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
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