Psoriasis during pregnancy: what is dangerous and how to treat it

A pregnant woman experiences major changes in her hormonal and immune systems, so during pregnancy complications and diseases may arise that the female body has not encountered before. One of the diseases that can complicate pregnancy is psoriasis. What is the reason for its appearance in the body of a healthy woman, how can this disease affect the course of pregnancy and how to treat it correctly?

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Epidemiology

This disease is considered hereditary and cannot be transmitted.

According to medical research, psoriasis affects 1 to 3% of the world's population, more often this disease occurs in young people (about 75%), less often in older people (about 25%), male and female populations suffer from this disease equally.

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Causes psoriasis in pregnancy

Psoriasis, or as it is called, scaly lichen, is a non-infectious organ-specific autoimmune dermatological disease. With this pathology, both the skin and hair and nails are affected.

The cause of psoriasis during pregnancy can be a huge stress load on the woman's body. During this period, global changes occur in the hormonal system of the female body, which can negatively affect the immune system, weakening it. Stress can be a trigger for the disease. Therefore, pregnant women are advised to avoid worries. The condition of the intestines and liver play a major role. It is necessary to monitor their work, prevent slagging of the body and the ingress of toxins. Lack of vitamin D also negatively affects the condition of the skin, so it is necessary to replenish the body's need for this vitamin and more often be exposed to sunlight.

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Risk factors

Although any woman can get psoriasis, there are still certain factors that can provoke or accelerate the disease:

• hereditary factor (if any of your relatives had this disease);
• viral and infectious diseases such as HIV, streptococcal infection;
• strong psycho-emotional stress;
• prolonged exposure to cold climate conditions;
• use of certain medications;
• excessive alcohol consumption, smoking;
• skin injuries;
• obesity.

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Pathogenesis

The pathogenesis of the disease is not fully understood, but the following theories stand out:

• hereditary;
• infectious;
• neurogenic;

There are three stages in the development of psoriasis:

• sensitization (accumulation);
• latent (hidden);
• effector.

In its form and structure, this disease is characterized by increased muscle activity, with accelerated proliferation of cells in the outer stratum corneum (epidermis), as a result of which the cells of the lower layers of the skin push out the upper cells, without allowing them to mature to keratinization.

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Symptoms psoriasis in pregnancy

The main clinical manifestation of this disease is a rash. The first signs of the disease appear as lesions on the skin, localized in skin folds, in the groin area and on the abdomen. Mucous membranes may be affected. The rash looks like pinkish or whitish papules of a round shape. Then psoriatic plaques can spread to other areas of the skin, including the scalp. Very often, the rash is localized on the extensor surfaces of the lower and upper extremities. In places of rash, the skin becomes dry, cracks, and may bleed. Itching occurs. In addition, nails are often affected. With psoriasis, joint pain may also occur. The disease is accompanied by general weakness, increased fatigue, and a depressed psychoemotional state.

Stages

According to the development of the disease, psoriasis is divided into three stages:

• progressive (characterized by the emergence of new lesions);
• stationary (there are no new rashes, the lesions are not increasing).

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Forms

Psoriasis is divided into several types, depending on the size and shape of the rash.

• punctate (the size of papules is the size of a pinhead);
• teardrop-shaped (slightly more point-shaped in size, in the form of a drop)
• coin-shaped (rashes are represented by large round plaques);
• figured (large lesions of the skin, figured in shape);
• annular (the shape of the rash resembles rings);
• geographic (affected areas merge, resembling a geographic map);
• serpiginous (constantly growing lesions of the skin).

In addition, according to the degree of severity, three forms of pathology are distinguished:

• mild (1-3% of the skin is affected);
• moderate severity (3–10% of the skin is affected);
• heavy.

The most severe forms of psoriasis include pustular (rashes with purulent contents, accompanied by reddening of the skin and its swelling) and arthropathic (joints, both small and large, are involved in the inflammatory process, which can lead to deformation of bones and limitation of joint mobility). If the pustular form of the disease began to develop during pregnancy, then after delivery the psoriasis goes away.

In more than half of cases, scalp psoriasis is observed. If the disease is neglected and neglected, it can lead to more severe forms of psoriasis. When the disease is localized on the scalp, the skin behind the ears, above them, and the earlobes are most often affected; the skin in the frontal and occipital parts of the head; on the back of the neck; in the hair parting. At the very beginning of the disease, several pinkish spots may form, without clear boundaries and inflammatory processes of the skin. Severe peeling of the scalp, resembling dandruff, is possible. With this mild degree of the disease, differential diagnosis is difficult, since its symptoms are very similar to the clinical manifestations of other dermatoses of the scalp. The most common sign of scalp psoriasis is the so-called psoriatic crown. In this case, the process of transition from the scalp to the skin in the forehead, back of the head, above and behind the ears is visible. Since the pathological process occurs in the upper layer of the epidermis and does not affect the hair follicles, this disease does not affect hair loss and growth.

If this disease is not treated seriously enough, psoriasis from the scalp will spread to other, healthy areas of the skin.

The classification of scalp psoriasis by severity and form of the disease is similar to the general classification of psoriasis.

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Complications and consequences

The course of the disease in mild and moderate severity has practically no effect on the condition of the pregnant woman and does not have negative consequences for either the woman herself or the fetus.

It is much more dangerous when, due to the coincidence of a number of negative factors affecting the body of a pregnant woman, complications may arise that can lead to serious consequences.

A very severe and dangerous complication that can threaten the life of the expectant mother and her child is generalized pustular psoriasis. This complication can be provoked by a hormonal imbalance, production and absorption of vitamin D by the female body. The onset of the disease is sudden, accompanied by the appearance of bright red erythema on the skin, huge areas of the skin are affected, on which small papules are formed - skin formations in the form of a rash, rising above the skin. Papules appear in large quantities, merge and pustules with purulent contents are formed in their place. Along with skin pathological processes, clinical symptoms of a general nature are observed: general weakness, a sharp increase in body temperature, chills, which are accompanied by a headache, loss of appetite, nausea and vomiting, mental disorders. This condition of a pregnant woman can lead to premature birth. Treatment must be started immediately. Symptoms disappear after termination of pregnancy. Pustular psoriasis complicated by secondary infection can lead to sepsis and then to death. With timely and proper treatment, pustules heal, and other general symptoms subside.

Another severe form of psoriasis is arthropathic psoriasis, which can lead to joint damage – psoriatic arthritis. At first, smaller joints are involved in the pathological process, then the inflammation spreads to medium joints, and then large joints are affected. As the disease progresses, cartilage tissue and tendons are involved in the inflammatory process. The clinical picture of the disease includes swelling and pain in the joints, the skin in the joint area becomes purple, and movement in the joints is limited. If left untreated, this form of arthritis leads to resorption and atrophy of bone tissue. Human motor function is impaired. Then, the connective tissue of the vessel walls joins the inflammatory process. In this case, we can talk about generalized psoriatic arthritis.

• Metabolic disorder.

One of the complications in severe forms of psoriasis may be a violation of metabolic processes in the body. As a result, the cardiovascular system suffers. As a result, such diseases as stroke, ischemic and hypertension, inflammation of the heart muscle (myocarditis), mitral valve disease, impaired nutrition of the heart muscle (myocardial dystrophy), renal failure, non-bacterial inflammation of the urethra and bladder, and in severe cases, the development of oncology may develop.

• Damage to mucous membranes and impact on vision.

If psoriasis is not treated, the disease progresses and can lead to damage to the mucous membranes of internal organs. In this case, the organs of the gastrointestinal tract suffer.

Ophthalmological complications include conjunctivitis (inflammation of the mucous membrane of the eye), scleritis (inflammation of the outer membrane of the eye), iritis (inflammation of the iris), uveitis (inflammation of the blood vessels of the eye). These diseases are not bacterial in nature, and with timely and proper treatment, these complications are curable.

• Psoriatic erythroderma.

This also applies to severe complications and usually occurs in untreated and advanced cases. In this case, almost all skin is affected, and the skin cannot cope with its physiological functions. Thermoregulation, respiratory and excretory functions of the skin are disrupted. The consequences of this complication can be septic blood poisoning and death.

• Nervous system disorders.

In some severe forms of psoriasis, damage to the central nervous system and brain may occur. Encephalopathy (organic non-inflammatory brain damage) develops, which can lead to epileptic seizures, the development of convulsions. Atrophy, accompanied by weight loss and muscle weakness.

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Diagnostics psoriasis in pregnancy

The basis for diagnosing psoriasis during pregnancy is a clearly expressed clinical picture and the patient's medical history. A dermatologist must identify a hereditary connection in the occurrence of the disease, factors that could provoke the disease. This disease is characterized by the presence of a psoriatic triad: staerine (waxy) spots, psoriatic film and bloody dew.

The following types of laboratory and instrumental diagnostics are provided.

A histological examination is prescribed, which may reveal keratoderma (hyperkeratosis - increased keratin content in the epidermis), the absence of the corium (dermis) with a granular surface and the germinal (spiny) layer of the epidermis.

A laboratory blood test is prescribed: general clinical and biochemical blood tests. A number of studies are also carried out (ECG, ultrasound of internal organs, radiography) in order to determine in which organs and systems the disorders occurred and what is the general condition of the pregnant woman's body.

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Differential diagnosis

Of great importance is differential diagnostics, the purpose of which is to exclude other skin diseases with similar symptoms, such as: seborrheic eczema, various dermatoses, papular syphilis, lichen planus and lichen pink, neurodermatitis, systemic lupus erythematosus, Reiter's syndrome (reactive uroarthritis).

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Treatment psoriasis in pregnancy

The treatment of this disease in a pregnant woman must be approached very carefully and systematically. If the disease was diagnosed in the patient before pregnancy, it is necessary to take into account that the drugs used to treat psoriasis have a teratogenic effect (negative toxic effect on the fetus, leading either to congenital anomalies or can provoke a miscarriage, fetal fading). When using these drugs, it is necessary to resort to the use of contraceptives, and it is necessary to plan a pregnancy 3-4 months after discontinuing the drugs. We are talking, first of all, about such drugs as acitretin (including other retinoids), methotrexate.

During pregnancy, it is recommended to resort to local therapy, using moisturizing and soothing agents (creams, lotions and oils). From exfoliating agents, you can use salicylic acid and urea. Cortisone is an approved drug for local therapy during pregnancy. However, its use should be minimized. The drug cortisone does not have a harmful effect on the mother's body, as well as on the unborn child, but under its influence, stretch marks may appear on the skin. The main external remedies for psoriasis during pregnancy are ointments, due to their soft and gentle effect on the epidermis affected by the disease.

• Salicylic acid.

Ointment containing salicylic acid in concentrations of 2%, 3%, 4%, 5% and 10%.

For psoriasis, a 2% ointment is most often used. A thin layer is applied to the affected area 1-2 times a day.

Of the side effects, local allergic reactions were rarely observed.

Do not apply the ointment to mucous membranes, warts, birthmarks. If the medicine gets on the mucous membranes, rinse with plenty of water.

• Urea.

In medicine it is used as an anti-edematous (dehydrating) and diuretic agent.

For psoriasis, a 10% cream and 30% ointment are used, which are applied in a thin, even layer to the affected areas of the epidermis 1-2 times a day.

When applied externally, the following side effects of the drug on the body are possible: local allergic reaction, itching and hyperemia of the skin.

Urea should be stored in a sealed package, in a dry place, at a temperature of no more than 25 C. The shelf life is 24 months from the date of manufacture of the drug.

• Cortisone.

1% hydrocortisone ointment for topical external use.

1-3 times a day apply a thin, even layer to the affected skin area. For better absorption into the epidermis, apply the ointment with light movements, massaging the skin.

No side effects were observed when this product was used externally.

This drug should be stored in a dry, dark place at room temperature.

• Zinc ointment.

An ointment based on zinc oxide.

It has antiseptic, astringent, anti-inflammatory, softening and drying effects.

Side effects occur extremely rarely, with individual hypersensitivity to the components of the ointment. In this situation, a burning sensation, dry skin, hyperemia may occur.

Storage conditions for zinc ointment include a cool, dry place at a temperature not exceeding 25 C.

Stop using the ointment after 24 months from the date of manufacture.

• Cream Zinokap.

It has anti-inflammatory and antifungal effects, reduces the feeling of burning and itching, and is a good antipsoriatic agent.

Apply 2-3 times a day to areas of skin affected by psoriasis.

Side effects are observed very rarely, as a rule, they manifest as a local allergic reaction to the drug: dry skin and redness at the site of application of the ointment.

The drug must be stored in a dark place at a temperature of no more than 25 C.

The shelf life is no more than 24 months after the product is released.

Physiotherapy treatment for psoriasis

The most common method of local treatment of psoriasis during pregnancy remains phototherapy (ultraviolet treatment). This method is completely safe for both the mother's body and the child.

In addition, for this pathology, you can resort to the following physiotherapeutic procedures: ultraviolet irradiation of blood, cryotherapy, excimer laser, ozone therapy, hypnosis, electrical stimulation, magnetic resonance therapy.

Pregnant women with psoriasis are recommended to take vitamins. Also, it should be taken into account that derivatives of vitamins A and D are prohibited for use in psoriasis during pregnancy, since these drugs have a teratogenic effect and can cause the development of abnormalities in the fetus.

Alternative medicine

In addition to drug and physiotherapy treatment, you can use traditional medicine methods. Of the folk remedies, various means for external use are mainly used. Let's consider some of them in more detail.

• Treatment with propolis.

To prepare a propolis-based product (a product of bees' vital activity), take 250 ml of vegetable oil, boil it, then after adding 25 g of propolis, thoroughly mix the resulting mass until smooth. This product is used to apply compresses to the affected areas of the skin for 1-2 days after preliminary treatment of the problematic areas of the epidermis with a hydrogen peroxide solution.

• Aloe juice.

A very effective folk remedy for psoriasis, it is necessary to use the juice of a plant that has reached three years of age to treat the disease. Aloe juice contains a large number of bioactive substances: vitamins, polysaccharides, micro and macro elements, enzymes. The juice of this cactus is a powerful healing and astringent agent, as well as a powerful biostimulant that helps to increase immunity.

Before cutting aloe leaves, it is necessary to stop watering the plant 2 weeks before, thus creating an artificial drought for it. Place the cut leaves in a cool, dark place for 5 days, then prepare juice from them. Treat problem areas of the skin with this remedy several times a day until the rash disappears completely.

• Celery juice.

It is used both externally and internally. Grind the celery root to a mushy state and spread the resulting solution on the affected areas of the epidermis for 2 hours. Take freshly prepared celery root juice orally, 2 tablespoons 3 times a day. The duration of treatment with this method is 2 months.

• Birch tar ointment.

Dilute ready-made pharmacy birch tar with sunflower oil in proportions of 1:1. Treat the affected areas of the skin with this mixture.

• Sea buckthorn oil.

Purchase ready-made 5% sea buckthorn oil from a pharmacy and treat problem skin areas with it 1-3 times a day.

• Herbal baths.

Pour 100 g of celandine herb into 4 liters of cold water, bring to a boil, cover and let it brew for 1 hour. Strain the resulting decoction and add it to a bath filled with water at 40 - 45 C. Take a herbal bath for 5-10 minutes every day.

Herbal baths with the addition of decoctions of the following plants also have a positive effect in the treatment of psoriasis: succession, chamomile, mint, and birthwort.

In the treatment of psoriasis in folk medicine, decoctions and tinctures of some plants are used, however, many of them have a large number of contraindications for pregnant women, therefore, treatment with folk remedies at various stages of pregnancy and during lactation is recommended to be limited to external use.

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Homeopathic medicines used for psoriasis.

• Psoriaten ointment.

Contains matrix tincture of Mahonia aquifolium. After cleansing the skin, rub in with light massaging movements into the affected areas of the epidermis three times a day. Avoid contact of the ointment with mucous membranes. Side effects are possible with individual hypersensitivity to the ointment, causing hyperemia (redness), itching on the problem area of the skin treated with the drug. In this case, discontinue use of the drug.

• Petroleum.

A derivative of refined petroleum. This homeopathic remedy is available in the form of granules or drops. The drug is taken orally. The dosage is prescribed by a homeopathic doctor on an individual basis. Side effects: at the beginning of treatment with the drug, a slight exacerbation of the clinical symptoms of the disease is observed. In very rare cases - increased sensitivity to the components of the drug.

• PsoriNokhel.

A complex homeopathic remedy, available in the form of oral drops. Apply 8-10 drops 3 times a day, either a few minutes before meals or an hour after meals. The drops can be dissolved in 10 ml of water and, holding the solution in the mouth for a few seconds, then swallowed. You can also drip the remedy under the tongue without dissolving it first.

No side effects were observed with this product.

• Solidago.

A complex homeopathic preparation. It is used parenterally, 1-3 ampoules per week. A side effect when using this remedy may be hypersalivation (increased salivation) or individual increased sensitivity of the body to some components of the drug.

• Sulfur.

Homeopathic preparation of sulfur. Available in the form of ointment, granules and drops. For external therapy, use the ointment, rubbing it into the affected areas of the epidermis once a day, at night. Granules and drops are used internally in the form of solutions. The dosage of the drug is prescribed by the doctor individually. When prescribing the drug at the initial stage of treatment, an exacerbation of the symptoms of the disease is possible, the drug, in this case, should not be canceled. In case of individual intolerance of the body to the components of the homeopathic remedy, allergic reactions are possible: hyperemia of the skin, itching.

Surgical treatment for psoriasis

Surgical treatment of psoriasis involves surgical intervention in the small intestinal valve to restore its functions. This operation, using the V. Martynov method, allows the small intestine to restore its ability to cleanse itself of toxins, as a result of which, several months after the surgical intervention, recovery from psoriasis was observed, or stable remission for a long period of time.

This method of treating psoriasis is questionable in terms of appropriateness and effectiveness!

Prevention

During the period of remission, it is very important to carry out preventive measures aimed at increasing the period of weakening or disappearance of the signs of the disease. For pregnant women suffering from psoriasis, there is a set of procedures that must be followed. They are as follows: moisturizing the skin and indoor air, wearing loose clothing made of natural fabrics, climate therapy (rest at the sea); avoid stress and heavy physical exertion, limit the consumption of fatty, spicy, smoked and fried foods in the diet, refuse to drink alcohol and nicotine, use medications with caution, strengthen the immune system, fight slagging of the body.

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Forecast

Psoriasis is a disease that cannot be cured completely. It is a chronic process and the task of medicine is to prevent the disease from becoming more severe, to minimize the number of exacerbations, to reduce clinical manifestations to a minimum, and to prolong the remission stage as much as possible.

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