Planifier une grossesse chez une patiente avec un psoriasis

Abstract

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.

Keywords: contraception; pregnancy; psoriasis.