Effect of Psoriasis and Its Treatment on Pregnancy

Pregnancy and psoriasis occurring concurrently often complicate the health status of a woman. Psoriasis is a skin condition marked by multiple patches or plaques on the skin covered with silvery scales. The relationship between pregnancy and psoriasis was recently reviewed by Jennifer M Landau et al.
Pregnancy does have an effect on psoriasis. The good news is, a number of women experience improvement in psoriasis during pregnancy. The bad news is, they also suffer from a flare of the disease following delivery.
Various ways in which psoriasis can affect pregnancy as reviewed in the above mentioned article are listed below:
• Psoriasis in pregnancy has been found to be associated with low birth weight of the baby, preterm birth and abortions. Low birth weight probably occurs due to the effect of inflammation of psoriasis on the placental blood and blood vessels. Some studies however contradict the above statement and concur that psoriasis is associated with the birth of ‘big babies.’

• The mental stress due to psoriasis may make the pregnant woman prone to depression, weight gain, smoking and alcoholism. The damaging effects of these situations on fetal health are well known. Depression may also make the pregnant women negligent in taking pre-natal vitamins, which in turn could affect fetal growth.
• Other health disorders are associated with psoriasis. These include diabetes, heart conditions like heart failure and heart attack, obesity and metabolic syndrome (metabolic syndrome consists of a group of disorders, which include obesity, high blood sugar, high triglycerides, low high density lipoproteins and high blood pressure). Not only do these conditions affect pregnancy, the drugs used to treat these conditions could also have harmful effects on the fetus. For example, high blood pressure or hypertension is associated with low birth weight, preterm births and increase in fetal deaths. Some drugs used to treat hypertension, like those belonging to a group called ACE inhibitors, can cause fetal abnormalities. Diabetes may result in big babies and fetal abnormalities. Obesity can result in big babies, low Apgar score and premature birth.

• Some of the local medications used over the skin for psoriasis are usually safe if applied in a limited amount. Chances of fetal abnormalities with locally-applied medications could arise if large amounts are applied, the skin is damaged, or the medications are applied under occlusion, to increase the absorption.

• Most medications administered orally for psoriasis result in fetal damage and should be avoided in pregnancy. One such medication, acitretin, is absolutely contraindicated due to its ability to cause serious malformations in the fetus. The medication should be stopped much before the woman plans to conceive. Other drugs like methotrexate and mycophenolate mofetil have also been proved to harm the fetus and should be avoided.
• Phototherapy or light therapy with broadband or narrow band ultraviolet B appears to be a safe option for treating psoriasis in pregnancy. Cyclosporin A also appears to be safe and may be considered as an option.
Thus, a careful assessment of the woman’s condition with psoriasis is required during pregnancy. Counseling may be necessary to relieve mental stress. The drug therapy has to be especially monitored to ensure a safe pregnancy and healthy baby.
Reference:
1. Psoriasis and the Pregnant Woman: What are the Key Considerations?; Jennifer M. Landau et al;Skin Therapy Letter.com. http://www.skintherapyletter.com/2011/16.9/1.html
Source-Medindia