Background and objectives: Systemic treatment of pregnant/breastfeeding atopic dermatitis (AD) patients is challenging due to limited safety data. We explored treatment practices with systemic agents, including the guideline-recommended cyclosporine as the first systemic choice as well as emerging therapies, in this vulnerable population.

Patients and methods: The Global Allergy and Asthma Excellence Network (GA²LEN) ADCARE initiative collected data from physicians worldwide who treat pregnant women with AD. Physicians completed an electronic questionnaire on the use of systemic agents in pregnant/breastfeeding AD patients.

Results: 103 physicians from 32 countries completed the survey, primarily dermatologists (n = 48) or allergologists (n = 43). Antihistamines were the systemic drug most often considered to be used during pregnancy/breastfeeding (n = 73/81, 90.1%), with fewer physicians considering the use of systemic agents for the first trimester compared to later stages of pregnancy. For acute flares, systemic corticosteroids (n = 34/80, 42.5%) were preferred, followed by biologics and antihistamines (each n = 15/80, 18.8%). Although the guideline-recommended cyclosporine is sometimes considered for AD during pregnancy (n = 38/81, 46.9%), it was rarely considered as the preferred drug by physicians (n = 1/80, 1.25%).

Conclusions: Our study shows a misalignment between guideline recommendations and prescription patterns and highlights an unmet need for knowing and using the existing recommendations.

Keywords: Atopic dermatitis; breastfeeding; pregnancy; survey; systemic treatment.

© 2025 The Author(s). Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.

背景和目的： 系统治疗怀孕或哺乳期的特应性皮炎（AD）患者具有挑战性，因为有关安全性的数据有限。我们探讨了在这一脆弱人群中使用系统药物的治疗方法，包括指南推荐的第一选择环孢素以及其他新兴疗法。

患者和方法： 全球过敏与哮喘卓越网络（GA²LEN）ADCARE倡议从世界各地治疗怀孕女性AD的医生那里收集了数据。医生们完成了一份关于在怀孕或哺乳期间使用系统药物情况的电子问卷。

结果： 来自32个国家的103名医生完成了调查，主要是皮肤科医生（n = 48）和过敏病专家（n = 43）。抗组胺药是最常被认为适合在怀孕或哺乳期间使用的系统药物（n = 73/81, 90.1%），相比之下，在孕早期阶段更少的医生考虑使用系统药物。对于急性发作，系统性皮质类固醇（n = 34/80, 42.5%）是最受欢迎的选择，其次是生物制剂和抗组胺药（每种 n = 15/80, 18.8%）。尽管指南推荐的环孢素有时被考虑用于怀孕期间AD的治疗（n = 38/81, 46.9%），但它很少被视为医生首选药物（n = 1/80, 1.25%）。

结论： 我们的研究显示了指南推荐和处方模式之间的不一致，并突显了了解和使用现有推荐的未满足需求。

关键词： 特应性皮炎；哺乳期；怀孕；调查；系统治疗。