Management of psoriasis in pregnancy

Weatherhead, Sophie; Robson, Stephen C.; Reynolds, Nick J.

doi:10.1136/bmj.39202.518484.80

Cited by 64 publications

(54 citation statements)

References 10 publications

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“…Chronic plaque psoriasis is thought to improve in 40–60% of patients during pregnancy, but deteriorates in 10–20%, and may require intensified treatment; more than half of the patients have a flare-up within 6 weeks of delivery [1]. On the other hand, psoriasis has been found to carry an increased risk of recurrent abortions (OR = 2.1), chronic hypertension (OR = 2.9) and cesarean delivery (OR = 4.1) [2].…”

Section: Discussionmentioning

confidence: 99%

“…For generalized disease, medications that may be considered first-line would be UVB, ciclosporin [1,3] and possibly topical PUVA [3]. All retinoids (both oral and topical, despite the limited bioavailability of the latter) are contraindicated in pregnancy due to teratogenicity, especially in the first trimester, with a characteristic pattern of malformations involving craniofacial, cardiac, thymic and central nervous system structures [3].…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Psoriasis with Anti-TNF Drugs during Pregnancy: Case Report and Review of the Literature

2009

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Published experiences of TNF-α inhibition during pregnancy consist of a limited number of case reports, series and ongoing registry data in patients with arthritis and inflammatory bowel disease. A 28-year-old woman – with psoriasis vulgaris since she was 8 years of age and generalized pustular psoriasis during her first pregnancy (partially controlled with ciclosporin, oral prednisone and topical corticosteroids, when lupus anticoagulant was detected at another hospital) – presented 4 months after delivery with severe psoriasis (PASI = 15.4) that did not respond to ciclosporin (3 mg/kg/day). Ten days after the first infusion of infliximab (5 mg/kg), when the patient became aware that she was pregnant again, there was PASI75 response, and the patient wished to continue this treatment after being fully informed. Complete blanching was achieved by week 6 of treatment, and was maintained thereafter until the moment of writing (19 months after the start of treatment). She gave birth by caesarean delivery to a healthy female baby, who was breastfed for 1 month and has developed normally. The current report extends the available evidence on successful infliximab treatment in pregnant women, with the first case of a patient with psoriasis who presented impetigo herpetiformis during her previous pregnancy. No detectable adverse effects were detected in the neonate, despite potential exposure to infliximab throughout gestation and breastfeeding. Even though absolute safety is difficult to prove, available data suggest that women who become pregnant while taking infliximab or other anti-TNFα agents can be reassured regarding the continuation of pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of Psoriasis with Anti-TNF Drugs during Pregnancy: Case Report and Review of the Literature

2009

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“…20% eine Verschlechterung der bestehenden Psoriasis [16,24]. Bisher ist noch nicht endgültig geklärt, ob eine Psoriasisexazerbation während der Schwangerschaft mit einem erhöhten Risiko für das Ungeborene einhergeht, wobei Einflüsse auf die Fertilität der Mutter sowie Missbildungen oder Frühgeburten offensichtlich selten sind [23,26]. Eine Psoriasisarthritis scheint sich eher zu verbessern [19], obgleich hierzu die vorliegenden Daten divergent sind [13] und größere Studienkollektive fehlen.…”

Section: > Schwangerschaft Und Geburt Sind In Der Regel Unkompliziertunclassified

“…Zur medikamentösen Behandlung einer lokalisierten Psoriasis während der Schwangerschaft eignen sich topische Glukokortikoide, Dithranol oder topisch kleinflächig applizierte Vitamin-D 3 -Derivate sowie eine Schmalspektrum-UVBTherapie [26]. In schweren Fällen können auch hochpotente topische Glukokortikoide oder systemisches Ciclosporin eingesetzt werden.…”

Section: Autoimmunity · Pregnancy · Autoimmune Dermatoses · Dermatoseunclassified

“…In schweren Fällen können auch hochpotente topische Glukokortikoide oder systemisches Ciclosporin eingesetzt werden. Kontraindiziert sind topische oder orale Retinoide, Methotrexat oder die Therapie mit oralem Psoralen [26]. Zu Fumarsäureestern existieren aktuell über den Labeltext einer Vermeidung in der Schwangerschaft hinaus keine klaren Empfehlungen.…”

Section: Autoimmunity · Pregnancy · Autoimmune Dermatoses · Dermatoseunclassified

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Chronisch entzündliche und autoimmun vermittelte Dermatosen in der Schwangerschaft

Renner

Sticherling

2010

Hautarzt

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Chronic inflammatory dermatoses during pregnancy can take varying courses in mother and child. The dominant Th2-response characteristic for pregnancy may explain why atopic eczema or lupus erythematosus may deteriorate while psoriasis vulgaris may improve. In contrast, impetigo herpetiformis frequently shows a severe course. Lupus erythematosus and other autoantibody-triggered dermatoses like pemphigus vulgaris pose an increased risk for the child because of placental transfer of autoantibodies with specific skin changes or systemic manifestations of the disease as well as placental insufficiency, growth retardation and premature birth. Such risks are not associated with linear IgA dermatosis. A severe pityriasis rosea during the first 20 weeks of pregnancy may lead to an increased risk of abortion or premature delivery. Early diagnosis and individually adjusted therapy of skin diseases is mandatory to avoid any risk for mother or child.

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Apiaceae Lindl.

and¹,

Tyrl²

2012

Toxic Plants of North America

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Management of psoriasis in pregnancy

Abstract: Many treatments for this chronic skin disease are harmful to the developing fetus, so careful pre-conception planning and management adjustment are crucial for the pregnant patient

Cited by 64 publications

References 10 publications

Treatment of Psoriasis with Anti-TNF Drugs during Pregnancy: Case Report and Review of the Literature

Treatment of Psoriasis with Anti-TNF Drugs during Pregnancy: Case Report and Review of the Literature

Chronisch entzündliche und autoimmun vermittelte Dermatosen in der Schwangerschaft

Apiaceae Lindl.

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