Psoriasis is a chronic skin issue that affects 2 to 3 percent of the world’s population. There are multiple ways to treat the skin plaques in psoriasis. Treatments can include biologics, systemic medications, and light therapy. The first medication your doctor is likely to give you, though, is a topical treatment.
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.
Why treatment is a concern during pregnancy
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 women, says Filamer Kabigting, M.D., an assistant professor of dermatology at Columbia University Medical Center.
“Most are categorized as pregnancy category C, meaning there is no clear evidence supporting or refuting associations with birth defects,” he says. There are ethical constraints when it comes to enrolling pregnant women in clinical trials. That makes it difficult to test out how medications affect a fetus during pregnancy.
These factors all mean it’s important for you to talk to your doctor about the risks and benefits of any drug you’re thinking about using.
What to avoid
You should not use any potent steroids, such as clobetasol, during pregnancy. This is true even if these drugs worked for you in the past. If you plan to breastfeed your baby, you should wait to use these drugs until after your child has stopped breastfeeding.
Coal tar has been used for decades in treating psoriasis in people who are not pregnant. However, Kabigting says that women should avoid this topical treatment during pregnancy. “Some animal studies have shown an increased risk of cleft palate and poorly developed lungs,” he says.
You should also avoid using tazarotene (Tazorac) during pregnancy. It’s labeled as a category X drug. Category X drugs have a high risk of causing permanent damage to the pregnancy and developing child.
Safe options during pregnancy
The good news is that your psoriasis symptoms may improve during pregnancy even without treatment. This happens in 40 to 60 percent of pregnant women, according to a study published in the British Medical Journal.
If your psoriasis symptoms are getting worse, though, there are safe options for treatment.
Emollients and OTC moisturizers
You may want to try emollients or OTC topical treatments first. These are among the safest options for pregnant women. They include:
- Petroleum jelly, such as Vaseline
- Mineral oil
Try using mineral oil in your baths, too. This can be a great complement to topical treatment. Prolonged exposure to mineral oil may dry out your skin, so be sure to limit your bath time 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. These ones 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 and can reach your baby.
The type also matters. Gary Goldenberg, M.D., a dermatologist at Mount Sinai Hospital and an expert on psoriasis, likes to recommend 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 your doctor exactly how much is safe for you.
Your safest bet
If these drugs don’t work to treat your psoriasis, you may want to look into light therapy. This includes phototherapy that uses ultraviolet light B. Although it’s considered a second-line treatment for psoriasis, phototherapy is the safest option of all for pregnant women.
“This is usually administered in the dermatologist's office and is completely safe during pregnancy,” Goldenberg says.
You may want to get back to your tried-and-true treatment regimen the day your baby is born. But if you’re breastfeeding, you should hold off on using powerful drugs until you’re done breastfeeding. That’s because some medications can pass through breast milk and cause side effects in your child. Ask your doctor which psoriasis treatments are safe when you’re breastfeeding.
Other things to consider
If your psoriasis symptoms get worse during pregnancy, try not to 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. Work with your doctor to find a treatment that’s effective for your psoriasis and safe for your pregnancy.