Mervic Liljana
Chamber of Dermatovenereology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. Corresponding author:
Acta Dermatovenerol Alp Pannonica Adriat. 2014;23(2):27-31. doi: 10.15570/actaapa.2014.7.
Psoriasis is not uncommon in the reproductive years and therefore in pregnant patients. There are limited data about the impact of psoriasis on the course and prognosis of pregnancy and about the impact of pregnancy on the course of psoriasis. Usually the disease improves during pregnancy and patients experience worsening between 4 and 6 weeks after delivery. A safe option for patients with limited disease is topical therapy, including moisturizers and topical steroids as well as UVB phototherapy. In the case of active psoriasis or even psoriasis worsening during pregnancy, there might be a need for continuation or even introduction of systemic therapy. Methotrexate and acitretin are known teratogens and mutagens, and they must be avoided. Ciclosporin may be regarded as a possible rescue therapy for pregnant psoriasis patients in the case of severe disease. Post-marketing experience regarding the safety of biologics is accumulating, with largely reassuring results. All four biologics approved for the treatment of moderate to severe psoriasis--etanercept, infliximab, adalimumab, and ustekinumab--are not currently recommended in pregnant psoriasis patients. The existing evidence implies that the risk of biologics in pregnancy is relatively low and that the risk of fetal drug exposure may be outweighed by the benefits for the mother.
银屑病在育龄期并不罕见，因此在孕妇中也较为常见。关于银屑病对妊娠过程及预后的影响，以及妊娠对银屑病病程的影响，相关数据有限。通常情况下，疾病在孕期会有所改善，而患者在产后4至6周病情会加重。对于病情较轻的患者，一种安全的选择是局部治疗，包括使用保湿剂、局部类固醇以及紫外线B光疗。如果在孕期出现活动性银屑病甚至病情加重，可能需要继续甚至开始全身治疗。甲氨蝶呤和阿维A是已知的致畸剂和诱变剂，必须避免使用。对于重症孕妇银屑病患者，环孢素可被视为一种可能的挽救治疗方法。关于生物制剂安全性的上市后经验正在积累，结果大多令人放心。目前，治疗中度至重度银屑病获批的四种生物制剂——依那西普、英夫利昔单抗、阿达木单抗和乌司奴单抗——均不推荐用于孕妇银屑病患者。现有证据表明，生物制剂在孕期的风险相对较低，胎儿药物暴露的风险可能会被对母亲的益处所抵消。
