Biologicals are a rapidly evolving group of drugs derived from biological agents which target specific immune mediators. The use of biologicals in dermatology is on the rise, especially for inflammatory and immunological conditions. As pregnancy and lactation are associated with exacerbation of various inflammatory conditions necessitating administration of biologicals in certain cases, their use in these physiologically altered states has to be evaluated. This article aims at reviewing the common biologicals used in dermatology and their feasibility in pregnancy and lactation. Tumor necrosis factor-alpha inhibitors are the most experienced group of biologicals in pregnancy and lactation, the newer biologicals have only animal studies and isolated case reports to back up their use. The commonly used biologicals are tabulated and discussed herewith. The guidelines and recommendations are derived from the data of use in other conditions such as inflammatory bowel disease and rheumatoid arthritis as there is no sufficient literature evidence for the use of biologicals in pregnancy for dermatological conditions. It was extrapolated that biologicals, being large molecular weight immunoglobulins or recombinant proteins, may be used with judicious care in the first two trimesters of pregnancy and after the 1st week of lactation, if benefits to the mother outweigh the theoretical risk to the infant.
Public education program on proper feeding and management practices is required to address the various issues identified and for containment of diarrhoea cases in future.
K E Y W O R D S : baboon syndrome, clozapine, drug patch testing, drug reaction, SDRIFE, systematized contact dermatitis, vasculitis Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE)is a benign drug reaction that is diagnosed clinically. We report a unique case of SDRIFE secondary to clozapine, confirmed by patch testing. CASE REPORTAn 18-year-old man presented with high fever and pruritic red eruptions and pustules for 3 days. The rash appeared progressively on the axillae, legs, groin, and back over 2 days. About 2 weeks before, he had been started on lithium and clozapine due to mania. On examination, confluent erythematous papules, coalescing to form larger plaques, studded with pinhead-sized pustules, were present in the aforementioned sites. In addition, discrete purpuric papules over the dorsum of the feet and shins were noted (Figure 1). Mucosae were not involved. An infectious exanthematous rash or lithium-induced acute generalized exanthematous pustulosis (AGEP)/SDRIFE was considered as differential diagnosis.Workup for acute febrile illness was unyielding. Gram stain from the pustules showed scant neutrophils with no evidence of bacteria.Biopsy for histopathology from the pustular lesion showed spongiotic epidermis, and occasional necrotic keratinocytes overlying a dermis showing perivascular lymphohistiocytic infiltrates with extravasated red blood cells, which is consistent with SDRIFE ( Figure S1A,B); and 318 SUVARNA ET AL.
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