Résumé
Le psoriasis est une maladie chronique inflammatoire qui inquiète beaucoup les femmes en âge de procréer. Les questions sont nombreuses sur l’hérédité de cette maladie, son impact sur la grossesse et le futur enfant, et le danger des thérapeutiques utilisées. La meilleure facon de les rassurer est de travailler en collaboration étroite avec les dermatologues. Une consultation préconceptionnelle auprès d’un gynécologue-obstétricien, spécialiste des grossesses pathologiques, est fortement recommandée pour un premier contact et expliquer le suivi de la grossesse. Le psoriasis en tant que maladie n’est pas dangereux pour la grossesse, mais certains traitements seront interdits, impliquant des conseils dès que la patiente est en âge d’avoir un enfant. Le premier trimestre de la grossesse est la période la plus dangereuse. Les complications obstétricales semblent plus fréquentes quand l’atteinte est sévère.
Abstract
Psoriasis is a common chronic inflammatory disorder which worries a lot of women of childbearing age. The questions are abundant about heredity of psoriasis, its effects on the pregnancy and the future child and the risks of the used treatments. The best way to reassure them is to work closely together with the dermatologists. A préconceptionnel consultation by an expert in pathologic pregnancies obstetrician gynaecologist is strongly recommended for a first contact to explain the following pregnancy. Psoriasis is not dangerous for the pregnancy but some treatments will be prohibited. This will justify advices as soon as the patient has a desire to have a baby. The first trimester is the highest-risk period and the obstetrical complications seem increasing when the psoriasis is severe.
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Références
- 1.
Orphanet www.orphanet.net.
- 2.
Maccari F, Fougerouse AC, Esteve E, et al. Crossed looks on the dermatologist’s position and the patient’s preoccupations as to psoriasis and pregnancy: preliminary results of the PREGNAN-PSO study. J Eur Acad Dermatol Venereol 2019; 33: 880–5.
- 3.
Di Lernia V, Ficarelli E, Lallas A, Ricci C. Familial aggregation of moderate to severe plaque psoriasis. Clin Exp Dermatol 2014; 39:801–5.
- 4.
Dauendorffer JN, Ly S. Le psoriasis génital. Groupe maladies anogénitales de la Société Francaise de Dermatologie. https://dermatoinfo.fr/fr/les-maladies-de-la-peau/le-psoriasis-génital-féminin
- 5.
Sarmah S, Muralidharan P, Marrs JA. Common congenital anomalies: environmental causes and prevention with folic acid containing multivitamins. Birth Defects Res C Embryo Today 2016; 108: 274–86.
- 6.
Gutteriez JC, Hwang K. The toxicity of methotrexate in male fertility and paternal teratogenicity. Expert Opin Drug Metab Toxicol 2017; 13:51–8.
- 7.
Remaeus K, Stephansson O, Johansson K, et al. Maternal and infant pregnancy outcomes in women with psoriasis arthritis: a swedish nationwide cohort study. BJOG 2019; 126: 1213–22.
- 8.
Hoffman MB, Farhangian M, Feldman SR. Psoriasis during pregnancy: characteristics and important management recommendations. Expert Rev Clin Immunol 2015; 11: 709–20.
- 9.
Le CRAT: Centre de Référence sur les Agents Tératogènes.
- 10.
Chi CC, Wang SH, Kirtschig G. Safety of topical corticosteroids in pregnancy. JAMA Dermatol 2016; 152: 934–5.
- 11.
Verberne EA, de Haan E, van Titelen JP, et al. Fetal methotrexate syndrome: a systematic review of case reports. Reprod Toxicol 2019; 87: 125–39.
- 12.
Fierens H, Baeck M. Psoriasis et grossesse à l’heure des traitements biologiques à propos d’un cas de grossesse sous Ustekinumab. https://www.louvainmedical.be/fr/revue/avril-2016.
- 13.
Carman WJ, Accortt NA, Anthony MS, Iles J, Enger C. Pregnancy and infant outcomes including major congenital malformations among women with chronic inflammatory arthritis or psoriasis, with and without etanercept use. Pharmacoepidemiol Drug Saf 2017; 26: 1109–18.
- 14.
Porter ML, Lockwood S, Kimball AB. Update on biologic safety for patients with psoriasis during pregnancy. Int J Womens Dermatol 2017; 3: 21–5.
- 15.
Lund T, Thomsen SF. Use of TNF-inhibitors and ustekinumab for psoriasis during pregnancy: a patient series. Dermatol Ther 2017; 30: 1–5.
- 16.
Jaime-Perez JC, Aguilar-Calderon PE, Salazar-Cavazos L, et al. Evans syndrome: clinical perspectives, biological insights and treatment modalities. J Blood Med 2018; 10: 171–84.
- 17.
Bröms G, Haerskjold A, Granath F, Kieller H, Pedersen L, Berglind A. Effect of maternal psoriasis on pregnancy and birth outcomes: A population-based cohort study from Denmark and Sweden. Acta Derm Venerol 2018;98:728–34.
- 18.
Trivedi MK, Vaughn AR, Murase JE. Pustular psoriasis of pregnancy: current perspectives. Int J Womens Health 2018; 10: 109–15.
- 19.
Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation. J Am Acad Dermatol 2014;70:401.e1–14.
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Varlet, MN., Barjat, T. Grossesse et psoriasis : le point de vue du gynécologue-obstétricien. Eur J Dermatol 30, 14–17 (2020). https://doi.org/10.1684/ejd.2020.3887
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Mots clés
- psoriasis
- grossesse
- malformations congénitales
- thérapeutiques
Key words
- psoriasis
- pregnancy
- congenital malformations
- therapeutics