Rademaker Marius, Agnew Karen, Andrews Megan, Armour Katherine, Baker Chris, Foley Peter, Frew John, Gebauer Kurt, Gupta Monisha, Kennedy Debra, Marshman Gillian, Sullivan John
Department of Dermatology, Waikato Clinical Campus, Auckland Medical School, Auckland, New Zealand.
Department of Dermatology, Greenlane Clinical Centre, Auckland, New Zealand.
Australas J Dermatol. 2018 May;59(2):86-100. doi: 10.1111/ajd.12641. Epub 2017 May 23.
The Australasian Psoriasis Collaboration has reviewed the evidence for managing moderate to severe psoriasis in those who are pregnant or are breast-feeding, or planning a family. The severity of the psoriasis, associated comorbidities and specific anti-psoriasis treatment, along with other exposures, can have a deleterious effect on pregnancy outcomes. Psoriasis itself increases the risk of preterm and low birthweight babies, along with spontaneous and induced abortions, but no specific birth defects have been otherwise demonstrated. The baseline risk for a live born baby to have a major birth defect is 3%, and significant neuro-developmental problem is 5%. In Australia, pregnant women with psoriasis are more likely to be overweight or obese, depressed, or smoke in their first trimester, and are also less likely to take prenatal vitamins or supplements. Preconception counselling to improve maternal, pregnancy and baby health is therefore strongly encouraged. The topical and systemic therapies commonly used in psoriasis are each discussed separately, with regards to pregnancy exposure, breast-feeding and effects on male fertility and mutagenicity. The systemic therapies included are acitretin, adalimumab, apremilast, certolizumab, ciclosporin, etanercept, infliximab, ixekizumab, methotrexate, NBUVB, prednisone, PUVA, secukinumab and ustekinumab. The topical therapies include dithranol (anthralin), calcipotriol, coal tar, corticosteroids (weak, potent and super-potent), moisturisers, salicylic acid, tacrolimus, and tazarotene. As a general recommendation, effective drugs that have been widely used for years are preferable to newer alternatives with less foetal safety data. It is equally important to evaluate the risks of not treating, as severe untreated disease may negatively impact both mother and the foetus.
澳大拉西亚银屑病协作组回顾了针对怀孕、哺乳期或计划怀孕的中重度银屑病患者的治疗证据。银屑病的严重程度、相关合并症、特定的抗银屑病治疗以及其他暴露因素，都可能对妊娠结局产生有害影响。银屑病本身会增加早产、低体重儿以及自然流产和人工流产的风险，但尚未发现有其他特定的出生缺陷。活产婴儿出现重大出生缺陷的基线风险为3%，出现严重神经发育问题的风险为5%。在澳大利亚，患有银屑病的孕妇在孕早期更有可能超重或肥胖、抑郁或吸烟，也不太可能服用产前维生素或补充剂。因此，强烈建议进行孕前咨询，以改善母亲、妊娠和婴儿的健康状况。文中分别讨论了银屑病常用的局部和全身治疗方法，涉及妊娠暴露、母乳喂养以及对男性生育能力和致突变性的影响。所包括的全身治疗药物有阿维A、阿达木单抗、阿普米司特、赛妥珠单抗、环孢素、依那西普、英夫利昔单抗、司库奇尤单抗、甲氨蝶呤、窄谱中波紫外线、泼尼松、补骨脂素紫外线A光化学疗法、苏金单抗和乌司奴单抗。局部治疗药物包括地蒽酚（蒽林）、卡泊三醇、煤焦油、皮质类固醇（弱效、强效和超强效）、保湿剂、水杨酸、他克莫司和他扎罗汀。一般建议，多年来广泛使用的有效药物优于胎儿安全性数据较少的新型替代药物。评估不治疗的风险同样重要，因为严重的未治疗疾病可能对母亲和胎儿都产生负面影响。
