ABSTRACT
La psoriasis es una enfermedad sistémica que puede ocurrir de múltiples formas durante el embarazo, con severidad variable, incluso con formas que amenazan la vida. Las variantes severas se han asociado a mayores riesgos maternos y fetales, y la mayor parte de los tratamientos tópicos y sistémicos disponibles están contraindicados durante el embarazo por el riesgo de toxicidad fetal. Los tratamientos de primera línea son los emolientes y los corticoides tópicos de baja-moderada potencia y en casos severos la fototerapia nbUVB es el tratamiento de elección. En pacientes con formas muy severas y refractarias otras alternativas de tratamiento son la ciclosporina, los corticoides sistémicos y los agentes biológicos, especialmente los anti-TNF-α, sin embargo, la información disponible sobre el uso de estas moléculas en embarazadas es muy limitada, y sólo deberían considerarse en casos muy seleccionados. El impétigo herpetiforme es una forma propia de psoriasis pustular severa durante el embarazo y las principales alternativas terapéuticas son la inducción del parto o el uso de corticoides sistémicos.
Psoriasis is a systemic disease that can be present during pregnancy in different clinical forms and variable severity; some forms can be life threatening. Severe clinical forms are associated with greater maternal and fetal risks, and topical and systemic treatments available are mainly contraindicated during pregnancy because of fetal toxicity risks. First line treatments are emollients and low-medium potency topical steroids; in severe cases nUVB phototherapy is the preferred treatment. In patients with more severe and recalcitrant clinical forms cyclosporine, systemic steroids and biologics agents specially anti-TNF-α are the options. Nevertheless the available information of the use of these treatments in pregnant women is limited and these drugs should be considered only in very special cases. Herpetiformis impetigo is a proper form of severe pustular psoriasis in pregnancy and the treatments for this entity should be delivery induction or systemic steroids.
Subject(s)
Humans , Pregnancy Complications/therapy , Psoriasis/complications , Psoriasis/therapyABSTRACT
Background: Ultraviolet light exposure has a pathogenic effect on the development of skin cancer, whose prevalence increases worldwide. In Chile and the rest of the world, preventive educational campaigns are carried out to change high risk sun exposure behaviors. Aim: To study the behavior of the Chilean population towards skin cancer prevention and to identify erroneous preventive practices and concepts. Material and methods: A survey containing 17 questions about sun exposure behaviors, photoprotective measures and knowledge about ultraviolet radiation and skin cancer was used. It was applied during January and February 2004, to 1,143 subjects (mean age 30 years, 409 males), taking vacations in beach resorts in Chile. Results: The hours of higher sun exposure ranged from 12 AM to 4 PM. Thirty seven percent of subjects were exposed more than 2 hours during this high risk lapse. Women and subjects aged less than 25 years were those with the riskiest behaviors. Fifty four percent used some type of photoprotection and 50% used ocular protection. Seventy percent used creams with sun screen and 74% used a sun protection factor higher than 15. Seventy percent applied the sun screen as recommended. Thirty eight percent had at least one sun burn in the last two years. More than 90% of subjects were aware of the relationship between sun exposure and skin cancer but 60% did not know the hours of higher ultraviolet radiation. The information about sun exposure was obtained from television in 57% of surveyed individuals. Conclusions: More educational campaigns about the risk of sun exposure are needed to reduce risky behaviors in the Chilean population.