The management of psoriasis in pregnant women will be reviewed here. The presence of psoriasis in a woman who is pregnant raises unique considerations. The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. 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. An assessment of any patient with psoriasis should include disease severity, the impact of disease on physical, psychological and social well-being, whether they have psoriatic arthritis, and the presence of any comorbidities. There is no strong evidence that any of the interventions have a disease-modifying effect or impact beyond improvement of the psoriasis itself. It should not be used by pregnant women or women planning a pregnancy, due to potential teratogenicity.
The increase in the melanocyte-stimulating hormone, estrogen, and progesterone, each play a role in these changes. PEP is the most common of the dermatoses unique to pregnancy, with an incidence of 1 in 160. The pathogenesis of this eruption is believed to be the presence of atopy in the pregnant woman. The treatment of psoriasis in pregnant women can be challenging. Plaque psoriasis is raised, roughened, and covered with white or silver scale with underlying erythema. The diagnosis of psoriasis is clinical, and the type of psoriasis present affects the physical examination findings.
Factors that increase the risk of developing psoriasis include:. A complete medical history and examination of the skin, nails, and scalp are the basis for a diagnosis of psoriasis. Rheumatoid arthritis, in particular, is diagnosed by the presence of a particular antibody present in the blood. Pregnant women should not use evening primrose oil, and patients with liver disease or high cholesterol should use it only under a doctor’s supervision. Generalized pustular psoriasis is an unusual manifestation of psoriasis which may be gradual or acute in onset. Clues that the erythroderma is secondary to psoriasis are the presence of the classic nail changes and usually, but not always, facial sparing. It is contraindicated in pregnant women with psoriasis. It may also increase the risk of malignancies, infection, and reactivate latent, chronic infections, as reflected in the clinical trials. 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. However, the hydrolysis that occurs naturally in the human body to convert etretinate to acitretin can be reversed in the presence of heavy alcohol consumption.46 Etretinate has been detected in the plasma of patients on monotherapy with acitretin, and since etretinate accumulates in adipose tissue and has a long half-life, its presence prolongs the teratogenic potential of acitretin. Use in Pregnant Women and Reproductive Considerations.
Dermatologic Diseases In Pregnancy
Pregnancy represents a unique challenge for the maternal organism. During pregnancy, the number of MCs increase in the myometrium and equal ratio of tryptase and chymase (MCTC) positive MCs shift toward a tryptase-only (MCT) phenotype (11). In addition, special treatment considerations should be applied to pregnant and lactating women (17, 23). Pregnant women with psoriasis or rheumatoid arthritis should not receive methotrexate. Methotrexate given concomitantly with radiotherapy may increase the risk of soft tissue necrosis and osteonecrosis. If methotrexate therapy is reinstituted, it should be carried out with caution, with adequate consideration of further need for the drug and increased alertness as to possible recurrence of toxicity. An in-depth report on the causes, diagnosis, treatment, and prevention of depression. Severity, duration, and the presence of other symptoms are the factors that distinguish normal sadness from clinical depression. (Women with depression may also have accompanying eating disorders, such as anorexia nervosa and bulimia. Depression during pregnancy may also increase the risk of developing postpartum depression. Etiology, pathophysiology, symptoms, signs, diagnosis & prognosis of Itching from the Professional Version of the Merck Manuals. Laboratory diagnosis of HSV infections consists of virologic and serologic tests. However, outbreaks have occurred in several groups and, in the presence of HIV infection, may manifest different signs and symptoms. All pregnant women should be screened serologically for syphilis at their first prenatal visit. Psoriasis and the pregnant woman: what are the key considerations? The response of the maternal placenta to psoriasis-induced inflammation and comorbid conditions, such as obesity, hypertension, and depression, The unique birth experience leads to unpredictable requirements for analgesics, from ‘none at all’ to ‘very high’ doses of pain medication.
Depression during pregnancy may also increase the risk of developing postpartum depression. In pregnant women, ALP is made in the placenta. ALP testing can also be helpful in investigating vitamin D deficiency, the presence of tumors, or unusual bone growth. Diagnosis Icon. Considerations in viewing recommended intakes for vitamin D Summary of the RNIs for vitamin D by age group Vitamin D toxicity Future research References Summary of the role of vitamin D in human metabolic processes. The cell differentiating and immuno-modulatory properties underlie the reason why vitamin D derivatives are now used successfully in the treatment of psoriasis and other skin disorders. All these events raise plasma calcium levels back to normal, that in turn is sensed by the calcium receptor of the parathyroid gland. In lactating women there appears to be no direct role for vitamin D because increased calcium needs are regulated by PTH-related peptide (36, 37), and recent studies have failed to show any change in vitamin D metabolites during lactation (38, 39). Women who are pregnant or a planning a pregnancy in their mid-30’s or 40’s. The burdens of some disorders or some forms of disability are more than offset by being raised in a loving home.