Fetal risks in pregnant women with psoriasis derive both from maternal disease and the medications used to control the illness. Cytokine excess causes endothelial dysfunction, resulting in systemic and placental vasculopathies through platelet aggregation, intermittent vasospasm and activation of the coagulation system. In cases with extensive lesions, this seems to be the safest therapy, however overheating during treatment should be avoided, especially during the first 28 days of gestation, due to the increased risk of neural tube defects. Chart 212,15 describes the effects of different modalities of phototherapy during pregnancy, according to data collected from bibliographical references analyzed in preparation for this review. Treating your psoriasis during pregnancy requires special precautions. It is important to consult with your doctor to verify your psoriasis treatments are safe for pregnancy and nursing. Narrow-band ultraviolet light B (UVB) phototherapy should be the second-line treatment. Broadband ultraviolet B phototherapy is considered the safest therapy for extensive psoriasis during pregnancy, although overheating during treatment should be avoided.
Psoriasis. Phototherapy is considered the safest therapy for extensive psoriasis during pregnancy. From Category B, loratidine and diphenhydramine are best-choice antihistamines. A summary of relevant known hazards in pregnancy is included here. Coal tar products are considered safe if used for short periods or on localised areas such as the scalp. UVB phototherapy is safe for pregnant women with more severe psoriasis. Joint disease is associated with psoriasis in a significant proportion of patients (reported in one study to be 13. It should not be used by pregnant women or women planning a pregnancy, due to potential teratogenicity. Phototherapy is a second-line treatment and is used for extensive and widespread disease or where there is resistance to topical treatment:. Studies suggest these drugs are both safe and effective.
Attempts to treat extensive disease with topical agents are often met with failure, can add cost, and lead to frustration in the patient-clinician relationship. For patients who continue methotrexate, liver biopsies should be considered after every 1 to 1. The treatment of psoriasis in pregnant women can be challenging. In psoriasis, the cells of the epidermis multiply at an abnormally rapid rate so in effect, too much skin is being produced and it becomes thickened and scaly. It is now known that an abnormal immune response causes the skin to react in this way and psoriasis is now considered to be an auto-immune disease. The main downside of UV treatment is that it does cause premature aging of the skin and skin cancer but if used carefully in modest amounts it is the safest and most effective treatment for psoriasis.
When The Patient Is Pregnant
For older children, limited courses of phototherapy eliminate some of the side effects associated with using systemic immunosuppressants. UVB: considered the safest treatment for severe psoriasis during pregnancy. UVB has been considered the safest treatment for extensive psoriasis during pregnancy. In some cases, psoriasis can be hard to treat if it is severe and widespread. Topical agents: Medications applied directly to the psoriatic skin lesions are the safest approaches to treatment but are only practical if treating localized disease. Disease that is considered too extensive to be treated by topical approaches, that is usually greater than 5 -10 of the total body surface area, is an appropriate indication for this sort of treatment. UV-B phototherapy is effective for treating moderate-to-severe plaque psoriasis. However, treatment is usually effective and will control the condition by clearing or reducing the patches of psoriasis. Tazarotene can cause birth defects so it should be strictly avoided during pregnancy or if breastfeeding. It is useful in treating pustular psoriasis, psoriatic erythoderma and extensive plaque psoriasis. Acitretin fulfills a unique role in the strategies used to treat psoriasis because its mechanism of action is different from that of other systemic drugs. Acitretin continues to be useful as monotherapy and in combination with other systemic treatments or phototherapy, and its role as a rescue drug or in combination with biologic agents is particularly interesting, as has been shown by recent reviews on this topic. IndicationsThe summary of product characteristics (SPC) for Neotigason specifies the following indications: severe extensive psoriasis that is resistant to other forms of therapy, palmoplantar pustular psoriasis, severe congenital ichthyosis, and severe Darier disease. Acitretin is absolutely contraindicated in pregnancy and in patients who are allergic to the product or any of its components. A further point is that the whole skin is abnormal in psoriasis. Pregnancy:In most cases pregnancy induces remissions, though raised levels of progesterone in the latter half of pregnancy can precipitate generalized pustular psoriasis in some. B phototherapy is considered the safest therapy for extensive psoriasis during pregnancy, although overheating during treatment should be avoided.
Treatment Of Psoriasis
We have 35 years of experience and interest treating extensive, difficult psoriasis with phototherapy. PUVA is safe in pregnancy. The phototherapy suppresses C. acnes, a bacteria that partially causes acne. It is category B, considered safe during pregnancy, and the treatment of choice for dermatophyte infection during pregnancy. Biologic Immune Modifiers These are indicated for treatment of moderate-to-severe plaque type psoriasis that is refractory to phototherapy and systemic treatments, or when other treatments are contraindicated; 40-60 of the patients with chronic psoriasis improve during pregnancy, but 10-20 experience worsening of the disease during pregnancy 34. It is the firstline treatment for patients with extensive moderate psoriasis. Pregnancy causes immunologic, endocrine, metabolic, defined, and vascular changes in the pregnant woman which modify her responses to skin diseases. UVB is the safest treatment for extensive psoriasis during pregnancy when topical therapy is not practical. Short-term use of cyclosporine during pregnancy is probably the safest option for the management of severe psoriasis that has not responded to topical therapy or phototherapy or for severe pustular psoriasis in pregnancy.