Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Am Acad Dermatol. 2012 Sep;67(3):459-77. doi: 10.1016/j.jaad.2011.07.039. Epub 2011 Oct 22.
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.
Our aim was to arrive at consensus recommendations on treatment options for psoriasis in pregnant and lactating women.
The literature was reviewed regarding all psoriasis therapies in pregnant and lactating women.
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-α 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.
There are few evidence-based studies on treating psoriasis in pregnant and lactating women.
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.
治疗妊娠和哺乳期妇女的银屑病具有特殊的挑战性。由于伦理原因，尽管这些患者除了病情恶化外，还会出现新发银屑病，并且在整个怀孕期间可能需要治疗，但尚未对这一患者群体进行前瞻性随机对照试验。
我们旨在就妊娠和哺乳期妇女的银屑病治疗选择达成共识建议。
对妊娠和哺乳期妇女所有银屑病治疗方法的文献进行了回顾。
对于患有局限性银屑病且处于妊娠或哺乳期的患者，外用疗法包括润肤剂和低至中效外用类固醇是一线治疗方法。对于孕妇的二线治疗，共识是如果无法使用窄谱紫外线 B 光疗，则选择窄谱或宽谱紫外线 B 光疗。最后，肿瘤坏死因子-α抑制剂（包括阿达木单抗、依那西普和英夫利昔单抗）、环孢素和全身类固醇（在第二和第三孕期）可谨慎使用。可以采用一些特定策略来最大程度地降低风险和暴露。
关于治疗妊娠和哺乳期妇女银屑病的循证研究较少。
由于将妊娠和哺乳期妇女置于前瞻性临床试验中总会存在伦理问题，因此不太可能对传统和生物制剂进行调查。一些用于治疗银屑病的这些药物已知是堕胎药、诱变剂或致畸剂，必须明确避免，但在适当咨询风险和收益的情况下，其他药物可以在某些合适的患者中相对有信心地使用。
