Psoriasis and pregnancy Pregnant women and psoriasis Psoriasis during pregnancy During pregnancy many women see improvements in their psoriasis and the reason might just be in the high levels of estrogen in the body at this particular stage of life. It is estimated that in about one third of cases pregnant women’s psoriasis undergoes deterioration.
What happens during pregnancy in women with psoriasis?
A Chinese study, published in the Journal of Investigative Dermatology, dealt with psoriasis in women during pregnancy in order to better understand how the skin improves or deteriorates when affected by high levels of female hormones, especially estrogen.
We know that high doses of estrogen are associated with improvements in psoriasis and psoriatic arthritis. We have also discovered that the skin condition deteriorates days before the menstrual cycle, during menopause and post partum when estrogen levels decrease.
During pregnancy many women see improvements in their psoriasis and the reason might just be in the high levels of estrogen in the body at this particular stage of life. Although the causes of psoriasis are not yet completely understood, it is known that the immune system plays a key role, in particular a specific population of cells, T-lymphocytes, which create an inflammatory process which alters the mechanisms of cell reproduction causing redness and the appearance of spots.
From the results of the Chinese study, the positive role of estrogen may be due to the fact that it suppresses the immune response of T-lymphocytes, thus reducing excess production of those cells that cause a loss of balance in the skin barrier.
In some cases, however, it is estimated that in about one third of cases pregnant women’s psoriasis undergoes deterioration. In these cases, scientists have hypothesized that high levels of female hormones may aggravate patches on the skin because they stimulate excessive proliferation of keratinocytes (which mainly protect from the aggression of pathogenic organisms, heat, UV radiation) and promote angiogenesis.
Numerous topical (ointments, creams) or systemic therapies (tablets or injections) that are commonly used to treat psoriasis are contraindicated in pregnancy for the effects they may have on the fetus. Therefore, pregnant women should always see their gynecologist and/ or dermatologist before starting any type of treatment. Even exposure to the sun, which is known to be beneficial for psoriasis patients, must be done with caution during the nine months of gestation.
Like pregnancy, breast-feeding is also a contraindication for most psoriasis therapies. Acute deterioration of the cutaneous clinical picture further aggravates the situation as observed in approximately 65 % of women during postpartum. In the most severe forms, this deterioration induces women with psoriasis to stop breastfeeding so that they may undergo perform specific psoriasis treatments. In this case it is also always essential to see the dermatologist for optimal management.
Recommendations during pregnancy:
The first-line therapy in pregnant women with mild to moderate psoriasis should be topical corticoids. We also recommend the use of the Psotherapy line as a natural product without side effects and systemic absorption.
UVB phototherapy is the most suitable option for cases of severe psoriasis.
Cyclosporine, biological therapy and PUVA baths can be recommended as second-line therapy, considering the risk/benefit balance according to each patient.
There are no data on the safety of the use of high-potency topical corticoids during breastfeeding. Its use is recommended in plaque psoriasis located on areas that are not close to the skin of the mammary glands and that may have frequent contact with the skin of the baby.
Some authors recommend caution in the use of cyclosporine during breastfeeding, although it has been used successfully and safely in some cases. If cyclosporine needs to be continued during breastfeeding, it is recommended to monitor its levels in breast milk and infant plasma.
The use of methotrexate and retinoids is contraindicated during breastfeeding.
UVB phototherapy is safely recommended during breastfeeding.
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