Treating Psoriasis during Pregnancy and Breastfeeding

Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation.
Bae YS, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo B Jr, Kimball AB; National Psoriasis Foundation.
J Am Acad Dermatol. 2012 Sep;67(3):459-77. doi: 10.1016/j.jaad.2011.07.039. Epub 2011 Oct 22. Review.

• Psoriasis affects 2-4% of the population. It is a challenge as it is a chronic dermatosis and it therefore raises compliance issues.
• It is even more a problem when the patient is a pregnant or lactating woman. In this review published in the Journal of American Academy of Dermatology (JAAD), the authors sought to determine safe treatment options in this population group.
• Although available data is quite poor the conclusion was that:
  • topical therapies as emollients and low- to moderate- potency steroids are the first line of treatment. This seems to be quite logical as penetration of the medication is very low if active substances are applied locally.
  • Second-line treatment consists of phototherapy (light treatment): Narrowband ultraviolet B (NBUVB) therapy or broadband UVB. PUVA requires injestion of a psoralen and is therefore not recommendable.
  • As a last resort TNF-inhibitors (adalimumab, etanercept, infliximab), cyclosporine and oral steroids (second and third trimesters) may be used. As a personal opinion, we would avoid biologics altogether as data is very poor. They have not been around for that long and it remains to be seen if  physicians would use it in practice in that population group.

Contributors

Dr Christophe Hsu – dermatologist. Geneva, Switzerland