CHART 3.

Systemic drugs used in psoriasis and psoriatic arthritis and their infl uence during pregnancy

Medication	Adverse events in pregnancy	Adverse events in animals	Conclusion
Systemic
Acitretin	Classic retinoid embryopathy (craniofacial, cardiac, thymicand central nervous system malformations)	Increased frequency of craniofacial, limb and other types of malformations	Contraindicated, high risk of malformations
Corticoids	Likely association with intrauterine growth retardation and low birth weight, increased risk of orofacial clefts	Fetal growth retardation, stenosis of ductus arteriosus, craniofacial, cardiac, genital and skeletal anomalies, abdominal wall defects, neural tube and CNS defects, behavioral disorders	Minimal risk of orofacial clefts; should be avoided during the first trimester
Cyclosporine	Increased risk of prematurity andintrauterine growth retardation, impairment in T, B and NK cells development in exposed children from mothers with compromised health	Alterations of immunological functions, fetal growth retardationand death	Risk of malformations, prematurity, intrauterine growth retardationand impairment in T cells development is low and may be linked to the maternal subjacent disease. Use indicated in patients with severe cases.
Methotrexate	Dose-dependent CNS, craniofacial and limb growth abnormalities (when used between 6 and 8 weeks of gestation)	Increased fetal death, dose-dependent malformations of limbs, craniofacial area, eyes, neural tube and others	Contraindicated during human pregnancy, high risk
Sulfasalazine	Absence of congenital malformations	No available data	Safe
Leflunomide	Absence of congenital defects or recognizable pattern of malformations	Teratogenic	Limited data contraindicate its use, but there is apparently low risk of teratogenicity in humans
Azathioprine	Prematurity	Absence of congenital defects or low birth weight	Safe