Hydroxychloroquine (Plaquenil) in Pregnancy
Is Plaquenil Safe for Pregnancy?
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts about hydroxychloroquine (Plaquenil) use in pregnancy.
Question
I am a 32 year old female and have lichen planopilaris. I use Plaquenil, along with topical steroids and topical tacrolimus. I am hoping to become pregnant again soon. I am finally doing quite well on hydroxychloroquine (after resistance on my part to use it!). I wan to know if I really need to stop it or not during pregnancy.
Answer
Thank you for the question. This is an important question.
I would encourage you to review a previous article I wrote on this topic. It covers so many important points.
I would also recommend that you review a prior article on the treatment of lichen planopilaris in pregnancy as it too is likely to be helpful for you.
In short, we don’t have any research studies of women with lichen planopilaris who used hydroxychloroquine (Plaquenil) during pregnancy. All the information that we do have comes from studies of women with the autoimmune disease known as systemic lupus. For women with lupus, it appears that hydoxychloroquine use at quite low doses does not seem to increase the risk of babies being born with deformities or congenital anomalies of any kind. It’s controversial whether using hydroxychloquine at 400 mg per day might be associated with risk. A 2021 study of 2045 women who took hydroxychloroquine during their pregnancy found a slight increase risk in congenital anomalies among women who used the highest doses. Fortunately, women using doses under 400 mg daily did not have an increased risk.
All in all, hydroxychloroquine at low doses can be used by some women but it’s not 100% clear if it is truly without risk to the baby or not. Please have a read of these two links and be sure to have thorough discussions with your dermatologist, and obstetrician about these issues.
Generally speaking LPP remains somewhat stable in pregnancy for many women. The periodic use of betamethasone lotion and zinc pyrithione shampoos can help keep inflammation to low levels and have good safety. Low level laser, clobetasol, tacrolimus and cetirizine can be used if needed.
Thank you again for your question