psoriasis and pregnancy

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  • prevalence in pregnant women is unknown - probably reflects that of non-pregnant women of child bearing age
  • psoriasis in pregnancy
    • chronic plaque psoriasis improves in 40-60% of patients during pregnancy
      • most improvement during the late first and second trimesters
    • psoriasis deteriorates in 10-20% of women during pregnancy
  • poriasis and pregnancy related morbidity:
    • does not affect fertility or rates of miscarriage, birth defects, or premature birth
    • psoriasis is associated with depression - however no evidence that pregnancy exacerbates depression more in patients with psoriasis than in the normal population
    • various treatments for psoriasis are contraindicated in pregnancy
  • treatment of psoriasis in pregnancy:
    • topical treatments are first line treatments for psoriasis
      • emollients, topical steroids, and dithranol are considered safe in pregnancy
      • manufacturers of vitamin D analogues such as calcipotriol advise that these agents should be avoided in pregnancy
        • however it unlikely that significant systemic absorption will occur when they are used for localised disease
      • coal tar products - animal studies have suggested teratogenicity, although this has not been reported in humans
        • such products are probably safe for use in the second and third trimesters (1)
      • consider referral to a dermatologist if topical treatments fail to control disease
        • ultraviolet B (UVB) is the safest second line therapy - followed by ciclosporin
  • psoriasis in the postpartum
    • more than 50% of women have a flare-up within six weeks of delivery - however this is usually not worse than their prepregnancy state
  • psoriasis and breast feeding
    • fiirst line treatment options for breastfeeding women
      • emollients, moderate to low potency topical steroids, and dithranol
      • use of topical treatment should be after breast feeding - must be washed off thoroughly before the next feed.
    • many treatments such as acetretin, methotrexate, ciclosporin, hydroxycarbamide, biological treatments, and PUVA are all contraindicated in breastfeeding women
      • safest second-line agent is ultraviolet B
      • if first line treatment options fail to control disease then breastfeeding may need to be curtailed to increase treatment options

Reference:

  1. BMJ. 2007 Jun 9;334(7605):1218-20

Last reviewed 01/2019

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