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Management of Psoriasis in pregnancy

Dr Syeda Ishrat Jahan
Psoriasis is a chronic disease of the immune system that appears on the skin, usually in the form of thick, ted, scaly patches. Women who develop psoriasis often worry about becoming pregnant. They ask themselves if the baby will develop normally. Will they be able to breastfed? Will their psoriasis get worse during pregnancy? Are the treatments safe for the baby?
According to medical science, Psoriasis is not necessarily a barrier to pregnancy, nor does it affect a woman's ability to have children.Women with psori-asis generally progress through pregnancy and give birth just like anyone else. However, expectant mothers who suffer from psoriasis need special precaution in their treatment and should be aware of the hereditary nature of this condition, the effect of hormonal changes and tips for ease in breastfeeding.
Treatment options Pregnant women with psoriasis need to be aware that some treatments for psoriasis may harm their babies. There are not many drugs available to treat pregnant women as most anti-psoriatic drugs are toxic for the fetus. The appropriate
treatment for psoriasis in a woman who is pregnant, or who plans pregnancy, will depend on the extent and severity of the skin condition.
Topical treatment:
Topical treatments are first line treatments for psoriasis in pregnancy as most of systemic drugs are toxic to fetus. However, medications for external use are not free from side effects as they are absorbed by the body. Some should be completely avoided during pregnancy as they are potentially teratogenic (causes birth defect).
Emollients: Soothing and moisturising creams may be used without incurring any
risk.
Vitamin A derivatives for local use should be avoided because of their teratogenic effect.
Vitamin D derivatives can be used in small quantities in very specific areas.
Corticosteroids (Cortisone): Dermatologists sometimes prescribe corticosteroids in small quantities for use on very limited areas. It can increase the risk of stretch marks, so it should not be applied to certain parts of the body such as the breasts, abdomen and hips.
Exfoliants such as urea and Salicylic acid: These treatments can be used if their application is limited to small areas of the skin.
Systemic treatment:
Systemic treatments are often teratogenic. These risks are very high when medication is taken during the first trimester of pregnancy. Consequendy, most orally administered medicines are stopped during pregnancy.
Systemic treatments to avoid
Acitredne (and other vitamin A derivatives) and methotrexate: These can bring about serious congenital abnormalities and miscarriage in some cases.
PUVA therapy: This can be dangerous for the foetus because of the psoralens (light-sensitising chemicals) administered prior to the PUVA sessions.
Possible systemic treatment in cases of widespread psoriasis
Cyclosporine: This drug is not dangerous for the foetus, but it does have side effects. A short course can be prescribed in exceptional cases for pregnant women who have severe psoriasis.
UVB treatment: Narrow spectrum UVB therapies which treat widespread psoriasis are safe during pregnancy.
The writer is an Associate Consultant of Department of Dermatology at Square Hospitals Ltd. Dhaka.