Psoriasis is a chronic inflammatory condition that can involve changes in the skin and joints. During pregnancy, a person’s experience of psoriasis may change.
Women may need to change their treatment plan while pregnant or breastfeeding.
This article looks at how pregnancy affects psoriasis, and how it may affect treatment options.
Some studies have suggested that psoriasis can increase the risk of experiencing adverse effects during pregnancy.
Overall evidence suggests that it does not, but changes in the hormonal and immune systems during pregnancy may change the way psoriasis affects someone at this time.
Previous research has suggested that around 55% of women with psoriasis see an improvement in their psoriasis symptoms during pregnancy, while the other 45% experience either no change or a worsening of symptoms. The reaction will vary from person to person.
Pustular psoriasis of pregnancy
During pregnancy, there may be a higher risk of a rare condition called pustular psoriasis of pregnancy (PPP) in women with a personal or family history of psoriasis. A person with no history of psoriasis can also have it.
If it develops, it tends to do so early in the third trimester.
A woman with PPP will have areas of inflamed skin with pustules on the top, usually in skin folds, such as under the breast and in the groin and armpits.
After around a day, the pustules can join together, creating large plaques.
Symptoms may spread to various areas of the skin but do not usually affect the face, palms of the hands, or soles of the feet.
There may also be:
Women with symptoms of PPP should seek medical treatment, as it is not only potentially life-threatening to the mother but can also be dangerous to the fetus. Treatment is available.
Learn about how to recognize pustular and other types of psoriasis here.
Complications and comorbidities
Psoriasis is an inflammatory condition that can occur alongside other autoimmune and inflammatory conditions. Diabetes, obesity, high blood pressure, and other aspects of metabolic syndrome may be present.
Smoking may be a trigger for psoriasis. One study found that women with psoriasis during pregnancy are more likely to have obesity, to smoke during the first trimester, to have depression, and not to take folate or vitamin supplements.
The evidence is not conclusive on whether psoriasis itself increases the risk of experiencing an adverse outcome in pregnancy, however.
Some regular treatment options for psoriasis may not be suitable during pregnancy.
Options will depend on the type and severity of the psoriasis, personal preference, and the doctor’s recommendations.
Women should work with their doctor to determine a suitable treatment plan during pregnancy and while breastfeeding.
Medications and therapies
It may not be necessary to stop all treatment, but some psoriasis medications may not be suitable during pregnancy. A doctor can advise on the most appropriate options.
Many topical applications, such as creams and ointments, may be safe to use during pregnancy, especially if the person only uses them on small areas on the body. Most moisturizers and emollients are also safe.
One study from 2015 concluded that topical steroids, especially of mild to moderate strength, are unlikely to cause any adverse outcomes in pregnancy.
However, the National Psoriasis Foundation recommend using limited amounts of steroid cream, if any.
Women should ask their doctor for advice on suitable topical treatments to use during pregnancy.
Light therapy, or phototherapy, appears to be safe to use during pregnancy, though data are limited.
A woman should cover her face or use a strong sunscreen to avoid a worsening of melasma, which is a change in skin color that can occur during pregnancy.
PUVA, another type of light therapy — in which a person takes medication to increase ultraviolet absorption — is not suitable for use during pregnancy.
Learn more about sunlight, light therapy, and psoriasis here.
Systemic and biologic drugs
Doctors usually advise women to avoid systemic and biological medication during pregnancy or breastfeeding, except where there is a clear medical need that outweighs any risk to the fetus.
There is evidence to suggest that the following systemic medications are not safe to use during pregnancy:
- oral retinoids
Biologics are an emerging class of medications that target the underlying cause of psoriasis by affecting specific parts of the immune system.
In 2017, researchers noted that there is increasing evidence that some biologic medications may be safe to use during pregnancy. However, more research is needed to confirm the safety of many of these drugs during this time.
Currently, doctors only prescribe them during pregnancy if a woman has severe psoriasis symptoms.
Safe treatment options for psoriasis during pregnancy include:
Stress may trigger a psoriasis flare. Lowering stress during pregnancy can help reduce the risk of a flare.
Getting enough sleep, regularly exercising, and taking part in yoga or meditation may also help. It is important for a person to discuss an exercise regimen with their doctor before starting it.
Taking oatmeal or Dead Sea salt baths
Oatmeal baths may help soothe the skin. Always use water that is warm but not hot and avoid rubbing the skin while washing or drying.
Some people also say that Dead Sea salt baths help keep the skin hydrated because of the minerals in the salt.
A pharmacist can recommend a moisturizer or emollient. A person should apply this within 5 minutes of finishing their bath or shower.
Genetic factors play a role in psoriasis, and it can run in families. However, not everyone with psoriasis-specific genetic features will develop the condition.
Psoriasis is not contagious. One person cannot catch it from another, and a pregnant woman cannot pass it to her baby, either before or after delivery.
Most people who have psoriasis develop symptoms during adulthood, and scientists believe that certain environmental factors must be present for psoriasis to appear.
The main risk of psoriasis during pregnancy or breastfeeding is the use of inappropriate treatment. A doctor can advise on how to avoid this problem.
What role do genetic factors play in psoriasis? Learn more here.
Delivery may increase the risk of experiencing a psoriasis flare.
Delivery-related triggers for psoriasis may include:
- surgery, such as for a cesarean delivery, as skin trauma is a key trigger for psoriasis
- hormonal changes, such as those that occur after giving birth
Experiencing psoriasis during pregnancy is unlikely to pose a risk to the fetus, but it can affect each individual differently, possibly due to hormonal changes.
Women with psoriasis who wish to become pregnant or who are pregnant should speak to their doctor about treatment options.
They can advise on how to avoid a flare or how to manage one should it arise.