Treating psoriasis during pregnancies

As psoriasis has a bimodal age of onset with a first peak between the age of 15 and 39, women of reproductive age account for a substantial group in psoriatic patients. Treatment choices for women of childbearing age should take planned and unplanned conception into account.

“During pregnancy, psoriasis in almost half or more of the patients improves, but in 24% we get a worsening of the disease and in 21% the disease remains stable,” said Prof. Mahira Hamdy El Sayed (Ain Shams University, Egypt) [1]. Results of various studies have demonstrated that being pregnant and having psoriasis included increased risks for pregnancy hypertension, premature rupture of membranes, low birth weight, large-for-gestational-age infants, and (pre-)eclampsia [2,3]. “We need more studies, but there is a growing body of evidence that pregnancies in women with psoriasis need special monitoring,” Prof. El Sayed indicated. Hormone changes during pregnancy may also induce pustular psoriasis, especially in the last trimester, and collaboration is advised should it occur between dermatologist, obstetrician, and neonatologist [1].

Options for topical treatment during pregnancy consist of (low potency) steroids, calcineurin inhibitors and emollients, while anthralin and retinoids are contraindicated for pregnancies. In terms of phototherapy, broadband and narrowband is considered safe, but psoralen plus UVA treatment is contraindicated. If systemic therapy is needed, cyclosporine and TNF-alpha inhibition are possible choices [4]. Certolizumab pegol is approved by the FDA for use during pregnancies and seems to be the safest among TNF blockers in this situation [5]. “It has a unique structure without the FC portion, so it does not cross the placental barrier and research did not find any harm that can come to the foetus,” Prof. El Sayed advised.

1. 
   
   1. El Sayed MH. Treating women with psoriasis.01, EADV Congress 2021, 29 Sept–2 Oct.
   2. Gottlieb AB, et al. Int J Womens Dermatol. 2019;5(3):141–150.
   3. Lambe M, et al. J Am Acad Dermatol. 2020 May;82(5):1109–1116.
   4. Puchner A, et al. Wien Klin Wochenschr. 2019;131(1–2):29–44.
   5. Tirelli LL, et al. Dermatol Ther. 2019;32(6):e13137.

 

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Posted on 18 November 202116 February 2024