A guide to prescribing systemic treatments for psoriasis during pregnancy, breastfeeding and in those trying to conceive: what does the current evidence suggest?

Clin Exp Dermatol. 2024 Oct 24;49(11):1316-1329. doi: 10.1093/ced/llae209.

Abstract

Psoriasis is a common inflammatory skin condition with an estimated prevalence of 1.5% in the UK. Its management has evolved rapidly over the past 15 years as our understanding of its pathogenesis has progressed. Treatment initiation often overlaps with peak reproductive years, posing specific therapeutic challenges for individuals hoping to conceive. Certain systemic agents are well established to be teratogenic during pregnancy, such as methotrexate and acitretin, but data on newer drug classes for psoriasis remain limited. This literature review evaluated recent data on the systemic agents for psoriasis, explicitly considering the context of male and female fertility, pregnancy and breastfeeding. Our goal was to equip clinicians with an accessible, concise summary of up-to-date evidence to help them educate patients and facilitate informed, shared decision-making aligned with their reproductive health.

Publication types

  • Review

MeSH terms

  • Acitretin / therapeutic use
  • Breast Feeding*
  • Dermatologic Agents* / therapeutic use
  • Female
  • Humans
  • Male
  • Methotrexate / therapeutic use
  • Pregnancy
  • Pregnancy Complications* / drug therapy
  • Psoriasis* / drug therapy

Substances

  • Dermatologic Agents
  • Methotrexate
  • Acitretin