Psoriasis and pregnancy: Effects, symptoms changes, and treatments
This article looks at how pregnancy affects psoriasis, and how both symptoms and treatments may change over time.
How does pregnancy affect psoriasis?
The reaction of psoriasis during pregnancy may vary from woman to woman.
While psoriasis has not been found to affect pregnancy, pregnancy may affect psoriasis.
Most women experience a reduction in psoriasis symptoms during pregnancy. However, some experience no change and others experience a worsening of symptoms. The reaction will vary from woman to woman and pregnancy to pregnancy.
Similarly, women with psoriatic arthritis (PsA) may experience either less or more severity in their symptoms.
The challenge with PsA is the treatment of pain as pregnancy limits the number of acceptable painkillers and other medication. As a result, treatment options should be reviewed before or during the early stages of pregnancy.
Women with psoriasis can become pregnant with minimal issues, assuming there are no other conditions that may be affecting fertility.
Do different types of psoriasis have different effects on pregnancy?
There is not much information or good evidence that different types of psoriasis affect pregnancy differently. Most psoriasis types have similar triggers, so it is unlikely they will have different reactions to pregnancy.
In any type of psoriasis, a woman may experience better or worse symptoms that will need to be dealt with during her pregnancy.
However, severe cases of rare erythrodermic psoriasis may trigger life-threatening complications for both mother and fetus.
Erythrodermic psoriasis causes redness across the body and lesions that can be extremely painful. People with erythrodermic psoriasis should seek immediate treatment.
Treatment safety and risks
Psoriasis treatment during pregnancy as opposed to normally may vary very little or alot. Whether treatment changes depends on a number of factors, including:
- type of psoriasis
- severity of the psoriasis
- current treatment
- patient choice
- recommendations by doctors
A woman and her doctors need to work out what changes to treatment are needed, and if she wants to continue treatment during and right after pregnancy while breast-feeding.
A pregnant woman should consider the following factors regarding her psoriasis treatment during pregnancy.
Type and severity of psoriasis
One of the first things to consider is the severity of the psoriasis.
A woman with moderate plaque psoriasis may find that she can stop taking her psoriasis medications during pregnancy. However, women with PsA may find that stopping treatment for their PsA causes them problems.
Women with psoriasis and their doctors should look at the benefits and the risks of their current treatment during the early stages of pregnancy or before becoming pregnant.
Medications and therapies
Many topical creams may be safe for use during pregnancy.
In some cases, a woman may not need to stop all treatment. However, many medications may not be safe for the baby while it is in the womb.
A doctor is the best person to determine what medications are safe or potentially worth the risk of taking.
Creams and ointments
Many of the creams applied directly to areas affected by psoriasis may be safe to use during pregnancy. Generally, moisturizers and emollients are considered safe at this time.
Topical steroids may be safe in low doses. However, they should not be used near the breast if the woman is nursing.
Narrow-band ultraviolet light B (UVB) phototherapy
When applied to areas of the body affected by psoriasis, UVB phototherapy is generally considered safe.
UVA (broad-band ultraviolet light) phototherapy may also be used.
Systemic and biologic drugs
These types of medication should be avoided during pregnancy or breastfeeding, except where there is a clear medical need that outweighs any risk to the baby.
Pregnant women should avoid the following medications as they have been linked to birth defects:
- oral retinoids
Some pregnant women may be unhappy taking any drugs during pregnancy. Others may worry about stopping treatment for psoriasis during pregnancy. Either way, a pregnant woman with psoriasis should discuss her options with her doctor.
Pregnant women with psoriasis do have some safe treatment options available to them. They may already be doing some of them and these should be continued through pregnancy.
A woman with psoriasis can safely try the following while pregnant:
- Reducing stress: Stress may cause a flare-up of psoriasis. Bringing your stress down while pregnant can help eliminate the chances of a flare-up.
- Getting more sunlight: Sunlight can help to reduce the swelling and inflammation. Controlled light therapy is considered best. If that is not available, 10 to 15 minutes of sun exposure can help reduce the risk of a flare.
- Using moisturizer: Petroleum jelly is generally considered safe to use while pregnant and can be used during a flare of psoriasis to help offset the symptoms.
How might symptoms change during pregnancy?
Unfortunately, there is no way for a doctor to know or predict how a woman's psoriasis will react when she becomes pregnant.
Many pregnant women with psoriasis see their symptoms clear up for the duration of the pregnancy. Others experience heightened symptoms during pregnancy.
Doctors and researchers believe these differences may be due to hormone changes within each woman.
Will the baby be affected or get psoriasis?
A child may develop psoriasis due to genetics, but a psoriasis flare during pregnancy won't increase the chance of a child developing psoriasis.
Though the likelihood of the child developing psoriasis is higher due to genetics, there is no guarantee they will develop the condition.
Similarly, the baby will not simply catch psoriasis because they were born during a mother's flare. It is most likely that if the child is going to develop psoriasis, it will be later in life.
Babies may be affected if the mother is breast-feeding and the psoriasis leads to bleeding ulcers forming on the nipple. Otherwise, psoriasis has no direct effect on the baby's health.
The greatest risk of a mother's psoriasis affecting her baby is the treatment that she receives during pregnancy or breastfeeding due to their risk of harm to an unborn fetus.
The last area of concern for pregnant women with psoriasis is delivery. Psoriasis may flare whether a woman requires a cesarean delivery or delivers vaginally.
Surgery and surgical procedures are a risk for psoriasis flares, as are sudden hormonal changes, such as those that occur after giving birth.
In either case, a woman with psoriasis should discuss the risk of a flare with her doctor. Women can also discuss what preventive measures can be taken to help avoid a flare or treat one immediately.