Psoriasis in pregnancy: challenges and solutions

Abstract

The available information about the effects of pregnancy on psoriasis and those of psoriasis on pregnancy is almost limited, despite the high frequency of the disease in the general population, as well as in women in reproductive years. Considering the existing evidence, pregnancy does not tend to have a negative influence on psoriasis, as in most women who experience a change in the severity and course of their psoriasis during pregnancy, the change is more likely to be reported as an improvement. This assumption can be applied more convincingly to plaque-type psoriasis, while an exception may be represented by generalized pustular psoriasis, which has been somehow linked to impetigo herpetiformis. Conflicting findings emerged from the few available studies that explored the effect of psoriasis on pregnancy outcomes. Recent studies found an association between moderate-to-severe psoriasis and some pregnancy complications, including pregnancy-induced hypertensive diseases, and have emphasized a trend toward a newborn with low birth weight in patients with psoriasis, especially in those suffering from severe forms. The safety profile during pregnancy is not completely known for many drugs used to treat psoriasis. Moisturizers and low- to moderate-potency topical steroids or ultraviolet B phototherapy represent the first-line therapy for pregnant patients. Many dermatologists may, however, recommend discontinuing all drugs during pregnancy, in consideration of medico-legal issues, and also taking into account that common forms of psoriasis do not compromise the maternal and fetal health. Anyway, for those women whose psoriasis improves during pregnancy, the interruption of any therapy for psoriasis can be a reasonable strategy. The objective of this paper was to review the most relevant literature data on psoriasis in pregnancy, trying to give concurrently practical information about clinical and prognostic aspects, as well as counseling and management.

Crossed looks on the dermatologist's position and the patient's preoccupations as to psoriasis and pregnancy: preliminary results of the PREGNAN‐PSO study

“…Considering this issue, it is paramount to recall that the safety profile of many drugs used to treat psoriasis is not fully understood during pregnancy. 4 All retinoids, whether topical or oral, are contraindicated in pregnancy, especially in the first trimester, on account of their teratogenicity. 12 A period of at least 2 years between oral retinoid discontinuation and pregnancy is recommended to negate the retinoids' teratogenic effects.…”

“…2,3 The available evidence concerning the impact of pregnancy on psoriasis and that of psoriasis on pregnancy is rather scarce, despite psoriasis's proven prevalence in the patient population concerned. 4 Many treatments commonly prescribed for this chronic skin disease, such as methotrexate or acitretin, 5 have been proven teratogenic, and are thus strictly contraindicated in this setting. Over the past decade, biological agents have emerged as a cornerstone of psoriasis management.…”

Widespread Erythematous Plaques in a Multigravid Female

“…10 Differing opinions exist as to whether personal or family history of psoriasis confers increased risk of GPPP. 7,10,11,12 Our patient had no personal or family history and reported complete resolution eight weeks postpartum with only faint post-inflammatory erythema.…”

“…Numerous publications note rapid resolution of disease following delivery, but some reports suggest GPPP may recur in subsequent pregnancies. 10,11,12 In some instances it has been reported that the pustular form evolved into classic psoriatic lesions. 10 Differing opinions exist as to whether personal or family history of psoriasis confers increased risk of GPPP.…”

Interaction of psoriasis and pregnancy: Maternal and fetal outcomes

“…Therefore, special attention should be paid to this period as about half of the pregnancies are not planned and the risks of many drugs are especially high in the fi rst trimester [9]. Otherwise, pre-pregnancy (preconception) counseling is mandatory in patients with a chronic disease such as psoriasis and possibly requiring long-term medical treatment [9,10].…”