For women with psoriasis, preparing for motherhood can sometimes be a mixed blessing in terms of their skin. “Almost two-thirds of women who become pregnant and have preexisting psoriasis will find their psoriasis spontaneously gets better during pregnancy,” says Alan Menter, M.D., chair of the dermatology program at Baylor University Medical Center in Dallas and president of the International Psoriasis Council. “The problem is that the majority of patients tend to flare—sometimes significantly—during the immediate postpartum period, within two weeks after the baby’s birth, and after.” Adding to those challenges, not all psoriasis medications are safe to use during pregnancy and breastfeeding. What to do? Here are some things to consider.
What Treatments Are Safe?
That’s the primary question that most women with psoriasis have when they become pregnant, or even when they’re thinking of conceiving. Research is still under way about the safety of many psoriasis medications during pregnancy, but doctors are learning more all the time. If you have psoriasis and hope to start a family in the near future, talk to your dermatologist and your OB/GYN to work out a treatment plan that can help keep your condition under control and your baby safe:
- Most topical medications for psoriasis, when used carefully, are considered safe during pregnancy. The one exception is tazarotene, which is a retinoid drug and is absorbable through the skin. The side effects can potentially lead to birth defects, so it is absolutely not recommended during pregnancy. Anthralin, calcipotriene and topical calcitriol and steroids are all listed as category C drugs by the Food and Drug Administration (FDA), which means that although there is no clear evidence they can cause birth defects, pregnant women should use them only sparingly if necessary.
- Light therapy that uses only UVB light is considered safe during pregnancy. PUVA treatments—light therapy that combines the use of a light-sensitizing medication (topical or oral psoralen) with exposure to UVA light—is not recommended during pregnancy as there may be a potential for birth defects.
- Biologics, including adalimumab (Humira), alefacept (Amevive), etanercept (Enbrel), infliximab (Remicade) and ustekinumab (Stelara), are listed as category B drugs by the FDA. That means that long-term studies on animals have shown no harm to the fetus when used during pregnancy. However, since no human studies have been conducted on these medications, pregnant women are advised to use them only when necessary. “Sometimes we’ll wean women off their biologic medications just before they start trying to conceive,” says Dr. Menter. “It usually takes three to four months for psoriasis to return after going off the drugs, and in some cases, the women might be almost in their second trimester by then and their psoriasis may spontaneously improve on its own.”
- Drugs to avoid completely during pregnancy, in addition to tazarotene, include methotrexate (an oral or injectable immunosuppressant medication; trade names Rheumatrex and Trexall) and acitretin (Soriatane, an oral retinoid medication), which the FDA list as category X: Causes birth defects. Absolutely avoid.
Will My Baby Have Psoriasis?
It’s a common worry among women with psoriasis: Will you pass your condition on? If you’re the only one in your family with psoriasis, your baby has about a 10 percent risk of inheriting the disease, says Dr. Menter. If one or two members of your family have it, the risk rises to between 10 and 30 percent. If both you and your husband have psoriasis, or if you’re one of multiple siblings and extended family members who have the disease, the risk rises to 40 to 50 percent. Within about five years, doctors hope to have a genetic test available that could predict more precisely how likely your children are to inherit psoriasis. Even if they do inherit it, only one out of 10 people develop symptoms in childhood or early adolescence, and there’s a good chance your children may never have symptoms at all.
“For instance, many women with breast cancer genes may never develop breast cancer, and patients with a genetic pattern suggesting psoriasis may never develop the condition,” says Dr. Menter. “There really is no reason to fear psoriasis, as we really do have an array of therapies that should control the vast majority of patients, even during pregnancy and the lactation period.”
For women with psoriasis it’s especially important to limit stress, eat well and stay healthy while pregnant, because stress and infections frequently act as triggers for the condition. Take extra care of your skin, too, by moisturizing your breasts and belly daily, as your skin expands, making the development of stretch marks and skin cracks more possible.