The impact of hormones in autoimmune cutaneous diseases

Figures & data

Figure 1. Diagram of study screening and selection.

Table 1. Summary of hormonal contraception in patients with lupus and dermatomyositis.

Hormonal Contraception
Disease:		Concerns
Lupus	If mild or stable forms of the disease: combined oral contraceptive pills (OCPs) are not linked to increased lupus flares. If thrombocytopenia/patient on anticoagulation: levonorgestrel intrauterine devices (IUD) and copper IUD reduced menstrual bleeding.	Interaction between OCPs and cyclosporine, warfarin, and mycophenolate mofetil (MMF) can reduce the efficacy of OCPs. Long use of implantable and intramuscular progestins can increase chance of osteoporosis in patients on glucocorticoids. OCPs, vaginal rings, and estrogen patches are contraindicated in patients who had prior thrombosis or positive aPL Ab.
Dermatomyositis	Effective contraceptive methods, such as IUDs, or subdermal progestin implants are recommended in patients taking teratogenic medications like methotrexate (MTX) and MMF.	Interaction between OCPs and MMF can reduce the efficacy of OCPs.

Table 2. Summary of lupus and dermatomyositis treatment during pregnancy.

Treatment in Pregnancy
Disease:	Allowed medications:	Forbidden medications:
Lupus	Sun protection and topical steroids Hydroxychloroquine (HCQ): Consider for all patients with SLE. Safe in pregnancy. Glucocorticoids (GC): Avoid fluorinated GC (they cross the placenta) and use the lowest effective dose. Azathioprine: Consider adding it if patient is not stable on HCQ + glucocorticoids	Mofetil Mycophenolate, Methotrexate or leflunomide: due to teratogenic effects Biologics: decision to initiate, continue, or discontinue should be individualized
Dermatomyositis	Sun protection and topical steroids Hydroxychloroquine (HCQ) Glucocorticoids (GC): Consider adding it if patient is not stable on HCQ. Avoid fluorinated GC (they cross the placenta) and use the lowest effective dose. Azathioprine: Consider adding it if patient is not stable on HCQ + glucocorticoids Intravenous immunoglobulin (IVIG): In severe instances, it can be used as limited research suggests its relative safety during pregnancy