Therapy of psoriasis during pregnancy and breast‐feeding

Abstract

Summary There have been multiple systemic drugs approved for the therapy of psoriasis vulgaris and psoriasis arthritis (PsA) in the last decade. However, treatment decisions are difficult to make in women planning a pregnancy and in pregnant and lactating women due to the paucity of data for such cases. The strongest evidence for psoriasis therapy during pregnancy exists for topical corticosteroids. Medically controlled use of UVB‐therapy is also considered safe. The best evidence regarding systemic therapy during pregnancy and lactation is available for the group of TNF‐alpha inhibitors, which is also reflected in the respective medical product information. This is especially important in cases of psoriatic arthritis. Among traditional systemic therapeutics, the largest clinical experience exists for ciclosporin, which, if medically necessary, may be continued during gestation. However, TNF‐alpha inhibitors, especially the pegylated form, should be preferred in case of pregnancy. Furthermore, an elective pregnancy termination is not necessary due to systemic therapy of psoriasis with many further substances during the first pregnancy weeks. The current work provides a comprehensive review of the scientific literature on treatment of psoriasis during pregnancy and lactation. Based on the available scientific information, severity of psoriasis and patient’s comorbidities, the best possible therapeutic approach can be found in consensus with the patient.

Allergic Contact Cell-Mediated Hypersensitivity in Psoriasis: A Narrative Minireview

“…Regarding pregnancy and lactation, skin patch testing may be performed if there are urgent reasons for the workup of contact allergies and postponement is not desirable [ 73 ], but psoriasis treatment decisions are difficult to make under these conditions [ 74 , 75 , 76 ]. To the best of our knowledge, there are no reports of positive patch tests in pregnant or lactating women treated with biologics for psoriasis.…”

Pregnancy and cutaneous changes

“…It is contraindicated during pregnancy [20,21]. TNF inhibitors are probably the best option for the systemic therapy of psoriasis during pregnancy based on increasing evidence that these medications have no teratogenic, embryotoxic, or fetotoxic effects [22].…”

Aktuelle Entwicklungen und Perspektiven bei Psoriasis

“…2 Seither erschienen in dieser Zeitschrift Publikationen zur Psoriasis in dreistelliger Zahl. In jüngster Zeit umspannen die Themen grundlegende pathophysiologische Aspekte, [3][4][5] therapeutische Ansätze, [6][7][8][9][10][11] epidemiologische Fragen, 12 diagnostische und klinische Entwicklungen, [13][14][15] psychosoziale Aspekte, [16][17][18] bis hin zu Versorgungsforschung und Registerstudien. [19][20][21][22] Empfehlungen zur praktischen Umsetzung neuer Erkenntnisse kulminieren schließlich in Leitlinien.…”