Psoriasis and Pregnancy

Psoriasis shouldn’t stop you from getting pregnant or carrying a healthy baby to term. In fact, pregnancy may give some women a nine-month reprieve from itchy, scaly skin plaques. If your symptoms don’t subside during pregnancy, finding relief can be a challenge. Some of the medicines you need to control your condition aren’t safe for your baby.

Here’s a guide to navigating pregnancy when you have psoriasis.

How does psoriasis affect pregnancy?

Psoriasis doesn’t affect a woman’s ability to get pregnant. Psoriasis hasn’t been linked to any birth defects or miscarriage. One study in the Journal of the American Academy of Dermatology did find that women with severe psoriasis were more likely to have a baby with low birth weight than those without psoriasis. Those with mild psoriasis didn’t have the same increased risk.

The biggest concern during pregnancy is the medicine used to treat psoriasis. Although some drugs are perfectly safe, others can lead to miscarriage and birth defects, and need to be avoided.

How does pregnancy affect psoriasis?

Just as every pregnancy is different, every pregnant woman with psoriasis is unique. Up to 60 percent of women find their psoriasis symptoms actually improve during those nine months of pregnancy. That’s because a rise in the hormone progesterone dampens the overactive immune response that triggers psoriasis symptoms.

For another 10 to 20 percent of women, pregnancy makes psoriasis worse. If you’re among them, you’ll have to work with your doctor to manage your symptoms in a way that’s safe for your baby.

Which medicines are safe to take during pregnancy?

The safest medicines during pregnancy are topical treatments, especially moisturizers and emollients like petroleum jelly. You can also use steroid creams. Just be careful once your baby is born and you are breastfeeding. Avoid rubbing steroid cream on your breasts, or be sure to wash off the cream thoroughly before breastfeeding.

If you have moderate to severe psoriasis and creams and ointments aren’t controlling your symptoms, you can try narrow-band ultraviolet light B (UVB) phototherapy. Ultraviolet A therapy with the drug psoralen isn’t recommended while you’re pregnant because the drug can get into breast milk and cause light sensitivity in your baby.

Which medicines should you avoid while pregnant?

Try to stay away from or limit your use of the medicines listed below. They haven’t been studied well enough to determine whether they’re safe during pregnancy:

Definitely avoid these drugs, which aren’t safe for your baby:

  • Methotrexate (Trexall) has been linked to miscarriages, cleft palate, and other birth defects. Because this drug can also cause chromosome problems, both men and women should stop taking it for at least three months before trying to conceive.
  • Oral retinoids such as acitretin (Soriatane) can cause birth defects, especially when used in the first trimester of pregnancy. The risk is so significant that doctors recommend waiting two years after stopping these drugs before getting pregnant.

If you do take any drugs by mouth to manage your symptoms, take care to avoid pregnancy. If you have an unplanned pregnancy, let your doctor know immediately. You may want to ask your doctor about enrolling in a pregnancy registry. Pharmaceutical companies use these registries to learn what effects their drugs have during pregnancy. We are getting a much better understanding of the effect of these medications in pregnancy and breastfeeding.

How to protect your baby

As soon as you decide to get pregnant, talk with your OB-GYN and dermatologist. You will need to go off some of your medicines for a few weeks or months before you start trying to conceive. Try to get your disease under control before you get pregnant. You’ll then be less likely to have flare-ups and require medicine during your pregnancy.

Once you are pregnant, tell your OB-GYN that you have psoriasis so you can be cared for appropriately. Also, let your dermatologist or rheumatologist know about the pregnancy so your medicines can be adjusted if needed. Here are 7 psoriasis triggers to avoid.

After you deliver

Some women who sail through pregnancy symptom-free develop a flare right after they deliver. More than half of women have a flare-up within six weeks after delivering. Any flare you have after delivery shouldn’t be worse than ones you had before you got pregnant.

If you plan to breastfeed, don’t go back on your medication just yet. You’ll still have to avoid:

  • oral retinoids
  • methotrexate (Trexall)
  • biologic drugs
  • PUVA
  • other drugs that weren’t safe during your pregnancy

Stick with emollients, topical steroids, and dithranol cream until your baby is weaned from breastfeeding.