Psoriasis is a chronic skin condition that often requires lifelong treatment. However, some topical treatments may not be safe to use during pregnancy.

Psoriasis is a chronic skin issue that affects an estimated 3% of adults over the age of 20 in the United States.

While there are multiple ways to treat the skin plaques in psoriasis, such as biologics, systemic medications, and light therapy, topical therapies are often used first.

If you’re pregnant, there are safety considerations to discuss with a doctor before use.

Some topical treatments are prescriptions. Others are over-the-counter (OTC) drugs. Like oral medications, topical treatments come with risks. You’ll want to know the risks before you put anything on your skin, especially if you’re pregnant.

Here’s what you need to know about which psoriasis creams are safe during pregnancy and which ones you’ll want to avoid, as well as other important treatment information that can help you manage your psoriasis while pregnant.

You may have found that a certain topical treatment works wonders for your plaque psoriasis or another type of psoriasis. What’s the risk? Well, it could be considerable if you’re pregnant.

Some topical steroids can be very strong. After you apply them, these creams can be absorbed into your blood supply. If you’re pregnant, this blood supply passes on to your unborn child. Because of this, certain topical psoriasis treatments could cause harm to a pregnancy.

Even if a medication hasn’t been clinically shown to harm a pregnancy, you should still take caution. Many of the prescription creams used to treat psoriasis don’t have enough safety data in pregnant people, says Filamer Kabigting, MD, an assistant professor of dermatology at Columbia University Medical Center.

There are ethical constraints when it comes to enrolling pregnant people in clinical trials. That makes it difficult to test out how medications affect a fetus during pregnancy.

As such, many topical psoriasis treatments are classified as potentially unsafe by the Food and Drug Administration (FDA). Research has shown adverse effects on fetuses in animal reproduction studies, but such effects haven’t yet been confirmed in human studies.

The drug or topical treatment in consideration should only be taken during pregnancy if the benefits outweigh the potential risks. Talk with a doctor if you’re pregnant or plan to become pregnant.

Examples of topical medications that are considered potentially unsafe during pregnancy include:

  • anthralin (Drithocreme HP, Zithranol)
  • betamethasone dipropionate (Alphatrex, Del-Beta, Diprosone)
  • betamethasone dipropionate/calcipotriene (Taclonex)
  • calcipotriene (Calcitrene, Dovonex, Sorilux)
  • calcitriol (Rocaltrol, Vectical)

Unlike mild steroids or drugs that may be used in some cases during pregnancy, you shouldn’t use any potent steroids or other contraindicated drugs while pregnant. This is true even if these drugs worked for you in the past.

If you plan to nurse, you should wait to use these drugs until after your child has stopped nursing.

Contraindication means that both animal and human studies have demonstrated fetal damage when using such drugs during pregnancy. Furthermore, such risks have been noted in adverse reaction data in marketing and investigational situations.

The risks of using contraindicated drugs during pregnancy outweigh any potential benefits.

One example is a drug called clobetasol (Clobex), which is contraindicated in pregnancy. You should also avoid using the topical retinoid tazarotene (Tazorac) during pregnancy, which is also contraindicated.

Coal tar has been used for decades in treating psoriasis in people who aren’t pregnant. However, Kabigting says that people should avoid this topical treatment during pregnancy. “Some animal studies have shown an increased risk of cleft palate and poorly developed lungs,” he says.

The good news is that your psoriasis symptoms may improve during pregnancy even without treatment. This happens in 40% to 60% of pregnant people, according to an older 2007 study.

If your psoriasis symptoms are worsening, though, there are safe options for treatment.

Emollients and OTC moisturizers

You may want to try emollients or OTC topical treatments first. Emollients help soften dry, rough, flakey skin. These are among the safest options for pregnant people. They include:

Try using mineral oil in your baths, too. This can be a great complement to topical treatment. According to this 2009 study, prolonged baths may dry out your skin, so be sure to limit your bathtime to about 10 minutes.

The best cream or moisturizing lotion is the one that works best for you. You should look for fragrance-free options, as they can be less irritating to your skin.

Low dose topical steroids

Topical steroids creams are a first-line treatment for mild to moderate psoriasis. Some are considered safe for pregnancy, Kabigting says. The amount matters, though. The more you use, the more of the drug is absorbed through your skin.

The type also matters. Gary Goldenberg, MD, a dermatologist at Mount Sinai Hospital and an expert on psoriasis, recommends low- and sometimes medium-potency steroids. This is especially true after the first trimester. He also recommends only using these drugs when and where you need them. Ask a doctor exactly how much is safe for you.

Some examples of lower potency steroids include desonide (Tridesilon) and triamcinolone (Triderm).

If these drugs don’t work to treat your psoriasis, you may want to look into light therapy. This includes phototherapy that uses either narrowband or broadband ultraviolet light B (UVB). Although it’s considered a second-line treatment for psoriasis, phototherapy is generally a safe option during pregnancy.

“This is usually administered in the dermatologist’s office and is completely safe during pregnancy,” Goldenberg confirms.

However, the type of light therapy also matters. While UVB is safe for most people during pregnancy, psoralen medications combined with UVA light (PUVA) are not considered safe. PUVA is so potent that people born female or male should avoid this therapy before conception as well as during pregnancy and nursing.

You may want to return to your tried-and-true treatment regimen after your baby is born. If you’re nursing, though, you should hold off on using powerful drugs until you’re done. That’s because some medications can pass through breast milk and cause side effects in your child.

Ask a doctor which psoriasis treatments are safe when you’re nursing. As a general rule of thumb, the following systemic and topical treatments aren’t recommended while nursing:

If your psoriasis symptoms worsen during pregnancy, try your best to manage stress. Anxiety and stress can make psoriasis worse.

You should also be sure to lather up your skin. Proper skin hydration goes a long way in psoriasis treatment, Kabigting says.

Whether you’re using petrolatum, Aveeno, or Eucerin, take special care of your belly and breasts. These areas are subjected to extra stress and skin stretching during pregnancy.

If you have psoriasis, talk with a doctor about what treatments are effective and safe during pregnancy.