State-of-the-Art Review of Pregnancy-Related Psoriasis

Abstract

Psoriasis is a chronic immunologic disease involving inflammation that can target internal organs, the skin, and joints. The peak incidence occurs between the age of 30 and 40 years, which overlaps with the typical reproductive period of women. Because of comorbidities that can accompany psoriasis, including metabolic syndrome, cardiovascular involvement, and major depressive disorders, the condition is a complex one. The role of hormones during pregnancy in the lesion dynamics of psoriasis is unclear, and it is important to resolve the implications of this pathology during pregnancy are. Furthermore, treating pregnant women who have psoriasis represents a challenge as most drugs generally prescribed for this pathology are contraindicated in pregnancy because of teratogenic effects. This review covers the state of the art in psoriasis associated with pregnancy. Careful pregnancy monitoring in moderate-to-severe psoriasis vulgaris is required given the high risk of related complications in pregnancy, including pregnancy-induced hypertensive disorders, low birth weight for gestational age, and gestational diabetes. Topical corticosteroids are safe during pregnancy but effective only for localised forms of psoriasis. Monoclonal antibodies targeting cytokines specifically upregulated in psoriasis, such as ustekinumab (IL-12/23 inhibitor), secukinumab (IL-17 inhibitor) can be effective for the severe form of psoriasis during pregnancy. A multidisciplinary team must choose optimal treatment, taking into account fetal and maternal risks and benefits.

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.…”

Case Report: Generalize Pustular Psoriasis Pregnancy (GPPP) in Multiple Pregnancies

“…In maternal serum or umbilical cord blood, psoriasis-specific pro-inflammatory cytokines such IL-1, IL-6, and TNF-alpha are present at significantly elevated levels. This inflammatory cytokines can cause preterm birth [17]. The production of IL-36 subfamily members has been linked to the development of inflammation (mostly psoriasis), but it is still unclear if they have a role in the development of a healthy pregnancy [18].…”

Exploring the Relationship between Psoriasis and Pregnancy: A Systematic Literature Review

“…Oral contraceptives have been shown to decrease the severity of psoriasis, but the exact mechanism is unknown. 3,8,13,15 Estrogen is known to have both immune dampening and immune activating properties. 6,16 At high doses, estrogen can improve the symptoms of psoriasis, whereas at low doses it is considered inflammatory; 15 however, this finding contradicts the effects of oral contraceptives which are typically low-dose estrogen.…”

“…2 Previous studies stress the possible negative teratogenic effects of continuing biologic medications during pregnancy, and recommend the use of topical treatments during as alternatives. 3,4 It is commonly believed that psoriasis symptoms tend to improve during pregnancy, however, there is limited research documenting the extent to which this occurs, 3,4 and how. The aim of this literature review is to examine the published literature on the relationship between psoriasis and pregnancy to elucidate possible new routes of treatment.…”