Psoriasis in Pregnancy
Psoriasis in pregnant women requires special considerations in view of its course during pregnancy and postpartum period, the possible adverse outcomes, and the restricted basket of therapeutic measures that can be used. Most studies of pregnant psoriatic women have shown that psoriasis remained unaltered in approximately 25 % of pregnancies, improved in 50 %, and worsened in 25 %. In contrast, during the 3-month postpartum period, approximately 30 % remain unchanged, 10 % improved, and 60 % deteriorated. Psoriatic arthritis improved in the vast majority of pregnancies. Impetigo herpetiformis—a rare generalized pustular psoriasis—precipitated by pregnancy has been reported repeatedly. Moderate-to-severe psoriasis, especially when associated with comorbidities, may carry an increased risk for cesarean delivery, chronic hypertension, low birth weight, and recurrent abortions. For mild and limited disease, the use of topical mild-to-moderate–potency steroids (category C) may be used. For moderate-to-severe psoriasis, UVB phototherapy appears to be safe and effective. Anti-TNF alpha agents (category B) should not be given beyond 30 weeks of pregnancy.