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Rau A, Keri J, Murase JE. Management of Acne in Pregnancy. Am J Clin Dermatol 2024; 25:465-471. [PMID: 38453786 DOI: 10.1007/s40257-024-00851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/09/2024]
Abstract
Acne is one of the most common dermatological conditions to affect women of childbearing age, so it is important to consider the safety of long-term acne treatments on women who could become pregnant. In this review article, we clarify what management options are available to treat acne during pregnancy. Topical treatments, typically first-line for acne, such as azelaic acid, clindamycin, erythromycin, metronidazole, benzoyl peroxide, salicylic acid, dapsone, and retinoids, were reviewed. Systemic treatments, such as zinc supplements, cephalexin, cefadroxil, amoxicillin, azithromycin, erythromycin, and corticosteroids, typically second-line for acne, were also reviewed. Alternative treatments such as light therapy and cosmetic procedures were also evaluated. Due to recommendation of sunscreen utilization during acne treatments, sunscreen usage during pregnancy was also assessed. Management of acne during unplanned pregnancy was discussed in further detail regarding safety and adverse effects. Through summarized tables and examples of studies demonstrating safety and efficacy of treatments, the following is a resource for providers and patients to utilize for management of acne during pregnancy.
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Affiliation(s)
- Akash Rau
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Jonette Keri
- Department of Cutaneous Surgery and Dermatology, University of Miami, Miami, FL, USA
- Miami VA Hospital, Miami, Florida, USA
| | - Jenny E Murase
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA.
- Department of Dermatology, Palo Alto Foundation Medical Group, 701 East El Camino Real (31-104), Mountain View, CA, 94040, USA.
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2
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Durán CE, Riera-Arnau J, Abtahi S, Pajouheshnia R, Hoxhaj V, Gamba M, Alsina E, Martin-Perez M, Garcia-Poza P, Llorente-Garcia A, Gonzalez-Bermejo D, Ibánez L, Sabaté M, Vidal X, Ballarín E, Sanfélix-Gimeno G, Rodríguez-Bernal C, Peiró S, García-Sempere A, Sanchez-Saez F, Ientile V, Ingrasciotta Y, Guarneri C, Tanaglia M, Tari M, Herings R, Houben E, Swart-Polinder K, Holthuis E, Huerta C, Gini R, Roberto G, Bartolini C, Paoletti O, Limoncella G, Girardi A, Hyeraci G, Andersen M, Kristiansen SB, Hallgreen CE, Klungel O, Sturkenboom M. Impact of the 2018 revised Pregnancy Prevention Programme by the European Medicines Agency on the use of oral retinoids in females of childbearing age in Denmark, Italy, Netherlands, and Spain: an interrupted time series analysis. Front Pharmacol 2023; 14:1207976. [PMID: 37663263 PMCID: PMC10469888 DOI: 10.3389/fphar.2023.1207976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background: In March 2018, the European pregnancy prevention programme for oral retinoids was updated as part of risk minimisation measures (RMM), emphasising their contraindication in pregnant women. Objective: To measure the impact of the 2018 revision of the RMMs in Europe by assessing the utilisation patterns of isotretinoin, alitretinoin and acitretin, contraceptive measures, pregnancy testing, discontinuation, and pregnancy occurrence concomitantly with a retinoid prescription. Methods: An interrupted time series (ITS) analysis to compare level and trend changes after the risk minimisation measures implementation was conducted on a cohort of females of childbearing age (12-55 years of age) from January 2010 to December 2020, derived from six electronic health data sources in four countries: Denmark, Netherlands, Spain, and Italy. Monthly utilisation figures (incidence rates [IR], prevalence rates [PR] and proportions) of oral retinoids were calculated, as well as discontinuation rates, contraception coverage, pregnancy testing, and rates of exposed pregnancies to oral retinoids, before and after the 2018 RMMs. Results: From 10,714,182 females of child-bearing age, 88,992 used an oral retinoid at any point during the study period (mean age 18.9-22.2 years old). We found non-significant level and trend changes in incidence or prevalence of retinoid use in females of child-bearing age after the 2018 RMMs. The reason of discontinuation was unknown in >95% of cases. Contraception use showed a significant increase trend in Spain; for other databases this information was limited. Pregnancy testing was hardly recorded thus was not possible to model ITS analyses. After the 2018 RMM, rates of pregnancy occurrence during retinoid use, and start of a retinoid during a pregnancy varied from 0.0 to 0.4, and from 0.2 to 0.8, respectively. Conclusion: This study shows a limited impact of the 2018 RMMs on oral retinoids utilisation patterns among females of child-bearing age in four European countries. Pregnancies still occur during retinoid use, and oral retinoids are still prescribed to pregnant women. Contraception and pregnancy testing information was limited in most databases. Regulators, policymakers, prescribers, and researchers must rethink implementation strategies to avoid any pregnancy becoming temporarily related to retinoid use.
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Affiliation(s)
- Carlos E. Durán
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Judit Riera-Arnau
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Shahab Abtahi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Vjola Hoxhaj
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Magdalena Gamba
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Ema Alsina
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mar Martin-Perez
- Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
| | | | | | | | - Luisa Ibánez
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Mònica Sabaté
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Xavier Vidal
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Ballarín
- Department of Clinical Pharmacology, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Gabriel Sanfélix-Gimeno
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Clara Rodríguez-Bernal
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Salvador Peiró
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Aníbal García-Sempere
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Francisco Sanchez-Saez
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Health Services Research Unit (FISABIO - HSRU), Valencia, Spain
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Ylenia Ingrasciotta
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Matilde Tanaglia
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | | | | | | | | | - Consuelo Huerta
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa Gini
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | - Giuseppe Roberto
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | | | - Olga Paoletti
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | | | - Anna Girardi
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | - Giulia Hyeraci
- Agenzia Regionale di Sanità Della Toscana (ARS), Florence, Italy
| | - Morten Andersen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sarah Brøgger Kristiansen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christine Erikstrup Hallgreen
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Miriam Sturkenboom
- Julius Center for Health Sciences and Primary Care, Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
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De Caux D, Mariappa G, Perera G, Girling J. Prescribing for pregnancy: chronic skin diseases. Drug Ther Bull 2023; 61:55-60. [PMID: 36990470 DOI: 10.1136/dtb.2022.000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Chronic skin disease is common in women of reproductive age. Although skin can improve or remain stable during pregnancy, it is also common for existing conditions to flare and for new conditions to develop. A small number of medications used to control chronic skin disease can potentially have adverse effects on the outcome of the pregnancy. This article forms part of a series on prescribing for pregnancy and highlights the importance of achieving good control of the skin disease prior to conception and during pregnancy. It emphasises the need for patient-centred, open and informed discussions around medication options to achieve good control. During pregnancy and breastfeeding each patient should be treated as an individual in accordance with the medications that are appropriate for them, their preferences, and the severity of their skin disease. This should be done through collaborative working across primary care, dermatology and obstetric services.
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Affiliation(s)
- Deborah De Caux
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Gayathri Perera
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Joanna Girling
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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4
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Treatment of Acne Vulgaris During Pregnancy and Lactation: A Narrative Review. Dermatol Ther (Heidelb) 2022; 13:115-130. [PMID: 36447117 PMCID: PMC9823189 DOI: 10.1007/s13555-022-00854-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/03/2022] [Indexed: 11/30/2022] Open
Abstract
Acne vulgaris frequently affects women during pregnancy and lactation. Hormonal and physiologic changes in pregnancy contribute to the pathogenesis of acne during the various phases of pregnancy. Several effective acne treatments commonly prescribed in the general population are contraindicated during pregnancy or lactation. There is a lack of guidelines and updated resources on acne management in these populations. In this narrative review, we summarize existing evidence on the safety and efficacy of acne treatments during pregnancy and breastfeeding. Acne management in pregnancy and lactation should follow a stepwise approach based on severity to minimize risk. Topical therapies, such as benzoyl peroxide, azelaic acid, or keratolytics, can be used to treat mild-to-moderate disease. Moderate-to-severe acne may require systemic treatments, including penicillin, amoxicillin, cephalexin, and erythromycin, with special consideration for trimester-specific teratogenicity of medications and relevant medical history of the mother and infant. For refractory cases, oral or intralesional corticosteroids as well as laser and light therapies may be considered. This review provides an updated reference to aid patient-physician decision-making on acne management in these special populations.
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5
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Milosheska D, Roškar R. Use of Retinoids in Topical Antiaging Treatments: A Focused Review of Clinical Evidence for Conventional and Nanoformulations. Adv Ther 2022; 39:5351-5375. [PMID: 36220974 PMCID: PMC9618501 DOI: 10.1007/s12325-022-02319-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/06/2022] [Indexed: 01/30/2023]
Abstract
Nowadays, numerous skincare routines are used to rejuvenate aging skin. Retinoids are one of the most popular ingredients used in antiaging treatments. Among the representatives of retinoids, tretinoin is considered the most effective agent with proven antiaging effects on the skin and can be found in formulations approved as medicines for topical treatment of acne, facial wrinkles, and hyperpigmentation. Other retinoids present in topical medicines are used for various indications, but only tazarotene is also approved as adjunctive agent for treatment of facial fine wrinkling and pigmentation. The most commonly used retinoids such as retinol, retinaldehyde, and retinyl palmitate are contained in cosmeceuticals regulated as cosmetics. Since clinical efficacy studies are not required for marketing cosmetic formulations, there are concerns about the efficacy of these retinoids. From a formulation perspective, retinoids pose a challenge to researchers as a result of their proven instability, low penetration, and potential for skin irritation. Therefore, novel delivery systems based on nanotechnology are being developed to overcome the limitations of conventional formulations and improve user compliance. In this review, the clinical evidence for retinoids in conventional and nanoformulations for topical antiaging treatments was evaluated. In addition, an overview of the comparison clinical trials between tretinoin and other retinoids is presented. In general, there is a lack of evidence from properly designed clinical trials to support the claimed efficacy of the most commonly used retinoids as antiaging agents in cosmeceuticals. Of the other retinoids contained in medicines, tazarotene and adapalene have clinically evaluated antiaging effects compared to tretinoin and may be considered as potential alternatives for antiaging treatments. The promising potential of retinoid nanoformulations requires a more comprehensive evaluation with additional studies to support the preliminary findings.
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Affiliation(s)
| | - Robert Roškar
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva cesta 7, 1000, Ljubljana, Slovenia.
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6
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Otlewska A, Baran W, Batycka-Baran A. Adverse events related to topical drug treatments for acne vulgaris. Expert Opin Drug Saf 2021; 19:513-521. [PMID: 32347138 DOI: 10.1080/14740338.2020.1757646] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Acne vulgaris is a widespread skin disease. Topical therapy is a standard treatment for mild to moderate acne. Given the complex pathophysiology of acne, various agents with complementary action are nowadays frequently combined to increase the efficacy of therapy.Area covered: This review focus on safety profile of topical agents used for the treatment of acne vulgaris, including topical retinoids, benzyl peroxide, azelaic acid, topical antibiotic, and combined agents. Data from clinical trials but also metanalyses, systematic reviews, and other secondary analyses are presented.Expert opinion: In general, topical agents used for acne vulgaris have a favorable safety profile. The most commonly reported AEs were associated with local skin irritation, usually mild to moderate in intensity, intermittent, and rarely led to the cessation of therapy. Irritative potential seems to be highest for BPO and topical retinoids. Due to the possibility of development of Cutibacterium acnes resistance, topical antibiotics should not be used in monotherapy but as a part of combination therapy. In female adolescent and adults of childbearing potential, topical retinoids should be used with caution, because they are contraindicated in pregnant females (FDA Pregnancy category) C (adapalene, tretinoin) and X (tazarotene).
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Affiliation(s)
- Agnieszka Otlewska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Wojciech Baran
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra Batycka-Baran
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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7
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Szymański Ł, Skopek R, Palusińska M, Schenk T, Stengel S, Lewicki S, Kraj L, Kamiński P, Zelent A. Retinoic Acid and Its Derivatives in Skin. Cells 2020; 9:E2660. [PMID: 33322246 PMCID: PMC7764495 DOI: 10.3390/cells9122660] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 12/30/2022] Open
Abstract
The retinoids are a group of compounds including vitamin A and its active metabolite all-trans-retinoic acid (ATRA). Retinoids regulate a variety of physiological functions in multiple organ systems, are essential for normal immune competence, and are involved in the regulation of cell growth and differentiation. Vitamin A derivatives have held promise in cancer treatment and ATRA is used in differentiation therapy of acute promyelocytic leukemia (APL). ATRA and other retinoids have also been successfully applied in a variety of dermatological conditions such as skin cancer, psoriasis, acne, and ichthyosis. Moreover, modulation of retinoic acid receptors and retinoid X (or rexinoid) receptors function may affect dermal cells. The studies using complex genetic models with various combinations of retinoic acid receptors (RARs) and retinoid X (or rexinoid) receptors (RXRs) indicate that retinoic acid and its derivatives have therapeutic potential for a variety of serious dermatological disorders including some malignant conditions. Here, we provide a synopsis of the main advances in understanding the role of ATRA and its receptors in dermatology.
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Affiliation(s)
- Łukasz Szymański
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology, Polish Academy of Science, Postępu 36A, 05-552 Magdalenka, Poland; (Ł.S.); (R.S.); (M.P.)
| | - Rafał Skopek
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology, Polish Academy of Science, Postępu 36A, 05-552 Magdalenka, Poland; (Ł.S.); (R.S.); (M.P.)
| | - Małgorzata Palusińska
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology, Polish Academy of Science, Postępu 36A, 05-552 Magdalenka, Poland; (Ł.S.); (R.S.); (M.P.)
| | - Tino Schenk
- Department of Hematology/Oncology, Clinic of Internal Medicine II, Jena University Hospital, 07747 Jena, Germany;
- Institute of Molecular Cell Biology, Center for Molecular Biomedicine Jena (CMB), Jena University Hospital, 07747 Jena, Germany
| | - Sven Stengel
- Department of Internal Medicine IV, Division of Gastroenterology, Hepatology and Infectious Disease, Jena University Hospital, Friedrich Schiller University of Jena, 07747 Jena, Germany;
| | - Sławomir Lewicki
- Department of Regenerative Medicine and Cell Biology, Military Institute of Hygiene and Epidemiology, 01-163 Warsaw, Poland
- Department of Medicine, Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities, 26-600 Radom, Poland
| | - Leszek Kraj
- Department of Oncology, Medical University of Warsaw, 01-163 Warsaw, Poland;
| | - Paweł Kamiński
- Department of Gynecology and Oncological Gynecology, Military Institute of Medicine, 01-163 Warsaw, Poland;
| | - Arthur Zelent
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology, Polish Academy of Science, Postępu 36A, 05-552 Magdalenka, Poland; (Ł.S.); (R.S.); (M.P.)
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8
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Viswanathan G, Chung LY, Srinivas UK. Heterogeneous Differentiation of Highly Proliferative Embryonal Carcinoma PCC4 Cells Induced by Curcumin: An In Vitro Study. Nutr Cancer 2020; 73:1780-1791. [PMID: 32875900 DOI: 10.1080/01635581.2020.1811883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Curcumin, the yellow pigment derived from turmeric rhizomes, exhibits antioxidant, anti-inflammatory, antimicrobial, and anticancer properties. We have previously reported in a study that curcumin could induce differentiation in embryonal carcinoma cell (EC). EC cells are the primary constituents of teratocarcinoma tumors, and hence differentiating them to a non-proliferative cell type may be useful in anticancer therapies. Here, we conducted a detailed study using various molecular approaches to characterize this differentiation at the cellular and molecular levels. The cells were treated with 20 µM curcumin, which was the optimal concentration to produce the highest amount of differentiated cells. Changes in protein and RNA expression, membrane dynamics, and migration of these cells after treatment with curcumin were then studied in a time-dependent manner. The differentiated cells were morphologically distinct from the precursor cells, and gene expression profiles were altered in curcumin-treated cells. Curcumin promoted cell motility and cell adhesion. Curcumin also induced changes in membrane fluidity and the lateral mobility of lipids in the plasma membrane. The findings of this study suggest that curcumin might have therapeutic potential in differentiation therapy for the treatment of teratocarcinomas or germ cell tumors (GCTs) such as testicular and ovarian GCTs.
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Affiliation(s)
- Geetha Viswanathan
- Centre for Cellular and Molecular Biology (CCMB), Hyderabad, India.,Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia
| | - Lip Yong Chung
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia
| | - Usha K Srinivas
- Centre for Cellular and Molecular Biology (CCMB), Hyderabad, India
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Williams AL, Pace ND, DeSesso JM. Teratogen update: Topical use and third‐generation retinoids. Birth Defects Res 2020; 112:1105-1114. [DOI: 10.1002/bdr2.1745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 01/21/2023]
Affiliation(s)
| | - Nelson D. Pace
- Exponent, Inc. Oakland California USA
- Genentech, Inc. South San Francisco CA USA
| | - John M. DeSesso
- Exponent, Inc. Alexandria Virginia USA
- Georgetown University School of Medicine Washington District of Columbia USA
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10
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MacDonald SC, Cohen JM, Panchaud A, McElrath TF, Huybrechts KF, Hernández-Díaz S. Identifying pregnancies in insurance claims data: Methods and application to retinoid teratogenic surveillance. Pharmacoepidemiol Drug Saf 2019; 28:1211-1221. [PMID: 31328328 PMCID: PMC6830505 DOI: 10.1002/pds.4794] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of the study is to develop an algorithm to identify pregnancies in administrative databases and apply it to assess pregnancy rates and outcomes in women prescribed isotretinoin or tretinoin. METHODS Using the 2011 to 2015 Truven Health MarketScan Database, we identified pregnancies, including losses and terminations. In a cohort design, nonpregnant women filling a prescription for isotretinoin or tretinoin were matched to five women without either prescription. Women were followed for 365 days or until conception, medication discontinuation, or enrollment discontinuation ("prescription episode"). Rates of pregnancy, risks of pregnancy losses, and prevalence of infant malformations at birth were assessed by exposure. RESULTS We identified 2 179 192 livebirths, 8434 stillbirths, 2521 mixed births, 415 110 spontaneous abortions, 124 556 elective terminations, and 8974 unspecified abortions. There were 86 834 isotretinoin and 973 587 tretinoin episodes, matched to 5 302 105 unexposed women. Pregnancy rates were 3 (isotretinoin), 19 (tretinoin), and 34 (unexposed) per 1000 person-years. Risk of spontaneous pregnancy losses were similar; however, terminations were more common in the isotretinoin-exposed (28% [95% CI: 21%-36%]) than the tretinoin-exposed (10% [95% CI: 9%-11%]) or unexposed pregnancies (6%). Malformations occurred in 4.5% (95% CI: 3.5%-5.6%) of the tretinoin-exposed pregnancies and 4.2% of the unexposed pregnancies (adjusted odds ratio: 1.16 [95% CI: 0.85-1.58]); isotretinoin-exposed births were too few to assess malformations. CONCLUSIONS Administrative databases can complement risk evaluation and mitigation strategies (REMS) for known teratogens and contribute to safety surveillance for other medications. Here, isotretinoin-exposed pregnancy rates were low, but existent, and many pregnancies were terminated. Tretinoin exposure was not associated with a meaningfully elevated risk of losses or malformations as compared with unexposed pregnancies.
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Affiliation(s)
- Sarah C MacDonald
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jacqueline M Cohen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alice Panchaud
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Thomas F McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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11
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12
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Brown SM, Aljefri K, Waas R, Hampton P. Systemic medications used in treatment of common dermatological conditions: safety profile with respect to pregnancy, breast feeding and content in seminal fluid. J DERMATOL TREAT 2018; 30:2-18. [PMID: 28092212 DOI: 10.1080/09546634.2016.1202402] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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.
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Affiliation(s)
| | - Khadija Aljefri
- a Dermatology Department , Royal Victoria Infirmary , Newcastle Upon Tyne , UK
| | - Rachel Waas
- a Dermatology Department , Royal Victoria Infirmary , Newcastle Upon Tyne , UK
| | - Philip Hampton
- a Dermatology Department , Royal Victoria Infirmary , Newcastle Upon Tyne , UK
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13
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Ethical approval for multicenter cohort studies on drug exposure during pregnancy: A survey among members of the European Network of Teratology Information Services (ENTIS). Reprod Toxicol 2018; 80:68-72. [PMID: 29913205 DOI: 10.1016/j.reprotox.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/14/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
The European Network of Teratology Information Services (ENTIS) is in a privileged position to perform independent post-marketing surveillance of drugs in pregnancy. The aim of this survey was to describe the legal requirements and procedures involved in obtaining ethical approval for collaborative cohort studies. We sent a survey questionnaire to all 28 Teratology Information Services (TIS), of which 25 (89%) in 18 countries completed our questionnaire. For 15 TIS, specific research ethical approval was mandatory. The review process was estimated to last from 2 up to 16 weeks. Procedures for patients' information and consent were oral (12), written (5) or both (3). Five TIS had no requirement to inform patients and seek consent. Since data on drug exposure during pregnancy are scarce, ENTIS research efforts should be further encouraged, and procedures optimized so that legitimate ethical and legal requirements do not translate into deterrent administrative constraints and costs.
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Panchaud A, Rousson V, Vial T, Bernard N, Baud D, Amar E, De Santis M, Pistelli A, Dautriche A, Beau-Salinas F, Cassina M, Dunstan H, Passier A, Kaplan YC, Duman MK, Maňáková E, Eleftheriou G, Klinger G, Winterfeld U, Rothuizen LE, Buclin T, Csajka C, Hernandez-Diaz S. Pregnancy outcomes in women on metformin for diabetes or other indications among those seeking teratology information services. Br J Clin Pharmacol 2018; 84:568-578. [PMID: 29215149 DOI: 10.1111/bcp.13481] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/23/2017] [Accepted: 11/13/2017] [Indexed: 12/11/2022] Open
Abstract
AIMS Metformin is used to treat type 2 diabetes, polycystic ovary syndrome associated infertility, and gestational diabetes. This study aims to evaluate the safety of metformin in early pregnancy. METHOD We evaluated the risk of major birth defects and pregnancy losses in a cohort of pregnant women exposed to metformin during the first trimester for different indications relative to a matched unexposed reference group. RESULTS The risk of major birth defects was 5.1% (20/392) in pregnancies exposed to metformin during the first trimester and 2.1% (9/431) in the reference group [adjusted odds ratio (OR) 1.70; 95% CI 0.70-4.38]. Among metformin users, this risk was 7.8% (17/219) in patients with pre-gestational diabetes and 1.7% (3/173) in those without this diagnosis. Compared to the unexposed reference, the OR for metformin user with diabetes was 3.95 (95% CI 1.77-9.41) and for metformin with other indications it was 0.83 (95% CI 0.18-2.81). The risk of pregnancy losses (spontaneous abortions and stillbirths) was 20.8% in women on metformin during the first trimester and 10.8% in the reference group [adjusted hazard ratio (HR) 1.57; 95% CI 0.90-2.74]. The risks for women on metformin with and without pre-gestational diabetes were 24.0% and 16.8% respectively, with adjusted HR of 2.51 (95% CI 1.44-4.36) and 1.38 (95% CI 0.74-2.59) when compared to the reference. CONCLUSION Pregnant women with pre-gestational diabetes on metformin are at a higher risk for adverse pregnancy outcomes than the general population. This appears to be due to the underlying diabetes since women on metformin for other indications do not present meaningfully increased risks.
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Affiliation(s)
- Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and Lausanne, Geneva, Switzerland.,Swiss Teratogen Information Service (STIS) and Service of Clinical Pharmacology, University Hospital, Lausanne, Switzerland.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Valentin Rousson
- Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thierry Vial
- Pharmacovigilance Center of Lyon, Hospices Civils de Lyon, France
| | - Nathalie Bernard
- Pharmacovigilance Center of Lyon, Hospices Civils de Lyon, France
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Departement "Femme-Mere-Enfant", University Hospital, Lausanne, Switzerland
| | - Emmanuelle Amar
- Registre des Malformations en Rhone Alpes (REMERA), Faculté Laennec, Lyon, France
| | - Marco De Santis
- Telefono Rosso-Teratology Information Service, Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandra Pistelli
- Centro di Riferimento Regionale di Tossicologia Perinatale, SODc Tossicologia Medica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Matteo Cassina
- Teratology Information Service, Clinical Genetics Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Hannah Dunstan
- UKTIS, Regional Drug and Therapeutics Centre, Newcastle upon Tyne, UK
| | - Anneke Passier
- Teratology Information Service (TIS), Netherlands Pharmacovigilance Centre Lareb, The Netherlands
| | - Yusuf Cem Kaplan
- Faculty of Medicine Department of Pharmacology Teratology Information Service, Izmir Katip Celebi University, Izmir, Turkey
| | - Mine Kadioglu Duman
- Faculty of Medicine, Department of Pharmacology, Karadeniz Technical University, Trabzon, Turkey
| | - Eva Maňáková
- CZTIS, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Gil Klinger
- BELTIS, Rabin Medical Center and NICU, Schneider Children's Medical Center of Israel, Petach Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ursula Winterfeld
- Swiss Teratogen Information Service (STIS) and Service of Clinical Pharmacology, University Hospital, Lausanne, Switzerland
| | - Laura E Rothuizen
- Swiss Teratogen Information Service (STIS) and Service of Clinical Pharmacology, University Hospital, Lausanne, Switzerland
| | - Thierry Buclin
- Swiss Teratogen Information Service (STIS) and Service of Clinical Pharmacology, University Hospital, Lausanne, Switzerland
| | - Chantal Csajka
- School of Pharmaceutical Sciences, University of Geneva and Lausanne, Geneva, Switzerland
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
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15
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Tan AU, Schlosser BJ, Paller AS. A review of diagnosis and treatment of acne in adult female patients. Int J Womens Dermatol 2017; 4:56-71. [PMID: 29872679 PMCID: PMC5986265 DOI: 10.1016/j.ijwd.2017.10.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 01/19/2023] Open
Abstract
This review focuses on the treatment options for adult female patients with acne. Acne in adult female patients may start during adolescence and persist or have an onset in adulthood. Acne has various psychosocial effects that impact patients’ quality of life. Treatment of acne in adult women specifically has its challenges due to the considerations of patient preferences, pregnancy, and lactation. Treatments vary widely and treatment should be tailored specifically for each individual woman. We review conventional therapies with high levels of evidence, additional treatments with support from cohort studies and case reports, complementary and/or alternative therapies, and new agents under development for the treatment of patients with acne.
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Affiliation(s)
- A U Tan
- Northwestern University, Department of Dermatology, Chicago, IL
| | - B J Schlosser
- Northwestern University, Department of Dermatology, Chicago, IL
| | - A S Paller
- Northwestern University, Department of Dermatology, Chicago, IL
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16
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Management of severe acne during pregnancy: A case report and review of the literature. Int J Womens Dermatol 2017; 3:145-150. [PMID: 28831424 PMCID: PMC5555287 DOI: 10.1016/j.ijwd.2017.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/26/2017] [Accepted: 06/02/2017] [Indexed: 12/02/2022] Open
Abstract
The treatment of acne during pregnancy is often limited by the potential toxicities that are posed to the fetus by the most common and effective acne therapies. As with all dermatoses during pregnancy, the treatment of acne vulgaris in this population requires a thorough understanding of the risks and benefits that are inherent to each treatment. We report on a case of a 30-year-old pregnant patient with severe acne conglobata who showed significant improvement with a combination treatment of topical modalities, oral metronidazole, and low dose prednisone during pregnancy. We also review the literature and present an approach for the care of these patients.
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18
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Carefully manage adverse effects of acne treatments to prevent significant harm. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Kaplan Y, Ozsarfati J, Etwel F, Nickel C, Nulman I, Koren G. Pregnancy outcomes following first-trimester exposure to topical retinoids: a systematic review and meta-analysis. Br J Dermatol 2015. [DOI: 10.1111/bjd.14053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Y.C. Kaplan
- TERAFAR - Izmir Katip Celebi University Teratology Information; Training and Research Center; Izmir Turkey
| | - J. Ozsarfati
- The Motherisk Program; Division of Clinical Pharmacology and Toxicology; Department of Pediatrics; The Hospital for Sick Children and University of Toronto; 555 University Avenue Toronto ON M5G 1X8 Canada
| | - F. Etwel
- Department of Physiology and Pharmacology; Schulich School of Medicine; University of Western Ontario; London ON Canada
| | - C. Nickel
- Hospital Library & Archives; The Hospital for Sick Children and University of Toronto; 555 University Avenue Toronto ON M5G 1X8 Canada
| | - I. Nulman
- The Motherisk Program; Division of Clinical Pharmacology and Toxicology; Department of Pediatrics; The Hospital for Sick Children and University of Toronto; 555 University Avenue Toronto ON M5G 1X8 Canada
| | - G. Koren
- The Motherisk Program; Division of Clinical Pharmacology and Toxicology; Department of Pediatrics; The Hospital for Sick Children and University of Toronto; 555 University Avenue Toronto ON M5G 1X8 Canada
- Leslie Dan Faculty of Pharmacy; University of Toronto; 144 College Street Toronto ON M5S 3M2 Canada
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20
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Oudenhoven MD, Kinney MA, McShane DB, Burkhart CN, Morrell DS. Adverse effects of acne medications: recognition and management. Am J Clin Dermatol 2015; 16:231-242. [PMID: 25896771 DOI: 10.1007/s40257-015-0127-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acne vulgaris is a very common chronic inflammatory disease of the skin. The clinical features of acne range from non-inflammatory comedones to inflammatory nodules. While often perceived as an adolescent disease, the prevalence remains high into adulthood, and the manifestations can have detrimental psychosocial effects. It is therefore not surprising that many patients are motivated to seek treatment. The existing treatment strategies for acne are complex due to the multifactorial pathogenesis of the disease. Although it is difficult to cure, four categories of medications have proved efficacious in reducing acne lesions: topical agents, systemic antibiotics, systemic retinoids, and hormonal agents. Unfortunately, these medications can cause adverse effects that may limit their use. Typically, these adverse effects are mild and transient and can be remedied by altering the dose or frequency of the offending agent. However, more serious adverse effects can occur that pose a significant health risk to the patient. Understanding how to recognize and manage the adverse effects of common acne therapies is imperative to providing the safest and most appropriate treatment for each patient. This article focuses on the recognition and management of adverse effects associated with current acne medications.
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Affiliation(s)
- Mollie D Oudenhoven
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Megan A Kinney
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Diana B McShane
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Craig N Burkhart
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Dean S Morrell
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA.
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Wacker E, Navarro A, Meister R, Padberg S, Weber-Schoendorfer C, Schaefer C. Does the average drug exposure in pregnant women affect pregnancy outcome? A comparison of two approaches to estimate the baseline risks of adverse pregnancy outcome. Pharmacoepidemiol Drug Saf 2015; 24:353-60. [PMID: 25644395 DOI: 10.1002/pds.3744] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/24/2014] [Accepted: 12/08/2014] [Indexed: 11/09/2022]
Abstract
PURPOSE The results of observational cohort studies on drug effects on pregnancy outcome may depend among others on suitable comparison cohorts. The aim of this investigation was to compare two distinct definitions of maternal exposure status for comparison cohorts. METHODS We performed an observational cohort study of prospectively ascertained pregnant women who spontaneously contacted the Teratology Information Service (TIS) Berlin for drug risk consultation. The only exclusion criteria were exposures to established teratogens and/or fetotoxicants. Pregnancy outcomes of 3250 women with this "average drug exposure" were compared with 546 non-exposed or insignificantly exposed pregnancies. RESULTS Neither the rate of major birth defects (3.0%; aOR 1.62; 95% CI 0.8-3.3) nor the risk of spontaneous abortion (16.0%; aHR 1.20; 95% CI 0.8-1.7) was significantly increased after average drug exposure, whereas the rate of electively terminated pregnancies was higher (11.1%; aHR 2.05; 95% CI 1.2-3.4). There were no differences in the risk of preterm birth (9.9%; aOR 1.38; 95% CI 0.9-2.0) and infants' birth weight (p = 0.60). CONCLUSIONS This study does not provide evidence for an increased risk of adverse pregnancy outcome after average drug exposure during pregnancy. Therefore, comparison cohorts with average drug exposure are appropriate for studies on potential teratogens or fetotoxicants based on observational data collected by TIS.
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Affiliation(s)
- Evelin Wacker
- Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie (Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy), Charité Universitätsmedizin Berlin, Berlin, Germany
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22
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How to Treat Acne in Pregnant Women. CURRENT DERMATOLOGY REPORTS 2014. [DOI: 10.1007/s13671-014-0084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Safety of dermatologic medications in pregnancy and lactation. J Am Acad Dermatol 2014; 70:401.e1-14; quiz 415. [DOI: 10.1016/j.jaad.2013.09.010] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 12/12/2022]
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24
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25
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Consider acne severity and potential risks when treating acne vulgaris in pregnant and breastfeeding women. DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-013-0092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Abstract
Acne vulgaris is a common condition in adolescence and also for many women of childbearing age. The management of acne in pregnancy is complicated by the lack of clinical studies and pharmacokinetic data in this patient population and safety concerns regarding retinoid use in pregnancy. Of primary concern to both patients and clinicians is the safety profile of medications used during pregnancy. This review seeks to clarify what management options are available to treat acne during pregnancy and what data are available to guide decision making. Topical treatments are considered the safest option during pregnancy. They have the best safety profile and minimize the levels of systemic absorption, and therefore the least risk of fetal exposure. If these are applied properly with a strong emphasis on adherence, excellent results can be achieved.
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27
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Pugashetti R, Shinkai K. Treatment of acne vulgaris in pregnant patients. Dermatol Ther 2013; 26:302-11. [DOI: 10.1111/dth.12077] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Rupa Pugashetti
- Department of Dermatology; University of California, San Francisco; San Francisco; California
| | - Kanade Shinkai
- Department of Dermatology; University of California, San Francisco; San Francisco; California
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29
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Petruzzi M, Lucchese A, Lajolo C, Campus G, Lauritano D, Serpico R. Topical Retinoids in Oral Lichen Planus Treatment: An Overview. Dermatology 2013; 226:61-7. [DOI: 10.1159/000346750] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 12/24/2012] [Indexed: 11/19/2022] Open
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