Title : The relationship between atopic dermatitis and pregnancy: Considerations for prenatal counselling and treatment for a global population
Abstract:
Globally, atopic dermatitis (AD) is the most common skin disorder in pregnancy and accounts for 36-59% of obstetric skin disease. The pathogenesis of AD in pregnancy is unclear. The prevailing theory suggests the immunity shift from Th-1 to Th-2 during pregnancy leads to AD exacerbations in gravid patients. Surprisingly, AD improves during pregnancy for some. The impact of AD must also be contextualized by a health equity lens, given its increased prevalence and severity in Black and Latinx populations. While clinical understanding of AD during pregnancy is unclear, current understanding of its disproportionate impact on gravid patients of color remains obscure.
A systematic review of Pubmed and Web of Science was conducted. Keywords included atopic dermatitis, eczema, pregnancy, and persons of color. Approximately 100 studies were reviewed, and 22 studies were selected based on relevance after review of titles and abstracts. In total, 11 manuscripts met inclusion criteria which included the following: (1) published in English and (2) discussed the AD course in pregnancy, (3) treatment for AD in pregnancy, or (4) AD in melanin-rich skin.
Results suggested that 30-50% of gravid patients with pre-existing AD experienced an exacerbation of symptoms while 20% experienced improvement. Literature on pathogenesis maintained that the progression of AD during pregnancy is due to a transition from cell-mediated to humoral immunity. A few studies explored treatment modalities for gravid populations. There was minimal data on the unique sequelae of AD in melanin-rich patients.
Audience Take Away:
- Understand how pregnancy can exacerbate or improve atopic dermatitis and the underlying pathophysiology of its diverse disease courses in the gravid patient.
- Explore the maternal and fetal complications linked to prepartum atopic dermatitis.
- Discuss available treatment options for atopic dermatitis during pregnancy and their respective safety profiles.
- Feel empowered to offer accurate and comprehensive prenatal guidance on atopic dermatitis to patients post-presentation.
- Understand the global health inequities associated with atopic dermatitis and its impacts on communities of color.
