Psoriasis and Pregnancy: Symptom Changes, Risks and Treatment Options
Psoriasis is a chronic autoimmune condition in which inflammation causes symptoms on the skin. For both men and women, having psoriasis usually does not have an effect on fertility and the ability to become pregnant. However, women who are pregnant or breastfeeding may need to use different types of treatments due to the effects that some treatments can have on an unborn child or child who is nursing2. Men may also need to be off of certain medications, methotrexate for example, prior to trying to conceive due to concern with fertility rather than the risk of birth defect1.
Does being pregnant affect my psoriasis?
Being pregnant can affect a woman with psoriasis in different ways. Some women experience an improvement in their symptoms during pregnancy, while others find that their symptoms get worse during that time2. Some women who have worse psoriasis during one pregnancy find that psoriasis gets better during another pregnancy, and vice versa.
Many women experience a psoriasis flare-up shortly after the baby is born. Women with psoriasis symptoms on the genitals should talk with their obstetrician about the possible effects the symptoms could have on a vaginal delivery2. One study found that women with severe psoriasis are more likely to have a baby with low birth weight, but this has not been seen in women with mild psoriasis3.
Women with chronic conditions such as psoriasis who become pregnant are more likely to be depressed, gain too much weight, smoke, forget to take prenatal vitamins and supplements. Talk with your healthcare provider about ways to treat and deal with these issues in order to have a healthy pregnancy.
Can pregnancy cause psoriasis to flare?
Generally speaking, pregnancy itself does not cause a woman to develop plaque psoriasis, which is the most common form of the condition. However, the average age at which women are diagnosed with psoriasis is 28 years, which is a time when many women try to become pregnant, so there are many women who have psoriasis during pregnancy. Between 65,000 and 107,000 women with psoriasis give birth every year, with between 9,000 and 15,0000 of those women having moderate or severe psoriasis.
Which psoriasis treatments should be avoided while pregnant or nursing?
Women with psoriasis should talk with their healthcare provider if they are pregnant or planning to become pregnant, to make sure that they are not using any potentially harmful treatments. This is especially true if you are taking very strong systemic or biologic medications for treating severe psoriasis. If you become pregnant but don’t know it yet, the medications can have serious effects on the fetus in the very early stages of development2. Healthcare providers will generally recommend that women should use birth control methods carefully during treatment with systemic or biologic medicines.
More research is needed about how psoriasis treatments may affect women who are pregnant and breastfeeding4. However, the National Psoriasis Foundation recommends that women with mild psoriasis should try over-the-counter topical treatments such as mineral oil and Vaseline used with occlusion2. Topical corticosteroids should be avoided if possible; if they are needed, then the smallest possible amount should be used. Breastfeeding women should try not to apply topical steroids to their breasts.
The following topical medicines have not been studied closely enough for their effect on pregnant and nursing women3:
Pregnant and nursing women are generally advised to avoid these medicines if possible, until further studies can show they are safe3. Healthcare providers will generally only recommend them if the benefit of treatment is much greater than the potential risk to the fetus or baby.
Phototherapy with UVB light is sometimes prescribed for pregnant and nursing women whose symptoms are not controlled well enough by topical medicines. However, women who are breastfeeding should not use UVA light or psoralen because it can be absorbed into breastmilk4.