pregnant woman

Pregnancy and Psoriasis: What You Need to Know

By Claire Gillespie
June 17, 2021

If you’re pregnant or thinking about becoming pregnant, you’re probably wondering how your psoriasis factors into these nine months and beyond. Could your psoriasis affect your baby? Will it get worse—or could it get potentially get better? And is your current treatment safe to continue? We’ve got answers to the most common questions about being pregnant when you have psoriasis.

How Psoriasis Affects Pregnancy

Psoriasis shouldn’t stand in the way of a healthy, full-term pregnancy or a straightforward delivery. One study published in the Journal of the American Academy of Dermatology found that women with severe psoriasis were 1.4 times more likely to have a baby with low birth weight than those without psoriasis. On the other hand, those with mild psoriasis didn’t have a significantly higher risk of low birth weight, C-section, or preeclampsia, which is good news. As is the fact that psoriasis has never been linked to miscarriage or birth defects.

No matter your severity, it’s important to stay on top of your prenatal care by seeing your OB/GYN regularly. They can closely monitor you and your baby to help keep your pregnancy as healthy as possible.

Psoriasis Symptoms Improve for Many

Will your psoriasis symptoms improve or flare during pregnancy? We can’t say for sure, but for most people, it’s good news. According to an article published in the British Medical Journal, up to 60 percent of women saw an improvement in their psoriasis symptoms during pregnancy. Ava Shamban, M.D., a board-certified dermatologist at Ava MD in Santa Monica, California, says she sees this among her patients, too.

“Many psoriasis patients can expect to see a significant drop in the severity of their psoriasis and/or a decrease in the surface area covered,” Shamban explains. She believes it’s a direct result of increased estrogen and progesterone levels.

An improvement in your psoriasis symptoms during early pregnancy might continue all the way through, but Shamban says that for most, it will peak at the end of the second trimester. And in most cases, the condition returns to its approximate prenatal levels postpartum.

For Some, Psoriasis Worsens

While it’s more likely for symptoms to improve, in the same British Medical Journal study, up to 20 percent of women’s psoriasis got worse during pregnancy. Scientists are still trying to figure out why this happens, says Rhonda Klein, M.D., a board-certified dermatologist at Modern Dermatology of Connecticut in Westport.

If your psoriasis is worsening during pregnancy, it’s important to let your OB/GYN and dermatologist know, so you can come up with a treatment plan together.

Psoriasis Medications During Pregnancy

When treating psoriasis while you’re pregnant, the first thing to consider is what psoriasis meds are safe for pregnancy. Many of the common ones aren’t.

Ideally, you should discuss your psoriasis treatment regimen when you’re trying to conceive, so you can have a safe treatment plan in place before you even get pregnant, says Klein. It’s crucial to avoid pregnancy altogether if you take oral meds to manage your psoriasis symptoms. Many of them require a “washout” period (in both biological parents) before trying to conceive.

As with any medication, procedure, or protocol, always check with your primary care physician and your OB/GYN before starting or continuing any psoriasis drugs during pregnancy.

Some medicines simply haven’t been studied well enough to establish whether they’re safe to use during pregnancy. These include the topical treatments coal tar and tazarotene (Tazorac) and biologic drugs like adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade).

“Biologics and biosimilars, which both suppress functions of the immune system, are in a really gray area for pregnancy,” Shamban says. Every patient’s circumstances are different; and, in some cases, biologic or oral treatments can be taken under medical supervision where the benefits to you would outweigh any potential risks to the baby.

“In some cases, TNF inhibitors (drugs that suppress inflammation) are recommended as there is more data that they can be used safely,” Shamban says. “Others that have less data but are shown not to cross the placenta, or have insignificant amounts of placental transfer, may be prescribed if the benefit to the mother is deemed necessary.”

Drugs that should definitely be avoided include methotrexate (Trexall), which has been linked to miscarriages, cleft palate, and other birth defects, and oral retinoids like acitretin (Soriatane), which can cause birth defects (particularly in the first trimester).

Finding Safer Treatments

If you can’t take your usual psoriasis meds during pregnancy, there may be other ways to relieve your symptoms.

Topical moisturizers and emollients like petroleum jelly are often recommended as the safest option for psoriasis during pregnancy, but they can have varying degrees of relief and benefits for the patient.

Shamban says low-dose topical steroids or prescription vitamin D products are commonly prescribed during pregnancy.

For pregnant women with moderate to severe psoriasis who find that creams and ointments aren’t controlling their symptoms, Shamban suggests trying narrow-band ultraviolet light B (UVB) phototherapy.

Note, though, that there’s another type of phototherapy treatment called PUVA that isn’t recommended during pregnancy. PUVA is a combination of ultraviolet light A (UVA) phototherapy and a drug called psoralen. Psoralen can pass into breast milk and cause light sensitivity in the baby.

Birth and Beyond

There are some things to consider as you prep for your baby’s birth, too. If you have genital psoriasis, it’s important to be mindful of the sensitivity of your skin—and your obstetrician should be, too, according the National Psoriasis Foundation. Also, whether you have a vaginal or C-section birth, it’s possible to experience psoriasis on any tears or incisions. Psoriatic lesions can form following trauma to the skin on an area that was previously unaffected. This is known as the Koebner phenomenon.

While there’s no way to predict exactly how your psoriasis will respond to pregnancy or childbirth, it’s common to have a psoriasis flare shortly after delivery.

If you plan to breastfeed, know that oral retinoids, methotrexate (Trexall), biologic drugs, and any other drugs unsafe during pregnancy may still be off the table. Until your baby is weaned from breastfeeding, you may have to stick to emollients, topical steroids, and dithranol cream.

If you do use topical steroids, be careful not to let the cream rub off onto your baby. If you have psoriasis on your breasts, it’s important to wash the cream off thoroughly before nursing.

More research is needed to better understand how pregnancy affects psoriasis and the effects of different drugs during pregnancy. If you’d like to help further the current research, ask your doctor about enrolling in a pregnancy registry, which tracks people who are on different medications during pregnancy to better understand their impacts on the mother and the fetus.