Hormonal effect on psoriasis in pregnancy and post partum
Hormonal effect on psoriasis in pregnancy and post partum
复制标题
DOI：
10.1001/archderm.141.5.601
复制
发表时间：
2005-05-01
影响因子：
--
通讯作者：
Weinstein, GD
中科院分区：
文献类型：
--
作者：
Murase, JE;Chan, KK;Weinstein, GD
目的：前瞻性研究银屑病在孕期和产后的波动，以及孕期激素(孕酮和雌激素)水平与银屑病变化的关系。设计：对妊娠期银屑病患者(研究组)和非妊娠、月经期银屑病患者(对照组)进行为期一年的5次银屑病体表面积(BSA)测定。研究组测定激素水平(孕酮和雌激素)，并与BSA的变化相关。地点：大学附属产科和皮肤科临床。患者：银屑病组47名怀孕患者和对照组27名未怀孕、经期患者。结果：妊娠期55%的患者有改善，21%的患者没有变化，23%的患者报告恶化。然而，产后，只有9%的患者报告有改善，26%的患者报告没有变化，65%的患者报告恶化。银屑病患者的BSA在妊娠10-20周与对照组相比显著降低(P<；.001)，而在产后6周与对照组相比显著升高(P=.001)。在银屑病BSA为10%或更高的患者中，报告改善的患者(n=16；平均BSA为40%)，在怀孕期间皮损减少了83.8%。BSA和雌二醇的改善之间存在显著或接近显著的相关性(P=。雌三醇(P=0.06，r=0.491)和雌孕激素比值(P=0.006，r=0.671)。结论：高水平的雌激素与银屑病的改善相关，而孕酮水平与银屑病的变化无关。
Objectives: To investigate prospectively how psoriasis fluctuates in pregnancy and post partum and to correlate hormone levels in pregnancy (progesterone and estrogens) with psoriatic change.Design: Psoriatic body surface area (BSA) in pregnant patients with psoriasis (study group) and nonpregnant, menstruating patients with psoriasis (control group) were assessed 5 times over a year. Hormone levels (progesterone and,estrogens) were measured in the study group and correlated with change in BSA.Setting: University-affiliated obstetric and dermatology clinics.Patients: Forty-seven pregnant patients in the psoriasis group and 27 nonpregnant, menstruating patients in the control group.Results: During pregnancy, 55% of the patients re-ported improvement, 21% reported no change, and 23% reported worsening. However, post partum, only 9% of patients reported improvement, 26% reported no change, and 65% reported worsening. Psoriatic BSA decreased significantly from 10 to 20 weeks'gestation (P < .001) compared with controls, whereas BSA increased significantly by 6 weeks post partum (P = .001) compared with controls. In patients with 10% or greater psoriatic BSA who reported improvement (n = 16; mean BSA, 40%), lesions decreased by 83.8% during pregnancy. There were significant or near significant correlations between improvement in BSA and estradiol (P =. 009, r = 0.648), estriol (P = .06, r = 0.491), and the ratio of estrogen to progesterone (P = .006, r = 0.671).Conclusion: High levels of estrogen correlated with improvement in psoriasis, whereas progesterone levels did not correlate with psoriatic change.