“Clear skin, safe baby?” First case report signals Secukinumab may be viable option for pregnant women with severe psoriasis

This article reports a clinically significant case of secukinumab exposure during pregnancy in a patient with severe plaque psoriasis and reviews current evidence regarding the safety of biologic therapies in this special population. Psoriasis is a chronic inflammatory skin disorder mediated by T lymphocytes, with more than half of affected patients being women, many of whom are of reproductive age. Managing moderate-to-severe psoriasis during pregnancy is particularly challenging, as commonly used systemic agents such as methotrexate and retinoids are strictly contraindicated due to teratogenicity.

The case describes a 27-year-old woman with a five-year history of severe plaque psoriasis involving the trunk and limbs, accompanied by significant pruritus and impaired quality of life. Previous treatments, including acitretin, narrow-band UVB phototherapy, topical corticosteroids, and calcineurin inhibitors, failed to achieve sustained disease control. Upon initiation of secukinumab (300 mg subcutaneously), the patient showed a dramatic clinical response, with marked reductions in PASI, BSA, PGA, and DLQI scores.

An unexpected pregnancy was identified at five weeks of gestation during the induction phase of secukinumab treatment, leading to immediate drug discontinuation. Despite early exposure to the biologic agent, the patient’s pregnancy progressed without complications. She delivered a healthy male infant at full term, with normal birth weight and unremarkable neonatal screening results. No obstetric complications such as gestational diabetes, hypertension, preeclampsia, or preterm labor were observed.

Long-term follow-up conducted approximately 2.5 years after delivery revealed normal growth parameters, laboratory screening results, and developmental milestones in the child, providing reassuring evidence regarding postnatal safety. After delivery, the patient resumed secukinumab therapy and maintained stable disease control during extended follow-up, further supporting the drug’s long-term efficacy and tolerability.

In the discussion, the authors place this case in the context of existing literature, noting that secukinumab is classified as a pregnancy Category B drug. While animal studies have not demonstrated reproductive toxicity, clinical data in pregnant women remain limited to case reports and pharmacovigilance analyses. Previous reports have similarly described favorable pregnancy outcomes following secukinumab exposure, including cases of plaque psoriasis and generalized pustular psoriasis of pregnancy.

Overall, this study provides additional real-world evidence supporting the relative safety of secukinumab during pregnancy in patients with severe psoriasis. Although conclusions are constrained by the limited number of cases and lack of randomized controlled trials, the findings contribute meaningfully to clinical decision-making. The authors emphasize that individualized risk–benefit assessment remains essential and call for larger observational studies and pregnancy registries to further clarify the long-term safety profile of secukinumab in this population.