Service de Dermatologie, CHU Brest, Brest, France, Laboratoire interactions épithéliums-neurones, EA 4685, université Brest Occidentale, France.
Eur J Dermatol. 2020 Oct 1;30(S1):18-24. doi: 10.1684/ejd.2020.3886.
Psoriasis is a common inflammatory skin disease that starts before the age of 40 years in 3/4 cases. Pregnancy in a couple where one of the future parents has psoriasis is therefore a frequent situation that the dermatologist may encounter and must anticipate. Contraception should be systematically discussed with psoriatic patients of childbearing age, as it is mandatory with certain treatments (as methotrexate or acitretin). Information for psoriatic women planning to become pregnant seems insufficient. Patients get a lot of information on the internet, with the risk of getting wrong information. Women's questions concern the impact of the disease on the fetus, the treatment of flare-ups during pregnancy, the transmission of the disease and the safety of medication during pregnancy. There was a tendency to consider that psoriasis does not affect fertility in men, but two recent studies have shown inflammation of the genital tract in men with psoriasis, with no evidence of an effect on fertility. Regarding the choice of treatment for psoriasis in men with a paternity project, methotrexate should be avoided in the 3 months prior to conception even though the data on many pregnancies occurring on methotrexate are reassuring. Other treatments can be continued. It does not seem that psoriasis affects women's fertility, however, studies are divergent concerning fertility with sometimes a decrease in fertility which would be multifactorial. Psoriasis is associated with many co-morbidities such as diabetes, obesity, high blood pressure, smoking, depression, and these co-morbidities can also affect fertility. Genital involvement is common in psoriasis and significantly alters the sexual life of patients. This location is important to investigate and treat. In women with psoriasis, the goal during pregnancy will be to keep the skin disease stable with treatment that is compatible with embryonic and fetal life. The risk-benefit balance should be carefully weighted and discussed with the patient. In a patient who is planning to become pregnant, the treatments to be favored will be according to the severity of the psoriasis: topical steroids, UVB, cyclosporine, anti TNFα, notably certolizumab pegol. In a patient who is planning to become pregnant and has already been treated for psoriasis, consideration should be given to the recommended delay between stopping treatment and conception.
银屑病是一种常见的炎症性皮肤病，有 3/4 的病例在 40 岁之前发病。因此，皮肤科医生经常会遇到一对夫妇中的一方有银屑病，而另一方计划怀孕的情况，必须对此有所预期。对于有生育能力的银屑病患者，应系统地讨论避孕问题，因为某些治疗方法（如甲氨蝶呤或阿维 A）是强制性的。计划怀孕的银屑病女性似乎获得的信息不足。患者在互联网上获得了大量信息，但存在获取错误信息的风险。女性的问题主要集中在疾病对胎儿的影响、怀孕期间病情加重的治疗、疾病的传播以及怀孕期间药物的安全性上。有一种倾向认为，银屑病不会影响男性的生育能力，但最近的两项研究表明，银屑病男性的生殖道存在炎症，而对生育能力没有影响。对于有生育计划的银屑病男性患者，即使许多在甲氨蝶呤治疗下怀孕的病例数据令人安心，也应避免在受孕前 3 个月内使用甲氨蝶呤。其他治疗方法可以继续使用。银屑病似乎不会影响女性的生育能力，然而，关于生育能力的研究结果存在分歧，有时生育能力会下降，这可能是多因素的。银屑病与许多合并症有关，如糖尿病、肥胖症、高血压、吸烟、抑郁症，这些合并症也会影响生育能力。银屑病常伴有生殖器受累，显著改变了患者的性生活。这一部位很重要，需要进行检查和治疗。对于患有银屑病的女性，在怀孕期间的目标是通过与胚胎和胎儿生命兼容的治疗方法来保持皮肤疾病的稳定。应仔细权衡风险-效益比，并与患者进行讨论。对于计划怀孕的患者，应根据银屑病的严重程度选择有利的治疗方法：局部类固醇、UVB、环孢素、抗 TNFα，特别是依那西普。对于计划怀孕且已经接受银屑病治疗的患者，应考虑停止治疗与受孕之间的推荐间隔时间。
