Université Claude-Bernard Lyon I, Hospices Civils de Lyon, service de dermatologie, hôspital Edouard Herriot, Lyon, France.
Eur J Dermatol. 2020 Oct 1;30(S1):8-13. doi: 10.1684/ejd.2020.3884.
Psoriasis typically affects young adults and therefore many women with a desire to become pregnant or already pregnant. In this particular situation, treatment can be a real challenge for some patients, especially in the case of severe forms. In addition to local treatments, which are generally well tolerated, UVB phototherapy and cyclosporin remain the first-line systemic treatments. Acitretin and methotrexate are contraindicated. Safety data regarding the administration of biologic agents during pregnancy, are reassuring, the main adverse event being immunosuppression of the newborn if treatment is not discontinued. Biologic agents should ideally be discontinued before pregnancy, but in case of absolute necessity, they can be maintained or even initiated during pregnancy. Overall, it is recommended that biologic agents should not be continued beyond the second trimester because of the risk of maternal-fetal infection. If a biologic agent should be initiated during pregnancy, tanercept or certolizumab will be preferred, because of their low transplacental passage and more extensive safety data.
银屑病通常影响年轻人，因此许多有生育愿望或已经怀孕的女性都会受到影响。在这种特殊情况下，治疗对某些患者来说可能是一个真正的挑战，尤其是在严重的情况下。除了一般耐受性良好的局部治疗外，UVB 光疗和环孢素仍然是一线系统治疗方法。阿维 A 酯和甲氨蝶呤禁忌使用。关于在怀孕期间使用生物制剂的安全性数据令人安心，主要不良事件是如果不停止治疗，新生儿的免疫抑制。生物制剂理想情况下应在怀孕前停药，但如果绝对必要，即使在怀孕期间也可以维持或甚至开始治疗。总体而言，建议不要在妊娠中期后继续使用生物制剂，因为有母婴感染的风险。如果在怀孕期间开始使用生物制剂，由于其胎盘通透性低且安全性数据更广泛，应首选替拉那单抗或certolizumab。
