics, received research funding from Novartis and DeepX Health, and is a PI for an Incyte trial. The other authors declare no conflicts of interest.
Funding source: None.
Abstract
Pregnancy is a conjectured risk factor for pyoderma gangrenosum (PG), an autoinflammatory neutrophilic dermatosis characterized by painful ulcers. Even so, there are no available treatment guidelines for those with PG who are pregnant or breastfeeding. To describe existing treatment options, we systematically reviewed the literature on PG treatment in pregnant or breastfeeding patients. A search over four databases was completed in October 2022. Independent reviewers accomplished screening and data extraction. 18 articles met the inclusion criteria. 15 cases involved the treatment of PG during pregnancy, and three cases involved the treatment of PG while breastfeeding. Most patients did not have a history of PG prior to pregnancy (77.7%), and most did not have PG-associated comorbidity (61.1%). Of the cases involving treatment of PG during pregnancy, the majority (73%) found treatment success with a systemic corticosteroid (SCS). Only three cases reported an adverse outcome, including premature rupture of membranes and premature birth (16.7%); all these cases involved treatment with a SCS at >0.5 mg/kg/day during pregnancy. We present a treatment algorithm for pregnant or breastfeeding patients with PG. Our findings suggest prioritizing topicals and TNF inhibitors due to more favorable side effect profiles. However, there is a paucity of data on the safety of PG therapies in pregnancy and breastfeeding, and thus, controlled studies and pregnancy registries must be pursued.
