Review of treatment options for psoriasis in pregnant or lactating women: From the Medical Board of the National Psoriasis Foundation - 11/08/12
, Sylvia Hsu, MD c, Neil J. Korman, MD, PhD d, Mark G. Lebwohl, MD e, Melody Young, RN f, Bruce Bebo, PhD g, Alexa Boer Kimball, MD, MPH aNational Psoriasis Foundation
Reprint requests: Abby S. Van Voorhees, MD, University of Pennsylvania, Department of Dermatology, 2M44, 3600 Spruce St, Philadelphia, PA 19104.Abstract |
Background |
Treating psoriasis in pregnant and lactating women presents a special challenge. For ethical reasons, prospective randomized control trials have not been conducted in this patient population although these patients do encounter new-onset psoriasis in addition to flares and may require treatment throughout their pregnancies.
Objective |
Our aim was to arrive at consensus recommendations on treatment options for psoriasis in pregnant and lactating women.
Methods |
The literature was reviewed regarding all psoriasis therapies in pregnant and lactating women.
Results |
Topical therapies including emollients and low- to moderate-potency topical steroids are first-line therapy for patients with limited psoriasis who are pregnant or breast-feeding. The consensus was that second-line treatment for pregnant women is narrowband ultraviolet B phototherapy or broadband ultraviolet B, if narrowband ultraviolet B is not available. Lastly, tumor necrosis factor-⍺ inhibitors including adalimumab, etanercept, and infliximab may be used with caution as may cyclosporine and systemic steroids (in second and third trimesters). Some specific strategies may be used to minimize risk and exposure.
Limitations |
There are few evidence-based studies on treating psoriasis in pregnant and lactating women.
Conclusions |
Because there will always be a question of ethical concerns placing pregnant and lactating women in prospective clinical trials, investigation of both conventional and biologic agents are unlikely to ever be performed. Some of these medications used to treat psoriasis are known abortifacients, mutagens, or teratogens and must be clearly avoided but others can be used with relative confidence in select patients with appropriate counseling of risks and benefits.
Le texte complet de cet article est disponible en PDF.Key words : consensus, female, lactation, pregnancy, psoriasis, treatment, women
Abbreviations used : FDA, PUVA, TNF, UV
Plan
| Funding sources: None. |
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| Disclosures: Dr Van Voorhees has served as a consultant/speaker/advisor for Amgen, Abbott, Biogen, Centocor, Genentech, Incyte, Warner Chilcott, Connetics, VGX, and Xtrac. She has been an investigator for Amgen, Astellas, Genentech, Warner Chilcott, Roche, Bristol Myers Squibb, and IDEC. She has served on a drug safety monitoring board for Synta. She also is a stockholder and owns stock options in Merck. Dr Hsu has been a consultant for Abbott, Amgen, Biogen Idec, Centocor, and Genentech. She has been a clinical investigator for Amgen and Centocor. Dr Korman has served on the Advisory Board and was an investigator and speaker for Abbott and Astellas, receiving grants and honoraria; served on the Advisory Board and was an investigator for Celgene and Pfizer, receiving grants and honoraria; was an investigator for Amgen, receiving grants; and was an investigator and speaker for Centocor, receiving grants and honoraria, as well as residency/fellowship program funding. Dr Lebwohl has been a consultant for Abbott, Amgen, Astellas, Centocor, Genentech, UCB Pharma, Stiefel, Triax, Pharmaderm, Medicis, Novartis, and Warner Chilcott. He has been a speaker for Abbott, Amgen, Astellas, Centocor, and Genentech. Ms Young has been a consultant or speaker for Abbott, Amgen, Astellas, Biogen Idec, Centocor, and Genentech. Dr Bebo is employed by the National Psoriasis Foundation, which receives unrestricted financial support from Abbott, Centocor, Amgen, Wyeth, Genentech, Astellas, Stiefel, Galderma, Warner Chilcott, and Photomedix. Dr Kimball is an investigator and consultant for Abbott, Amgen, and Centocor. Dr Bae has no conflicts of interest to declare. |
Vol 67 - N° 3
P. 459-477 - septembre 2012 Retour au numéro
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