State-of-the-Art Review of Pregnancy-Related Psoriasis.

Anca Angela Simionescu,Ana Maria Alexandra Stanescu,Bianca Mihaela Danciu

doi:10.3390/medicina57080804

Abstract

Psoriasis is a chronic immunologic disease involving inflammation that can target internal organs, the skin, and joints. The peak incidence occurs between the age of 30 and 40 years, which overlaps with the typical reproductive period of women. Because of comorbidities that can accompany psoriasis, including metabolic syndrome, cardiovascular involvement, and major depressive disorders, the condition is a complex one. The role of hormones during pregnancy in the lesion dynamics of psoriasis is unclear, and it is important to resolve the implications of this pathology during pregnancy are. Furthermore, treating pregnant women who have psoriasis represents a challenge as most drugs generally prescribed for this pathology are contraindicated in pregnancy because of teratogenic effects. This review covers the state of the art in psoriasis associated with pregnancy. Careful pregnancy monitoring in moderate-to-severe psoriasis vulgaris is required given the high risk of related complications in pregnancy, including pregnancy-induced hypertensive disorders, low birth weight for gestational age, and gestational diabetes. Topical corticosteroids are safe during pregnancy but effective only for localised forms of psoriasis. Monoclonal antibodies targeting cytokines specifically upregulated in psoriasis, such as ustekinumab (IL-12/23 inhibitor), secukinumab (IL-17 inhibitor) can be effective for the severe form of psoriasis during pregnancy. A multidisciplinary team must choose optimal treatment, taking into account fetal and maternal risks and benefits.

Highlights

Psoriasis is a chronic inflammatory disease, a T cell–mediated disorder secondary to inflammation and keratinocyte hyperproliferation that affects 1–3% of the population [1].Its course is unpredictable and capricious but usually is associated with chronic immunemediated findings and generalised inflammatory disease
Genetic studies have reported pregnancy as predisposition to severe generalised pustular psoriasis for persons carrying the mutation of the interleukin 36 receptor antagonist gene (IL36RN genes) [9]
The implications of immune tolerance in psoriasis-related to maternal-fetal immune tolerance during pregnancy, and how pregnancy-specific hormones influence the T cell cytokines responses involved in the evolution of the disease are intensely debated topics of multidisciplinary interest

Summary

Introduction

Psoriasis is a chronic inflammatory disease, a T cell–mediated disorder secondary to inflammation and keratinocyte hyperproliferation that affects 1–3% of the population [1]. The implications of immune tolerance in psoriasis-related to maternal-fetal immune tolerance during pregnancy, and how pregnancy-specific hormones influence the T cell cytokines responses involved in the evolution of the disease are intensely debated topics of multidisciplinary interest. We review the current state of the art to construct a comprehensive but straightforward assessment of psoriasis during pregnancy We emphasise both the difficult treatment decisions during the pregnancy and postpartum periods and the high-risk pregnancy complications arising from psoriasis-associated pathologies. With this approach, we hope to raise awareness for obstetricians, general practitioners, dermatologists, and others who may be involved in monitoring these cases

Clinical Phenotypes of Psoriasis in Pregnancy

Specific Complications of Pregnancy-Associated Psoriasis

Treatment of Psoriasis during Pregnancy

Biologic Treatments

Findings

Conclusions