Psoriasis and the Unpredictability of Pregnancy

Psoriasis is an unpredictable beast at the best of times, but when we're going through significant hormonal and emotional changes, we are more vulnerable.

Psoriasis and pregnancies are all different

The general literature on psoriasis in pregnancy shows two directions: Lucky as heck when psoriasis clears in pregnancy or unlucky as heck where pregnancy makes psoriasis worse. I find this interesting as I have had four pregnancies, and all of them have been different.

While I would class myself in the former ‘lucky category’ there are several things that are worth considering.

Psoriasis clearance with my first pregnancy

This was a relatively easy pregnancy - ginger biscuits helped nausea. Only people cooking lamb within a 1-mile radius were at risk of verbal damage. The plaques cleared almost entirely. Those that remained were very pale and flat and inconspicuous with no flaking.

The birth was stressful, and the post-birth recovery was long. My psoriasis came back within five weeks, but it returned slowly so I had time to adjust emotionally. Anticipating its return helped, I think if I had been more optimistic, I would have been more devastated by my short postpartum respite.

My previous experiences of treatments like UV taught me five weeks is my clearance time zone so yours will probably be completely different. If I could go back in time I would ask for more help with coping. I soldiered on by myself, eating chocolate instead of actual meals and this stressful transition into parenthood plus an inflammatory high sugar diet will not have helped with my psoriasis at all.

Suriving pregnancy number two with psoriasis

This pregnancy was harder than the first, with bad 24 hour morning sickness for many of the earlier months. My psoriasis did not manifest as quickly. I kept hydrocortisone in the car to apply to my ears as nausea meant I needed to wear my hair tied up and my ear psoriasis is particularly persistent.

I kept its use to the absolute minimum I needed to keep the scaling down as topical steroid use is something that can affect the body, and therefore is something you need to discuss with your doctor when you're pregnant. Nausea cleared around the end of the first trimester, and with it, the scaling around my ears improved too.

There was still much milder, less active psoriasis around my ears, but it was a case of being reminded every so often to apply the cream than religiously using it every morning. I failed to prioritize myself in this pregnancy and ended up in hospital on a drip. Interestingly my psoriasis was much less active while I was in the hospital.

Suriving psoriasis with pregnancy number three

A strep infection at six weeks pregnant left me with a psoriasis mega flare which couldn't be treated with systemic as it could harm the baby. Extensive use of topical steroids is not recommended in pregnancy, so that wasn't an ideal solution either. My guttate is a stubborn beast and isn't bothered by topical steroids at all.

The safest option for me was UV treatment. My skin did worsen slightly as the pregnancy progressed, but I was still more than 95% clear. Having the nbUVB machine residing in my bedroom helped with the post flare anxiety.

I steered clear for a much longer time after this pregnancy. I think it was because I had easier labor and birth and recovered quickly, so my stress levels were much lower than they had been before. I also knew to ask for help and felt less ashamed to admit when I was struggling. Emotional burden really can affect psoriasis- and so it's important to factor this in when thinking about post-birth recovery.

Partial psoriasis clearance during pregnancy four

My diet was appalling. I could only stomach ham and tomatoes (a trigger food for me) and then pot noodles. A meal I would never eat normally. My psoriasis did not improve at all in the first four months, which I think is due to the emotional and physical stress of being almost entirely bedbound — eating inflammatory foods certainly didn't help!

I don't have as much clearance as I did in my previous pregnancies - but I have reduced the number of plaques by about 50 -60%. The spots are mostly on the places that are being stretched and are more sweaty. So my abdomen, and under and between my breasts.

More recently psoriasis has come back down my arms. This is because my immune system is dampened in pregnancy to protect my growing baby. Of course, this leaves me vulnerable to infections and I am still battling a cold I came down with three weeks ago.

What have I learned about managing psoriasis in pregnancy?

You need to include your doctor. Some treatments are not suitable for use in pregnancy. It's worth talking to your doctor before your pregnant if your anxious about in pregnancy treatments to find out what options you have. Cyclosporine and Methotrexate are a definite no-no and should be stopped before you start trying to conceive, but using different strength topicals is more nuanced and depends on your circumstances and the strength of the topical.

Reducing stress is a priority.Reducing stress is not just to help our skin clear but also because stress can reduce our ability to fight infections. Reduced immune function due to stress on top of the reduced bug fighting strength we have being pregnant means even more vulnerability to infection. Having a strep infection is a horrific place to be. And it's worse when you're pregnant.

Ask for help. People want to help, and anyone who has been pregnant or effectively supported a pregnant woman will know the strain you are under, and they want to help. You need to get past your 21st-century programming and let them.

It's harder than you think, but it's worth it.

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