Practical Pearls
Treating Psoriasis in Pregnant Women
Pregnant patients can experience improved severity of their psoriasis or worsening disease. Treating psoriasis during pregnancy requires special...
Pregnant women should avoid biologics and other systemic medications for psoriasis management, according to Jenny Eileen Murase, MD, Assistant Clinical Professor of Dermatology, University of California, San Francisco, at the 74th Annual Meeting of the American Academy of Dermatology (March 4-8, 2016) in Washington, DC. Patients should opt to use topical treatments such as moisturizers, emollients, and low- to moderate-dose corticosteroids.
Some women may experience improvement of their psoriasis during pregnancy because of an autoimmune system shift, often to the point of not needing treatment to manage the condition. “About half of pregnant women experience a dramatic improvement that may allow them to temporarily discontinue treatment,” Dr. Murase explained.
If additional therapy is needed, phototherapy may be utilized. Narrowband UVB is the best option for pregnant women but broadband UVB may be considered. Psoralen plus UVA should be avoided, as psoralen may enter breast milk and lead to light sensitivity in babies.
If the treatment regimen for the condition is discontinued or altered during pregnancy, Dr. Murase recommends that patients restart their prepregnancy regimen as soon as possible after giving birth, as the condition may flare postpregnancy.
In a recent installment of “Practical Pearls From the Cutis Board,” Jeffrey M. Weinberg, MD, discussed first-line treatments for psoriasis in pregnant women. “Pregnant patients need to know that it is important to carefully monitor them throughout their pregnancy,” he stated. “Although many drugs are not contraindicated, it is still important for the dermatologist to consult with the patient’s obstetrician to discuss risks and benefits of different therapies.”
He also indicated that if a pregnant woman does wish to continue biologic therapy, close monitoring and enrollment in a pregnancy registry (http://www.pregnancystudies.org) would be good options. “This registry is analyzing whether medications that are used to treat autoimmune diseases are safe to take during pregnancy.”
Dermatologists need to see these patients regularly to keep the dialogue ongoing and to monitor their condition.