Psoriasis: Considerations for the Management of Women of Childbearing Potential.

Abstract

As women of childbearing potential constitute a considerable portion of the total psoriasis population, dermatologists must consider both the clinical and psychosocial implications of psoriasis when treating these patients. This review summarizes key clinical considerations when treating women of childbearing potential with psoriasis, regarding family planning, pregnancy, and the postpartum period, aiming to assist in identifying common concerns within this population. Many women report initiating the discussion on family planning but having limited access to information. Concerns about the impact of psoriasis and its treatment on fertility, pregnancy, and lactation are common, and lack of adequate information can lead to irrevocable decisions. Despite conflicting results, current evidence suggests a potential negative correlation between moderate-to-severe psoriasis and fertility. Studies on adverse maternal and neonatal events associated with psoriasis show inconsistent outcomes and should be communicated with caution. With the increase in available treatment options during pregnancy and lactation, particularly in cases of severe psoriasis, personalized treatment plans are becoming more achievable, allowing dermatologists to better address the needs of their patients. The majority of patients can be treated during pregnancy with topical treatments or ultraviolet-B irradiation. While the general recommendation is to stop systemic treatment before conception, decisions should be made on an individualized basis. If treatment cannot be discontinued, tumor necrosis factor-α inhibitors and cyclosporine can be used. It is essential to inform parents of the additional risks associated with live or live-attenuated vaccines in cases where the mother has received systemic treatment during pregnancy and to delay vaccinations accordingly.