26-Year-Old Female with Worsening Psoriasis Who Is Planning Pregnancy

  • Deeti J. Pithadia
  • Kelly A. Reynolds
  • Jashin J. Wu
Part of the Clinical Cases in Dermatology book series (CLIDADE)


A 26-year-old woman presents with worsening diffuse-body psoriasis while on a regimen of topical steroids and ultraviolet B phototherapy. She qualifies for treatment with biologics, but she is also planning pregnancy. Certolizumab pegol, a novel tumor necrosis factor inhibitor that does not undergo transplacental transport, is considered the safest biologic with regards to fetal outcomes. After counseling on the risks and benefits of biologic therapy, the patient chose to switch her regimen to certolizumab pegol prior to becoming pregnant.


Pregnancy Fetus Certolizumab pegol Biologics Ultraviolet B Topical corticosteroids 


  1. 1.
    Murase JE, Chan KK, Garite TJ, Cooper DM, Weinstein GD. Hormonal effect on psoriasis in pregnancy and post partum. Arch Dermatol. 2005;141(5):601–6.CrossRefGoogle Scholar
  2. 2.
    Ceovic R, Mance M, Bukvic mokos Z, Svetec M, Kostovic K, Stulhofer buzina D. Psoriasis: female skin changes in various hormonal stages throughout life—puberty, pregnancy, and menopause. Biomed Res Int. 2013;2013:571912.CrossRefGoogle Scholar
  3. 3.
    Vena GA, Cassano N, Bellia G, Colombo D. Psoriasis in pregnancy: challenges and solutions. Psoriasis (Auckl). 2015;5:83–95.Google Scholar
  4. 4.
    Cohen-Barak E, Nachum Z, Rozenman D, Ziv M. Pregnancy outcomes in women with moderate-to-severe psoriasis. J Eur Acad Dermatol Venereol. 2011;25(9):1041–7.CrossRefGoogle Scholar
  5. 5.
    Lima XT, Janakiraman V, Hughes MD, Kimball AB. The impact of psoriasis on pregnancy outcomes. J Invest Dermatol. 2012;132(1):85–91.CrossRefGoogle Scholar
  6. 6.
    Trivedi MK, Vaughn AR, Murase JE. Pustular psoriasis of pregnancy: current perspectives. Int J Women’s Health. 2018;10:109–15.CrossRefGoogle Scholar
  7. 7.
    Chi CC, Lee CW, Wojnarowska F, Kirtschig G. Safety of topical corticosteroids in pregnancy. Cochrane Database Syst Rev. 2009;3:CD007346.Google Scholar
  8. 8.
    Park KK, Murase JE. Narrowband UV-B phototherapy during pregnancy and folic acid depletion. Arch Dermatol. 2012;148(1):132–3.CrossRefGoogle Scholar
  9. 9.
    Mason RJ, Thomson AW, Whiting PH, et al. Cyclosporine-induced fetotoxicity in the rat. Transplantation. 1985;39(1):9–12.PubMedGoogle Scholar
  10. 10.
    Paziana K, Del Monaco M, Cardonick E, et al. Ciclosporin use during pregnancy. Drug Saf. 2013;36(5):279–94.CrossRefGoogle Scholar
  11. 11.
    Johansen CB, Jimenez-Solem E, Haerskjold A, Sand FL, Thomsen SF. The use and safety of TNF inhibitors during pregnancy in women with psoriasis: a review. Int J Mol Sci. 2018;19(5):pii: E1349.Google Scholar
  12. 12.
    Raja H, Matteson EL, Michet CJ, Smith JR, Pulido JS. Safety of tumor necrosis factor inhibitors during pregnancy and breastfeeding. Transl Vis Sci Technol. 2012;1(2):6.CrossRefGoogle Scholar
  13. 13.
    Weber-Schoendorfer C, Oppermann M, Wacker E, et al. Pregnancy outcome after TNF-α inhibitor therapy during the first trimester: a prospective multicentre cohort study. Br J Clin Pharmacol. 2015;80(4):727–39.CrossRefGoogle Scholar
  14. 14.
    Carter JD, Valeriano J, Vasey FB. Tumor necrosis factor-alpha inhibition and VATER association: a causal relationship. J Rheumatol. 2006;33(5):1014–7.PubMedGoogle Scholar
  15. 15.
    Carter JD, Ladhani A, Ricca LR, Valeriano J, Vasey FBA. Safety assessment of tumor necrosis factor antagonists during pregnancy: a review of the Food and Drug Administration database. J Rheumatol. 2009;36(3):635–41.CrossRefGoogle Scholar
  16. 16.
    Gottlieb AB, Blauvelt A, Thaçi D, et al. Certolizumab pegol for the treatment of chronic plaque psoriasis: results through 48 weeks from 2 phase 3, multicenter, randomized, double-blinded, placebo-controlled studies (CIMPASI-1 and CIMPASI-2). J Am Acad Dermatol. 2018;79(2):302–314.e6.CrossRefGoogle Scholar
  17. 17.
    Lebwohl M, Blauvelt A, Paul C, et al. Certolizumab pegol for the treatment of chronic plaque psoriasis: results through 48 weeks of a phase 3, multicenter, randomized, double-blind, etanercept- and placebo-controlled study (CIMPACT). J Am Acad Dermatol. 2018;79(2):266–276.e5.CrossRefGoogle Scholar
  18. 18.
    Mariette X, Förger F, Abraham B, et al. Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, pharmacokinetic study. Ann Rheum Dis. 2018;77(2):228–33.CrossRefGoogle Scholar
  19. 19.
    Clowse MEB, Schuerele AE, Chambers C, et al. Pregnancy outcomes after exposure to certolizumab pegol: updated results from a pharmacovigilance safety database. Arthritis Rheumatol. 2018;70:1399–407.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Deeti J. Pithadia
    • 1
  • Kelly A. Reynolds
    • 2
  • Jashin J. Wu
    • 3
  1. 1.Medical College of GeorgiaAugusta UniversityAugustaUSA
  2. 2.University of CincinnatiCollege of MedicineCincinnatiUSA
  3. 3.Founder and CEODermatology Research and Education FoundationIrvineUSA

Personalised recommendations