Treating Psoriasis During Pregnancy: Safety and Efficacy of Treatments

Abstract

Psoriasis is a chronic inflammatory disease with a well-documented negative effect on the quality of life of affected patients. Psoriasis often occurs in the reproductive years, during which the issue of pregnancy needs to be addressed. The course of psoriasis during pregnancy is unpredictable, and many patients face the challenge of needing treatment during pregnancy. In this review we provide an overview of the key considerations for managing psoriasis in pregnant women, covering the potential effects of active psoriasis and co-morbid conditions on the health of the mother and fetus, as well as the effects of psoriasis treatment options on the developing fetus. Although there are no robust data on the safety of systemic treatment of pregnant women, increasing evidence regarding the safety of cyclosporine (ciclosporin) treatment as well as anti-tumor necrosis factor-α is available and should be considered in pregnant women with moderate to severe psoriasis unresponsive to local corticosteroids and UVB light treatment.

Recent Advances in Small Molecule and Biological Therapeutic Approaches in the Treatment of Psoriasis

“…Long‐term phototherapy may be cumbersome to patients, as access to lightboxes and time constraints often affect patient adherence to therapy (although home phototherapy and tanning beds offer more easily accessible options) . Acitretin, a vitamin A analog, may be a practical option for some patients, but is generally avoided in women of reproductive age given the risk for severe birth defects . Cyclosporine and methotrexate have a long record of efficacy in psoriasis, but may cause organ toxicity and drug interactions .…”

“…21 Acitretin, a vitamin A analog, may be a practical option for some patients, but is generally avoided in women of reproductive age given the risk for severe birth defects. 22 Cyclosporine and methotrexate have a long record of efficacy in psoriasis, but may cause organ toxicity and drug interactions. 23,24 In patients with recalcitrance to the aforementioned treatment options, severe disease, or according to preference, biologics and small molecule medications may be a more favorable option.…”

Genital psoriasis: a hidden multidisciplinary problem — a review of literature

“…Despite being classified as C category by the FDA, mild to moderate topical corticosteroids with emollients are the first line treatment in pregnant patients with psoriasis. In second line treatment UVB is used, while cyclosporine and biological therapy with anti-TNF-α are recommended as third line [35]. Unfortunately, patients commonly do not use prescribed drugs adequately, and this has a negative impact on treatment results.…”

Application of phototherapy in the treatment of psoriasis vulgaris

“…Ciąża nie stanowi przeciwwskazania do stosowania naświetlań UVB [1,6]. Są one uważane za sku-to be both effective and safe, and in pregnant women with mild psoriasis it is used as second-line treatment after failure of topical therapy (BB-UVB when NB-UVB is unavailable) [29][30][31].…”