Management of psoriasis in pregnancy
- Miriam Keltz Pomeranz, MD
Miriam Keltz Pomeranz, MD
- Associate Professor of Dermatology
- New York University School of Medicine
- Bruce E Strober, MD, PhD
Bruce E Strober, MD, PhD
- Professor and Chair, Department of Dermatology
- University of Connecticut Health Center
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- Louise Wilkins-Haug, MD, PhD
Louise Wilkins-Haug, MD, PhD
- Section Editor — Prenatal Diagnosis and Genetics
- Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- Kristina Callis Duffin, MD
Kristina Callis Duffin, MD
- Section Editor — Psoriasis
- Assistant Professor, Department of Dermatology
- University of Utah
Psoriasis is a chronic skin disorder characterized by well-demarcated erythematous papules and plaques with a silver scale, although atypical or nonclassic forms also exist. It commonly occurs on the extensor surface of the elbows or knees, or the scalp (picture 1A-C). Psoriasis commonly occurs in women of reproductive age because three-quarters of patients develop the disease before reaching age 40 years . (See "Epidemiology, clinical manifestations, and diagnosis of psoriasis".)
The management of psoriasis in pregnant women will be reviewed here. The general treatment of psoriasis and pustular psoriasis of pregnancy, a severe pustular form of psoriasis, is discussed separately. (See "Treatment of psoriasis" and "Dermatoses of pregnancy".)
The presence of psoriasis in a woman who is pregnant raises unique considerations. Examples include the impact of maternal psoriasis on the fetus, therapeutic restrictions during pregnancy, and the effects of pregnancy on psoriasis severity.
●Impact of psoriasis on pregnancy outcomes – Few studies have investigated the impact of psoriasis on pregnancy outcomes, leaving the relationship between psoriasis and pregnancy outcomes unclear . A systematic review of observational studies that evaluated the relationship between psoriasis and pregnancy outcomes found that four of the nine included studies reported increased risk for at least one adverse fetal outcome (spontaneous abortion, caesarean delivery, low birth weight, macrosomia, large-for-gestational age, or a composite outcome that included prematurity and low birth weight) . However, study results were inconsistent.
●Impact of pregnancy on treatment choices – Choosing drug therapies that pose the least risk to the fetus is the major issue in managing the pregnancies of affected women. Ideally, women should try to plan pregnancy when they are in remission and they are off medication or are taking the minimum effective dose of medications that have the best fetal safety profiles. Because many women with moderate to severe psoriasis do not achieve complete remissions, postponing pregnancy until a period of remission often is unrealistic in this population. The selection of treatments with good fetal safety profiles is particularly important for these patients. (See 'Treatment principles' below.)
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- SPECIAL CONSIDERATIONS
- TREATMENT PRINCIPLES
- First-line therapy
- - Emollients and moisturizers
- - Topical corticosteroids
- Second-line therapy
- - UVB phototherapy
- Third-line therapy
- - Anti-TNF biologic agents
- - Cyclosporine
- CONTRAINDICATED THERAPIES
- OTHER PSORIASIS THERAPIES
- Topical calcineurin inhibitors
- Coal tar
- PUVA phototherapy
- Systemic glucocorticoids
- Interleukin-17 inhibitors and apremilast
- Fumaric acid
- SUMMARY AND RECOMMENDATIONS