Antibiotics during pregnancy and risk of childhood seborrheic dermatitis

Antibiotics during pregnancy and risk of childhood seborrheic dermatitis
Antibiotics during pregnancy and risk of childhood seborrheic dermatitis

Maternal exposure in utero to antibiotics was associated with an increased risk of childhood seborrheic dermatitis, regardless of maternal history of seborrheic dermatitis, but this association was not as strong for childhood-onset seborrheic dermatitis.

The findings come from a large analysis of UK data that was presented during a breaking abstract session at the Annual Congress of the Society for Investigative Dermatology (SID) of 2024.

Seborrheic dermatitis is a common skin disease “that shares similarities with atopic dermatitis or atopic eczema, as both are prevalent inflammatory skin diseases that can present with a chronic, relapsing, and remitting course,” he said in an interview. corresponding author of the study, Dr. Zelma C. Chiesa Fuxench, master of science in clinical epidemiology, assistant professor of dermatology at the University of Pennsylvania in Philadelphia, United States. “Like atopic dermatitis, the pathophysiology of seborrheic dermatitis is believed to be complex and involves an interaction between genetics, immune dysregulation, and alterations in lipid composition and the skin microbiome, among others.”

In a previous study, she and her colleagues showed that exposure to antibiotics both in utero and during the first 90 days of life increases the risk of atopic dermatitis in boys and girls, with the risk being higher with penicillin exposure even among infants whose mothers had no history of atopic dermatitis.[1]

For the current study, the research team turned to a large electronic medical record database in the United Kingdom to conduct a prospective cohort analysis of mother-child pairs that used proportional hazards models to examine the association between exposure maternal antibiotics in the uterus and seborrheic dermatitis in the child. The population included 1,023,140 children with linked maternal data who were followed for an average of 10.2 years, equivalent to more than 10 million person-years of data. At the beginning of the study, the average age of the mothers was 28 years, 3% had seborrheic dermatitis, 14% had atopic dermatitis, and 51% were men.

In unadjusted analyses, mothers with seborrheic dermatitis were more likely to receive an antibiotic during pregnancy than those without seborrheic dermatitis (odds ratio [OR]: 1.42; confidence interval [IC] 95%: 1.39 to 1.46). Additionally, maternal in utero exposure to any antibiotic was associated with an increased risk of childhood seborrheic dermatitis (odds ratio: 1.70; 95% CI: 1.65 to 1.76) but less childhood-onset seborrheic dermatitis (odds ratio: 1.26; 95% CI: 1.20 to 1.32). “This effect changed little after adjustment and was maintained when mothers with seborrheic dermatitis and their children were excluded,” the author team wrote.

Any exposure to penicillin during pregnancy increased the likelihood that a child would have seborrheic dermatitis (odds ratio: 1.54; 95% CI: 1.50 to 1.59), with a higher risk of childhood seborrheic dermatitis (odds ratio: 1.70; 95% CI: 1.65 to 1.76) than onset in childhood (odds ratio: 1.25; 95% CI: 1.18 to 1.32). “The trimester of intrauterine penicillin exposure did not appear to affect the association with seborrheic dermatitis,” they wrote. The risk also increased with exposure to cephalosporins, but was lower with sulfonamides and not with childhood-onset seborrheic dermatitis.

“We found that antibiotic exposure in utero was primarily associated with an increased risk of childhood seborrheic dermatitis, regardless of maternal history of seborrheic dermatitis, but this association was not as strong for childhood-onset seborrheic dermatitis.” said Dr. Chiesa Fuxench. “This would suggest that in utero exposure to antibiotics, particularly penicillin, may have its greatest effect on the colonization of the skin microbiota in the neonatal period, leading to the development of infantile seborrheic dermatitis. In addition to looking for “To improve our understanding of the pathophysiology of seborrheic dermatitis, our findings also suggest that infantile seborrheic dermatitis and childhood-onset seborrheic dermatitis may be separate entities with different risk factors, a hypothesis that should be further studied.”

Dr. Chiesa Fuxench acknowledged certain limitations of the analysis, including the possibility of unrecorded seborrheic dermatitis diagnoses or misclassified cases in the database. For example, atopic dermatitis and psoriasis “can appear clinically as seborrheic dermatitis,” she said, although they performed sensitivity analyzes excluding patients with these diagnoses and found similar results. Additionally, there is a possibility that not all antibiotic exposures have been captured in the database and that antibiotic exposure data are missing, she added.

Dr. Chiesa Fuxench disclosed that she received research grants from Lilly, LEO Pharma, Regeneron, Sanofi, Tioga, Vanda and Incyte for work related to atopic dermatitis and from Menlo Therapeutics and Galderma for work related to prurigo nodularis. She has also served as a consultant for the Asthma and Allergy Foundation of America, the National Eczema Association, AbbVie, Incyte Corporation, and Pfizer and received honoraria for her continuing medical education work in atopic dermatitis sponsored by educational grants from Regeneron/Sanofi and Pfizer and from Beiersdorf for his work related to skin cancer and sun protection.

 
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