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Psoriasis is a complex autoimmune disease, most commonly characterized by silvery scale erythematous plaque. During pregnancy, there is a physiologic change of immunology status, which shifts from an inflammatory state to an anti-inflammatory state, in order to avoid fetal rejection. As a result of this immunomodulatory changes, the majority of pregnant patients experience improvement of their psoriasis. The treatment of psoriasis in pregnancy can be challenging, mainly because there is only a few evidence-based studies. The objective of this paper is to review the relevant data on psoriasis in pregnancy and its treatment.
2. Feldman SR. Epidemiology, clinical, manifestations, and diagnosis of psoriasis. [Updated 2019 Aug 6]. In: UpToDate [Internet]. Available from: https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-psoriasis (accessed 31 October 2019).
3. Lebwohl M, Ting PT, Koo JY. Psoriasis treatment: traditional therapy. Annals of the rheumatic diseases. 2005 Mar 1;64(suppl 2): ii83-6.
4. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Archives of internal medicine. 2000 Mar 13;160(5): 610-9.
5.. Ryan S. Psoriasis: characteristics, psychosocial effects and treatment options. British journal of nursing. 2008 Mar 13;17(5): 284-90.
6. Reali E, Brembilla NC. Editorial: Immunology of psoriatis disease.Frontiers in Immunology. 2019 Mar 29;10(657):1-3.
7. Blauvelt A, Ehst B. Patophysiology of plaque psoriasis. [Updated 2019 Apr 30]. In: UpToDate [Internet]. Available from: https://www.uptodate.com/contents/ pathophysiology-of-plaque-psoriasis (accessed 31 October 2019).
8. Robinson, D. P., & Klein, S. L. (2012). Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Hormones and behavior, 62(3), 263-271.
9. MacLean MA, Wilson R, Thomson JA, Krishnamurthy S, Walker JJ. Immunological changes in normal pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1992 Feb 28;43(3): 167-72.
10. Hoffman MB, Farhangian M, Feldman S. Psoriasis during pregnancy: characteristics and important management recommendations. Expert Rev. Clin. Immunol. 11(6), 709–720 (2015)
11. Yip L, McCluskey J, Sinclair R. Immunological aspects of pregnancy. Clin Dermatol 2006;24(2):84-7
12. Boyd AS, Morris LF, Phillips CM, et al. Psoriasis and pregnancy: hormone and immune system interaction. Int J Dermatol 1996;35(3):169-72
13. Murase JE, Chan KK, Garite TJ, Cooper DM, Weinstein GD. Hormonal effect on psoriasis in pregnancy and post-partum. Archives of dermatology. 2005 May 1;141(5): 601-6.
14. Nolten WE, Rueckert PA. Elevated free cortisol index in pregnancy: possible regulatory mechanisms. Am J Obstet Gynecol 1981;139(4):492-8
15. Weatherhead S, Robson SC, Reynolds NJ. Management of psoriasis in pregnancy. BMJ. 2007 Jun 7;334(7605): 1218-20.
16. Bae YS, Van Voorhees AS, Hsu S, et al. Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2012; 67(3):459-77
17. Dhar S, Seth J, Parikh D. Systemic side-effects of topical corticosteroids. Indian J Dermatol 2014;59(5):460-4
18. Chi CC, Kirtschig G, Aberer W, et al. Evidence-based (S3) guideline on topical corticosteroids in pregnancy. Br J Dermatol. 2011;165(5): 943–952
19. Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol. 2014;70(3):401. e1–e14
20. Vena GA, Cassano N, Bellia G, Colomb\o D. Psoriasis in pregnancy: challenges and solutions. Psoriasis: Targets and Therapy 2015;5:83-95.
21. Lam J, Polifka JE, Dohil MA. Safety of dermatologic drugs used in pregnant patients with psoriasis and other inflammatory skin diseases. J Am Acad Dermatol 2008;59(2):295-315
22. El-Saie LT, Rabie AR, Kamel MI, Seddeik AK, Elsaie ML. Effect of narrowband ultraviolet B phototherapy on serum folic acid levels in patients with psoriasis. Lasers Med Sci. 2011;26(4):481–485.
23. Emer JJ, Frankel A, Zeichner JA. A practical approach to monitoring patients on biological agents for the treatment of psoriasis. The Journal of clinical and aesthetic dermatology. 2010 Aug;3(8): 20.
24. Story, C.M. A major histocompatibility complex class I-like Fc receptor cloned from human placenta: Possible role in transfer of immunoglobulin G from mother to fetus. J. Exp. Med. 1994, 180, 2377–81
25. Porter ML, Lockwood SJ, Kimball AB. Update on biologic safety for patients with psoriasis during pregnancy. Int J Womens Dermatol 2017;3:21–5.
26. European Medicines Agency. Certolizumab pegol (Cimzia) summary of product characteristics [Internet]. [cited 2019 November 8]. Available from: https://www. ema.europa.eu/en/documents/product-information/cimzia-epar-productinformation_en.pdf; 2019.
27. Watson N, Wu K, Farr P, Reynolds NJ, Hampton PJ. Ustekinumab exposure during conception and pregnancy in patients with chronic plaque psoriasis: a case series of 10 pregnancies. Br J Dermatol. 2018;180(1):195-6.