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Clinical considerations for the management of psoriasis in women [Image: see text] ()()
The burden of psoriasis is particularly high for women, who report lower levels of happiness (women: 18.5%; men: 11.3% lower vs. general population) and are more likely to experience stress (women: > 60%; men: 42%), loneliness (women: 25-28%; men: 19-24%), stigmatization (Feelings of Stigmatizati...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637092/ https://www.ncbi.nlm.nih.gov/pubmed/31360745 http://dx.doi.org/10.1016/j.ijwd.2019.04.021 |
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author | Gottlieb, Alice B. Ryan, Caitriona Murase, Jenny E. |
author_facet | Gottlieb, Alice B. Ryan, Caitriona Murase, Jenny E. |
author_sort | Gottlieb, Alice B. |
collection | PubMed |
description | The burden of psoriasis is particularly high for women, who report lower levels of happiness (women: 18.5%; men: 11.3% lower vs. general population) and are more likely to experience stress (women: > 60%; men: 42%), loneliness (women: 25-28%; men: 19-24%), stigmatization (Feelings of Stigmatization Questionnaire score; women: 93.2; men: 78.0), and reduced sexual activity (women: 33%; men: 19%) compared with men. The onset of psoriasis is bimodal, with one incidence peak (15-30 years) that coincides with the prime reproductive age for women, which poses specific challenges for their treatment. However, well-established guidelines for the treatment of women of childbearing age are lacking. Many women experience stabilization (21%) or improvement (55%) of their skin during pregnancy, but up to a quarter can experience disease worsening, and postpartum flares are common (> 50%). Therefore, balancing the risk of treatment with the risk of uncontrolled disease is important. Because half of pregnancies are unplanned, the implications of therapeutic options must be considered for all women with psoriasis who are sexually active, irrespective of intentions to start a family. Timely initiation of these discussions by health care professionals is paramount to prevent unintentional toxicity to the developing fetus. For example, acitretin, methotrexate, and oral psoralen/ultraviolet A are all contraindicated in pregnancy. Reassuringly, safety data for other psoriasis treatments during pregnancy are increasingly available, particularly for anti-tumor necrosis factor therapies. Despite encouraging data from pregnancy exposure registries and clinical studies now being included in anti-tumor necrosis factor drug labels, comfort with prescribing these therapies to pregnant women remains low (U.S. dermatologists: 21%; EU-5 dermatologists: 10%). In this article, we review issues specific to treating women of childbearing age with psoriasis and highlight the need for treatment guidelines to ensure consistent care and optimal outcomes for these patients. |
format | Online Article Text |
id | pubmed-6637092 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-66370922019-07-29 Clinical considerations for the management of psoriasis in women [Image: see text] ()() Gottlieb, Alice B. Ryan, Caitriona Murase, Jenny E. Int J Womens Dermatol Article The burden of psoriasis is particularly high for women, who report lower levels of happiness (women: 18.5%; men: 11.3% lower vs. general population) and are more likely to experience stress (women: > 60%; men: 42%), loneliness (women: 25-28%; men: 19-24%), stigmatization (Feelings of Stigmatization Questionnaire score; women: 93.2; men: 78.0), and reduced sexual activity (women: 33%; men: 19%) compared with men. The onset of psoriasis is bimodal, with one incidence peak (15-30 years) that coincides with the prime reproductive age for women, which poses specific challenges for their treatment. However, well-established guidelines for the treatment of women of childbearing age are lacking. Many women experience stabilization (21%) or improvement (55%) of their skin during pregnancy, but up to a quarter can experience disease worsening, and postpartum flares are common (> 50%). Therefore, balancing the risk of treatment with the risk of uncontrolled disease is important. Because half of pregnancies are unplanned, the implications of therapeutic options must be considered for all women with psoriasis who are sexually active, irrespective of intentions to start a family. Timely initiation of these discussions by health care professionals is paramount to prevent unintentional toxicity to the developing fetus. For example, acitretin, methotrexate, and oral psoralen/ultraviolet A are all contraindicated in pregnancy. Reassuringly, safety data for other psoriasis treatments during pregnancy are increasingly available, particularly for anti-tumor necrosis factor therapies. Despite encouraging data from pregnancy exposure registries and clinical studies now being included in anti-tumor necrosis factor drug labels, comfort with prescribing these therapies to pregnant women remains low (U.S. dermatologists: 21%; EU-5 dermatologists: 10%). In this article, we review issues specific to treating women of childbearing age with psoriasis and highlight the need for treatment guidelines to ensure consistent care and optimal outcomes for these patients. Elsevier 2019-04-10 /pmc/articles/PMC6637092/ /pubmed/31360745 http://dx.doi.org/10.1016/j.ijwd.2019.04.021 Text en © 2019 Published by Elsevier Inc. on behalf of Women's Dermatologic Society. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Article Gottlieb, Alice B. Ryan, Caitriona Murase, Jenny E. Clinical considerations for the management of psoriasis in women [Image: see text] ()() |
title | Clinical considerations for the management of psoriasis in women [Image: see text] ()() |
title_full | Clinical considerations for the management of psoriasis in women [Image: see text] ()() |
title_fullStr | Clinical considerations for the management of psoriasis in women [Image: see text] ()() |
title_full_unstemmed | Clinical considerations for the management of psoriasis in women [Image: see text] ()() |
title_short | Clinical considerations for the management of psoriasis in women [Image: see text] ()() |
title_sort | clinical considerations for the management of psoriasis in women [image: see text] ()() |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637092/ https://www.ncbi.nlm.nih.gov/pubmed/31360745 http://dx.doi.org/10.1016/j.ijwd.2019.04.021 |
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