Navigating the Road to Psoriasis Control in Women: Strategies to Optimise the Reproductive Journey

Abstract

The importance of discussions around the management of women of childbearing age with psoriasis, an issue that has been largely neglected for many years, was introduced and emphasised by Prof Ryan as the topic for this symposium. The changing needs and hurdles faced by this patient population due to the different hormonal phases throughout a woman’s reproductive life can reduce quality of life (QoL), aggravate disease burden, and complicate treatment decisions. This was exemplified by Dr Kleyn using three case studies for which delegates provided useful insights on management options. It was noted that fears and misconceptions often result in women of childbearing age delaying the decision to start a family and that improved doctor–patient interactions are key to helping women overcome concerns surrounding conception and pregnancy. Prof Augustin discussed the significant impact of psoriasis on physical and psychological comorbidities and stigmatisation using the concept of cumulative life-course impairment (CLCI) as a measure. He then presented clinical trial data on anti-TNF biologic therapy during pregnancy, with a particular focus on results relating to placental transfer and transfer into breast milk. The delegates’ opinions on family planning and postpartum flares were then sought for three relevant clinical scenarios illustrated by Prof Ryan. The use of anti-TNF agents in women who are actively trying to conceive, are pregnant, or are breastfeeding was discussed, with the majority of delegates indicating that they would recommend anti-TNF treatment to patients where appropriate. The lack of practical guidance in dermatology the management of women of childbearing age with psoriasis was highlighted, and the symposium concluded with an overview of current recommendations by the European League Against Rheumatism (EULAR) for patients with rheumatological conditions. These emphasise the importance of discussing family planning with female patients and directly involving them in treatment decisions to optimise their reproductive journey.