Psoriasis and Pregnancy

To identify the relationship between hormonal changes and course of psoriasis have been several studies. However, many women and so point out that pregnancy makes their disease and menopause — worse. According to experts, the changes of the flow of psoriasis at different stages of their reproductive years, women due to hormonal fluctuations, but we can not exclude the actions of other, yet unknown, factors.

Psoriasis — a chronic skin disease caused by genetic, immunological and environmental factors. External factors that can trigger the disease include stress, use of certain drugs, and infectious diseases. Hormonal fluctuations in women may also influence the course of the disease, leading to the appearance of new lesions or, on the contrary, improving the skin condition.

Most women noted that in time pregnancy, the disease is more easily, and after the birth of her flow becomes more difficult. During menopause, the disease often becomes Bole severe. Moreover, Psoriasis often begins during menopause.

While the relationship between hormonal changes and the passage of psoriasis has been studied in several studies, is still unknown what hormonal mechanisms trigger psoriasis and affect its course.

It is believed that the development and exacerbation of disease may be due to other, non-hormonal factors. According to some experts, the frequent onset of psoriasis during adolescence necessarily means that the sole cause of the disease are hormonal changes. Perhaps this is the result of a special genetic program.

Although some women report that they psoriasis depends on the stage of the menstrual cycle, no studies suggest that the hormonal fluctuations during the menstrual cycle can affect the course of the disease. There is also clear evidence that oral contraceptives have a positive or negative effect on psoriasis.

 

What do pregnant women?

Psoriasis is not a barrier to pregnancy and does not violate the reproductive function in women.

Many psoriasis patients are afraid that their disease can pass on to their children. Since psoriasis is contagious, you can safely breastfeed and pressed it without fear of transmitting the disease. However, psoriasis can have a genetic predisposition. According to studies, sick if one of the parents, the risk of transmission of psoriasis seed is 8-15%, if both — from 50% to 60%.

Women with psoriasis are often afraid of getting pregnant. They ask questions — whether the disease will not break a child's development, whether they can feed him, not whether the pregnancy will exacerbate psoriasis, do not hurt whether their treatment of the child?

Psoriasis pregnant difficult, especially if it is severe. During pregnancy, women should discontinue the majority of drugs for systemic use, as they can lead to disruption of fetal development.

If a woman is planning to become pregnant, she should please inform the dermatologist. Then the dermatologist will be able to decide whether to continue the pregnancy during the previous treatment of psoriasis, and assign a different treatment if need be.

Women suffering from psoriatic arthritis during pregnancy may feel increased pain in the joints due to weight gain.

Most of the studies in pregnant shows that pregnancy affects the course of psoriasis.

U.S. study * involving 248 women with psoriasis revealed the hormonal changes that occur during pregnancy and at menopause, which can have an effect on psoriasis.

The study showed that 30-40% of women surveyed during pregnancy psoriasis took a mild course, which is usually observed in the I trimester of pregnancy. About 20% of women reported that pregnancy worsened their illness, others do not notice any changes. The study also found that age, pregnant women and the severity of psoriasis does not influence its course. In another study, pregnancy improves the condition of patients with psoriasis in 63% of cases. In some women during pregnancy, there is a significant improvement, as manifested in the areas of hypopigmentation defeat.

Changes in current psoriasis (for the worse or better) during the first pregnancy can predict how it will proceed in future pregnancies. The previous study showed that 87% of mothers with several children, each pregnancy was accompanied by similar changes in psoriasis.

Although the reasons for improvement of the patients with psoriasis during pregnancy are not known, it is possible to give some explanation. Some researchers believe that this improvement is due to higher levels of estrogen and progesterone. Perhaps the transient immunosuppressive effect of these hormones suppress the autoimmune response in psoriasis.

Other researchers emphasize the positive role of cortisone. The fact that cortisone anti-inflammatory action and, during pregnancy, the level rises in the body, so inflammation due to psoriasis, becomes less pronounced (as when applying cortisone cream).

It is obvious that the positive effect of pregnancy on psoriasis is caused by many factors. Perhaps the most important of these is the increase in cortisol levels in pregnant secreted by the adrenal glands and the mother and fetus. But it is equally probable, and that this may be due to other, as yet unidentified, substances.

In a number of cases (less than a quarter), pregnancy has a negative effect on psoriasis.

The reasons for this, as already mentioned, is unknown, but it is possible that it may be a stress-related hormone metabolism disorders.

Some women began psoriasis during pregnancy.

Impetigo herpetiformis — one of the clinical variants of generalized pustular psoriasis that occurs normally during pregnancy.

It is extremely difficult, but fortunately very rare form of psoriasis. It usually develops in the III trimester of pregnancy or immediately after delivery.

About a third of women suffering from this form of the disease, psoriasis started earlier or refer to a family history of psoriasis.

It is estimated that by the exacerbation of pustular psoriasis in pregnant and hormonal fluctuations result in violation of the metabolism of vitamin D.

Defeat often begins with a skin fold. Throughout the abdomen and groin area rife red plaques, sometimes accompanied by itching. Pustules appear around the plaques. Sometimes in the pathological process involved mucous membranes.

Impetigo herpetiformis is accompanied by a deterioration of the general state of health. Along with other symptoms, patients may experience nausea, fever, and mental disorders.

Glucocorticoids are generally not effective, so during exacerbations often prescribe antibiotics.

This form of psoriasis often has dire consequences for the fetus, in half of the cases leading to miscarriage.

Pustular psoriasis, which arose during pregnancy, after birth usually goes. Although 82% of cases it develops during the first pregnancy, the risks of retained in subsequent pregnancies.

In the first three months after giving birth, most women with psoriasis, skin rash re-appear, including in those areas where previously there were improvements. The data from different studies are mixed.

Some studies show that about 88% of women in the first four months after giving birth psoriasis aggravated.

According to a study conducted in the U.S., 41% of women immediately postpartum exacerbation occurs, however, 55% of women do not note any changes in the nature of the disease during this period.

 

Treatment during pregnancy

Selection of treatments for psoriasis during pregnancy is low, because most of them are toxic to the fetus.

During pregnancy, psoriasis can become easier, thus reducing the dose or stop certain medications.

Pregnant women should be closely monitored for the skin, preventing it from drying.

 

Local treatment

Since most of the drugs for systemic use during pregnancy have to cancel, the dermatologist is to appoint
a means of local therapy.

However, these drugs are not without side effects as they may be absorbed through the skin. Some of them are contraindicated in pregnant women, as are teratogenic. With the exception of emollients that pose no threat to the mother or fetus, the remaining funds for the local treatment can be applied only to limited areas of the skin.

Local media, the use of which should be avoided during pregnancy:

Derivatives of vitamin A — are contraindicated in pregnancy because of their teratogenic.

Derivatives of vitamin D — can be used in very small quantities and in very limited areas of the body.

Permitted by the local media:

Emollients — soothing and moisturizing creams can be used without any risk.

Glucocorticoids (cortisone) — can sometimes be used in small quantities for a very limited areas of the skin. These drugs may increase the risk of stretch marks, so they should not be applied to the skin in certain areas of the body, including the breasts, abdomen and shoulders.

Exfoliating agents, including urea and salicylic acid — may be used in restricted areas of the skin.

 

Systemic treatment

Most of the funding for the systemic treatment of psoriasis has a teratogenic effect, ie, they can lead to severe fetal anomalies. Teratogenic risk is particularly high in the I trimester of pregnancy. Therefore, most drugs for oral administration during pregnancy overturned.

Preparations for systemic effects, the use of which should be avoided during pregnancy:

Acitretin (and other retinoids), and methotrexate — can cause severe birth defects and lead to spontaneous abortion. During treatment with these drugs women should use contraception. Plan pregnancy You can take a few months after withdrawal of these drugs (after the abolition of acitretin must pass two months after discontinuation of methotrexate — four months) to wait for their complete elimination from the body.

It should be noted that methotrexate affect spermatogenesis. Therefore, if a man uses methotrexate, during treatment and for three months after its cancellation married couple should use contraception.

PUVA-therapy — may pose a threat to the fetus, since the UV radiation before the session the patient uses psoralens (photosensitizing agent).

Tools for systemic effects, admissible in psoriasis with extensive lesions during pregnancy:

Cyclosporine — safe for the fetus, but has side effects on the body of the mother. Resolved during pregnancy only if severe psoriasis.

Phototherapy using UV-B — narrow band phototherapy used for the treatment of extensive lesions in psoriasis is safe during pregnancy.

 

Lactation

Women with psoriasis, including those who became ill during pregnancy and after childbirth can breastfeed.

Avoid breastfeeding is only for women who used drugs for systemic effects or local funds for large areas of the skin, because these drugs can be absorbed into the milk and hit him in the body of the child

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