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Psoriasis During Pregnancy
 It
seems pregnancy brings more than a "healthy glow." It might also help clear
psoriasis for those who have the skin disease. A study showed that psoriatic
women who have high estrogen levels during pregnancy experience significant
improvements of their psoriasis. The retrospective studies suggested that from
16 percent to 63 percent of women with psoriasis improved during pregnancy and
researchers theorized that progesterone was the hormone spurring the
improvement.
It was also found that when the psoriasis returned at about six weeks postpartum
on those who had improved during pregnancy, with the actual body surface area
affected about the same as it had been at baseline. Dr. Murase said she expected
more of an "angry flare" but says patients probably feel their psoriasis is
worse than baseline postpartum because they have grown accustomed to the relief
from their disease during pregnancy.
The hormones that displayed the strongest correlation to psoriatic improvement
were estradiol and estriol. Progesterone alone did not have any correlation. In
the 50 percent who did not improve, the women's levels of estriol were lower. In
those who did improve, their estriol rose about 100-fold from their nonpregnant
levels.
Treatment Options :
Nothing is 100% safe. The potential risk factor to the baby versus the risk
factor of a severe flare in the mother (the need to treat the symptoms) must be
weighed.
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 UVB,
going to the beach, ultraviolet B light, narrow-band UVB with moisturization
is extremely effective in the treatment of psoriasis, especially during
pregnancy.
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 Of
the systemic treatments, oral retinoids and methotrexate are very bad, while
cyclosporine and etanercept (Enbrel) are relatively safer. No treatment
should be undertaken without the counsel of the OB doctor.
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Avoid the use of coal tar during pregnancy and during the period of
breastfeeding thereafter.
Pregnant patients are treated very conservatively. Topical
corticosteroids, calcipotriene, and UVB are probably safest
treatments, but patients should check with their obstetrician
before starting any treatment.
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Treatments to avoid:
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Methotrexate, which is teratogenic even in men, should be discontinued
at least twelve weeks before trying to conceive. Possibility of chemical
effect of, methotrexate on the ova cannot be ignored. Cyclosporine although
not as risky, should not be used when
trying to get pregnant, during
pregnancy, or while they're breast feeding.
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Avoid using PUVA during pregnancy. Reports shave indicated that some of
the babies were of lower birth weight than on average.
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 Biologic
therapies work by the mechanism of action on the T-cell, and hold much less
risk on DNA in the ova than methotrexate, and can be used in women of
childbearing ages prior to conception. With regards to the pregnancy issue,
almost all of the biologic therapies are category B, which means the
medicines are expected to be safe to be used during pregnancy, but formal
testing has not been done. Raptiva should only be given to pregnant or
nursing women if there is a clear medical need, and if this decision is
reached by a patient and doctor together.
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The psoriasis drugs Tegison (etretinate) and Soriatane (acitretin) may
be harmful even if taken up to three years before a woman becomes pregnant.
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 The
effect of Amevive on pregnancy and fetal development is not known, therefore
treatment is not recommended during pregnancy.
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Oral retinoids should never be prescribed for pregnant women or women of
childbearing age who intend to become pregnant within three years of
discontinuation of therapy.
Note: Check with your health care provider before taking any
over-the-counter drugs (including aspirin) or herbal teas, pills or other
supplements.
Related Links
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