Psoriasis during pregnancy: the more dangerous and what to treat

At the pregnant woman there are big changes in hormonal and immune systems, therefore, during pregnancy complications and diseases with which the female organism did not face before can arise. One of the diseases that pregnancy can complicate is psoriasis. What is the reason for his appearance in the body of a healthy woman, how can this disease affect the course of pregnancy and how to be treated properly?

[1], [2], [3], [4], [5]

Epidemiology

This disease is considered hereditary, infection with it is impossible.

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

[6], [7], [8], [9], [10], [11]

Causes of the psoriasis in pregnancy

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

The cause of psoriasis during pregnancy can be a huge stress on the body of a woman. During this period, there are global changes in the hormonal system of the female body, which can negatively affect the immune system, weakening it. The impetus to the onset of the disease can become stress. Therefore, it is recommended that pregnant women avoid unrest. An important role is played by the state of the intestine and liver. It is necessary to control their work, avoid slagging the body and getting toxins. Lack of vitamin D, as negatively affects the condition of the skin, so you need to fill the body's need for this vitamin and more often stay under the influence of sunlight.

[12], [13], [14], [15], [16], [17]

Risk factors

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

• hereditary factor (if any of the relatives had the disease);
• viral, as well as infectious diseases such as HIV, streptococcal infection;
• strong psycho-emotional stress, stress;
• long stay in cold climatic conditions;
• use of certain medications;
• excessive use of alcohol, smoking;
• trauma to the skin;
• obesity.

[18], [19], [20], [21], [22], [23]

Pathogenesis

The pathogenesis of the disease is not fully understood, but the following theories are distinguished:

• hereditary;
• infectious;
• neurogenic;

With the development of psoriasis, three stages are distinguished:

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

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

[24], [25], [26], [27], [28], [29], [30]

Symptoms of the psoriasis in pregnancy

The main clinical manifestation of this disease are rashes. The first signs of the disease are manifested in the form of appearance on the skin, with localization in the skin folds, in the groin and on the abdomen. Possible damage to the mucous membranes. Eruptions have the appearance of pink, in color, or whitish papules, rounded. Then psoriatic plaques can spread to other parts of the skin, including the scalp. Very often, the rash is localized on the extensor surfaces of the lower and upper extremities. In the area of rashes, the skin becomes dry, cracked, and can bleed. There is itching. In addition, the nails are often affected. In psoriasis, pain can also occur in the joints. The disease is accompanied by general weakness, increased fatigue, oppressed psycho-emotional state.

Stages

The development of the disease in psoriasis is divided into three stages:

• progressing (characterized by the emergence of new lesions);
• stationary (new rashes are not present, the centers of a lesion do not increase).

[31], [32], [33]

Forms

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

• point (the size of the papules with a pinhead);
• teardrop-shaped (slightly more precise in size, in the form of a droplet)
• coin-like (the rashes are represented by large round plaques);
• figured (large foci of skin lesions, shaped shape);
• ring-shaped (the shape of the rash resembles a ring);
• geographic (the affected foci merge, resembling a geographical map);
• Serpiginous (constantly growing foci of skin lesions).

In addition, in terms of severity, there are three forms of pathology:

• light (affects 1-3% of the skin);
• medium severity (3-10% of the skin are affected);
• heavy.

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

In more than half the cases, psoriasis of the head is observed. If the disease is neglected and run it - this can lead to more severe forms of psoriasis. When the disease is located on the scalp, the skin behind the ears, above them, the lobes of the ears, are most often affected; skin in the frontal and occipital part of the head; on the back of the neck; in the parting of the hair. At the very beginning of the disease several pink spots can form, without clear boundaries and inflammatory processes of the skin. Perhaps a strong peeling of the scalp, reminiscent of dandruff. With this mild degree of 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 psoriasis of the head is the so-called psoriatic corona. In this case, the process of transition from the scalp to the skin in the forehead, occiput, above the ears and behind them is seen. 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 subjected to sufficiently serious treatment, psoriasis from the scalp will pass to other, healthy, skin areas.

Classification of psoriasis of the head in terms of severity and form of the disease is similar to the general classification of psoriasis.

[34]

Complications and consequences

The course of the disease in mild and moderate severity hardly affects the condition of the pregnant woman and does not have negative consequences, both for the woman herself and for the fetus.

It is much more dangerous when, when a number of negative factors affecting a pregnant woman's body coincide, complications can arise that can lead to serious consequences.

A very serious and dangerous complication that can threaten the life of the expectant mother and her child is generalized pustular psoriasis. This complication can be triggered by a violation of the hormonal background, the development and assimilation 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 skin are affected on which small papules form skin lesions that rise above the skin. Papules appear in large numbers, merge and in their place pustules are formed, with purulent contents. Along with skin pathological processes, clinical symptoms of a general nature are observed: general weakness, a sharp rise in body temperature, chills accompanied by headache, decreased appetite, nausea and vomiting, and mental disorders. Such a condition of a pregnant woman can lead to premature birth. It is necessary to start treatment immediately. Symptoms disappear after the termination of pregnancy. Pustular psoriasis, complicated by a secondary infection, can lead to sepsis, and then, to a lethal outcome. With timely and proper treatment, pustules heal, other common symptoms die out.

Another severe form of scaly lichen - arthropathic psoriasis, can lead to joint damage - psoriatic arthritis. First, the pathological process involves smaller joints, then the inflammation spreads to the middle joints, and then the large joints are affected. With the progression of the disease, the cartilaginous tissue and tendons are involved in the inflammatory process. In the clinical picture of the disease, swelling and tenderness of the joints are observed, skin integuments in the joint area acquire a purple color, there is a restriction of movement in the joints. In the absence of treatment, this form of arthritis leads to resorption and atrophy of bone tissue. The motor function of a person is disturbed. Further, the connective tissue of the vessel walls is attached to the inflammatory process. In this case, we can talk about generalized psoriatic arthritis.

• Metabolic disease.

One of the complications in severe forms of psoriasis can be a violation of metabolic processes in the body. As a result, the cardiovascular system suffers. As a consequence, such diseases as: stroke, ischemic and hypertensive disease, cardiac muscle inflammation (myocarditis), mitral valve defect, cardiac muscle disorders (myocardial dystrophy), renal failure, not bacterial inflammation of the urethra and bladder, and in severe cases development of oncology.

• Lesion of mucous membranes and influence on vision.

If the scaly lichen is not treated, then the disease progresses and can lead to damage to the mucous membranes of internal organs. In this case, the organs of the gastrointestinal tract are affected.

Ophthalmic complications include conjunctivitis (inflammation of the mucous membrane of the eye), sclerites (inflammation of the outer shell of the eye), irites (inflammation of the iris), uveitis (inflammation of the vessels of the eye). These diseases are not bacterial in nature, with timely and correct treatment, these complications are cured.

• Psoriatic Erythrothroderma.

The same applies to severe complications and occurs, as a rule, in untreated and neglected cases. In this case almost all skin integuments are affected, and the skin does not cope with its physiological functions. Violated thermoregulation, respiratory and excretory functions of the skin. Consequences of this complication can be septic infection of blood and death.

• Violations of the nervous system.

With some severe forms of scaly lichen, lesions of the central nervous system and brain can occur. Encephalopathy develops (organic non-inflammatory brain damage), which can lead to epileptic seizures, the development of seizures. Atrophy, accompanied by a decrease in body weight and muscle weakness.

[35], [36], [37], [38], [39], [40]

Diagnostics of the psoriasis in pregnancy

At the heart of the diagnosis of psoriasis in pregnancy is a pronounced clinical picture and anamnesis of the patient. A dermatologist must identify a hereditary relationship in the onset of the disease, factors that could provoke the disease. For this disease is characterized by the presence of psoriatic triad: staser (waxy) spots, psoriatic film and bloody dew.

The following types of laboratory and instrumental diagnostics are provided.

A histological examination is prescribed, in which keratoderma (hyperkeratosis - increased keratin content in the epidermis), a lack of corium (dermis) with a granular surface and a sprouting (spiny) layer of the epidermis can be revealed.

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

[41], [42], [43], [44], [45], [46]

Differential diagnosis

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

[47], [48], [49], [50], [51], [52], [53]

Treatment of the psoriasis in pregnancy

To treatment of this disease in a pregnant woman should be approached extremely carefully and systematically. If the disease was diagnosed in the patient prior to pregnancy, it should be noted that the drugs used for the treatment of psoriasis have a teratogenic effect (a negative toxic effect on the fetus, resulting either in congenital anomalies, or may provoke miscarriage, fetal fading). When using these medicines, it is necessary to resort to the use of contraceptives, and it is necessary to plan pregnancy 3-4 months after the withdrawal of drugs. It is, 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 belongs to the approved preparations of local therapy during pregnancy. However, its use must be minimized. The drug cortisone does not have a harmful effect on the mother's body, as well as on the future child, but under its influence stretch marks on the skin may appear. The main external means for psoriasis in pregnancy are ointments, because of their mild and sparing effect on the epidermis affected by the disease.

• Salicylic acid.

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

In psoriasis, ointment 2% is most often used. Thin layer is applied to the affected surface 1-2 times a day.

Out of side effects, local allergic reactions were rarely observed.

Do not apply ointment to mucous membranes, warts, birthmarks. When the drug enters the mucous membranes, it is necessary to rinse it with water, in large quantities.

• Urea.

In medicine, it is used as a decongestant and diuretic.

In psoriasis, 10% cream and 30% ointment are applied, which 1-2 times a day are applied in a thin uniform layer on the diseased parts of the epidermis.

With external application, there are possible side effects of the drug on the body, such as: local allergic reaction, itching and hyperemia of the skin.

Storage of urea is provided in a sealed package, in a dry place, with a temperature regime of not more than 25 C. Shelf life - 24 months from the date of production.

• Cortisone.

1% hydrocortisone ointment for topical external application.

1-3 times a day is applied in a thin, even layer on the skin area affected by the disease. For better absorption in the epidermis, apply the ointment with light movements, massaging the skin.

With external application of this drug, no side effects were observed.

Storage of this drug is provided in a dry, dark place at room temperature.

• Zinc ointment.

Ointment, which is based on zinc oxide.

Has antiseptic, astringent, anti-inflammatory, softening and drying effect.

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

The storage conditions of zinc ointment assume a dry cool place, at a temperature of no higher than 25 ° C.

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

• Cream of Cynocap.

Has anti-inflammatory and antifungal effect, reduces the feeling of burning and itching, is a good antipsoriatic agent.

It is applied 2-3 times a day to the affected areas of the skin with psoriasis.

Side effects are very rare, usually manifested local allergic reaction to the drug: dry skin and redness in the place of application of the ointment.

Store the drug in a dark place, with a temperature regime of not more than 25 C.

Shelf life - not more than 24 months after the release of the funds.

Physiotherapeutic treatment of psoriasis

The most common method of local treatment of squamous lichen during pregnancy remains phototherapy treatment with ultraviolet. This method is completely safe for both the mother and the baby.

In addition, with this pathology, one can resort to the following physiotherapeutic procedures: blood ultraviolet radiation, cryotherapy, excimer laser, ozone therapy, hypnosis, electrostimulation, magnetic resonance therapy.

Pregnant, psoriasis patients are recommended to take vitamins. Also, it should be borne in mind that vitamin A and D derivatives are prohibited for use in psoriasis during pregnancy, since these drugs have a teratogenic effect and can cause fetal anomalies.

Alternative Medicine

In addition to medical and physiotherapy treatment, alternative medicine methods can be used. Of the alternative means, in general, various means for external use are used. Let's consider some of them in more detail.

• Propolis treatment.

To prepare a propolis-based product (a product of the bees' vital activity), it is necessary to take 250 ml of lean oil, boil it, then after adding 25 gr. Propolis, carefully mix the resulting mass to homogeneity. From this remedy, compresses are applied to the affected areas of the skin for 1-2 days after preliminary treatment with the hydrogen peroxide solution of the problematic areas of the epidermis.

• Aloe juice.

Very effective alternative means for psoriasis, to apply for the treatment of the disease must be the juice of a plant that has reached the age of three. In the juice of aloe 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, as well as a powerful biostimulator, which helps to increase immunity.

Before cutting aloe leaves, it is necessary to stop watering the plant for 2 weeks, thus creating an artificial drought for it. Cut off the leaves in a cool dark place for 5 days, then prepare a juice from them. This means to handle problem areas of the skin several times a day until the rash disappears completely.

• Celery juice.

It is applied simultaneously externally and orally. Grind the root of the celery to a coughing-like condition and spread the affected parts of the epidermis with the product obtained for 2 hours. Freshly prepared juice from the root of the celery take inside 2 tablespoons 3 times a day. Duration of treatment with this method is 2 months.

• Ointment from birch tar.

Finished pharmacy birch tar is diluted with sunflower oil in the proportions of 1: 1. With this mixture, treat affected areas of the skin.

• Sea buckthorn oil.

Buy a ready-made 5% sea-buckthorn oil in the pharmacy, which treat the problem skin areas 1-3 times a day.

• Herbal baths.

100 gr. Herbs celandine pour 4 liters of cold water, bring to a boil, cover and let it brew for 1 hour. Strain the resulting broth and add it to a bath filled with water 40 - 45 C. Take a herbal bath 5-10 minutes every day.

Positive effect in the treatment of psoriasis also have herbal baths with the addition of broths of the following plants: alternating stems, chamomile, mint, Kirkazon.

In the treatment of scaly lichen in alternative medicine, decoctions and tinctures of some plants are used, however, many of them have a large number of contraindications for pregnant women, so treatment with alternative agents at various stages of pregnancy and lactation is recommended to be limited to external application.

[54], [55]

Homeopathic medications used for psoriasis.

• Psoriatin ointment.

Contains matrix tincture of mahogany padiubolostnoy. After cleansing the skin rubbed with light massaging movements into the diseased areas of the epidermis three times a day. Do not get the ointment on the mucous membranes. Side effects are possible with individual hypersensitivity to the ointment, while there is hyperemia (redness), itching in the problem area of the skin, subjected to treatment with the drug. In this case, it is necessary to cancel the use of the drug.

• Petroleum.

Derivative of refined oil. This homeopathic remedy is available in the form of granules or drops. The drug is taken internally. Dosage is prescribed by a homoeopathic doctor individually. Side effects: at the beginning of treatment with the drug there is a slight exacerbation of the clinical symptoms of the disease. In very rare cases - hypersensitivity to the components of the drug.

• Psorinochel.

A complex homeopathic remedy, is available in the form of oral drops. Apply 8-10 drops 3 times a day, or a few minutes before meals, or an hour after eating. The drops can be dissolved in 10 ml of water and, after holding the solution for a few seconds in the oral cavity, then swallow it. And as you can drip the tool under the tongue, without dissolving them beforehand.

Side effects of this agent were not observed.

• Solidography.

Complex complex homeopathic preparation. It is used parenterally, 1 3 ampoules a week. A side effect with this drug may be hypersalivation (increased salivation) or individual hypersensitivity to certain components of the drug.

• Sulfur.

Homeopathic preparation of sulfur. Produced in the form of ointments, granules and drops. With external therapy, apply the ointment, rubbing into affected areas of the epidermis 1 time per day, at night. Granules and drops are used inside as solutions. The dosage of the drug is prescribed by the doctor individually. When prescribing the drug in the initial stage of treatment, the symptoms of the disease may worsen, the drug, in this case, should not be canceled. With individual intolerance to the body components homeopathic remedy, allergic manifestations are possible: skin hyperemia, itching.

Operative treatment for psoriasis

Surgical treatment of flaky diarrhea consists in an operative intervention in the valve of the small intestine to restore its functions. This operation by the method of V. Martynov allows the small intestine to restore the ability to purify toxins, as a result, several months after the surgery, there was a recovery from psoriasis, or a persistent remission for a long period of time.

This method of treatment of psoriasis is questionable in terms of expediency 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 air in the room, wearing loose clothes from natural fabrics, climatotherapy (rest at sea); avoid stress and strong physical exertion; in the diet, limit the consumption of fatty, spicy, smoked and fried foods, stop using alcohol and nicotine, use medicines carefully, strengthen immunity, fight slagging of the body.

[56], [57], [58], [59], [60], [61]

Forecast

Psoriasis is a disease that can not be cured completely. This is a chronic process and the task of medicine to prevent the transition of the disease to a more severe form, the minimum amount of exacerbations, the reduction of clinical manifestations to a minimum, the maximum prolongation of the stage of remission.

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