There’s good news for moms-to-be with psoriasis: Thanks to the hormonal changes that are taking place inside your body, there's a chance that you may get a welcome reprieve from your itchy, scaly skin condition.
Another positive? While more research needs to be done to know for sure, experts believe that having mild or moderate psoriasis doesn’t increase the risk for pregnancy complications or problems for your baby-to-be.
What is absolutely clear is that the best pregnancy outcomes occur if you conceive when your condition is in remission and you’re off your medications.
What is psoriasis?
Psoriasis is a chronic inflammatory disease of the immune system that affects about 3 percent of the population. If you have it, you’ve likely experienced those unwelcome raised, red, scaly patches on the skin that may itch, burn or sting.[1]
This skin disorder can go hand-in-hand with other challenging diseases and conditions, including diabetes, cardiovascular disease and depression.
In living with the condition, you’ve also likely experienced outbreaks often triggered by factors such as stress, an injury to the skin (sunburns, scratches, insect bites), certain medications and even infections (strep throat, respiratory infections).
Other possible triggers may include allergies, heated and drier indoor air, diet and the weather. It’s wise to discuss with your doctor how to best minimize or even eliminate these triggers. Interestingly, what may cause one person's psoriasis to flare up may not affect another's.
What are the effects of pregnancy on psoriasis?
Many expectant women say they see an improvement in the severity of their psoriasis during pregnancy, while others report that their condition gets worse.
If that’s the case for you, check in with your doctor and prenatal practitioner to figure out the best (and safest) way to manage your symptoms for the duration of your pregnancy.
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Also, be aware that even if your psoriasis improves while you're expecting, you may experience a flare-up postpartum. If you're breastfeeding, check with your doctor to determine which treatment options are safest for you and your baby.
How will psoriasis affect my baby?
Some research has found that women with severe psoriasis are at greater risk of delivering low birth weight babies than women who have mild psoriasis and women who don’t have the chronic skin condition at all, while other research finds no adverse outcomes. Again, psoriasis can be different for everyone.
It's true that psoriasis occurs more often in people who have a family history of the condition, and estimates have found that when one parent has psoriasis, their child has a 10 percent chance of also developing it. If both parents have psoriasis, the child's odds jump to about 50 percent. Even then, people have to be exposed to specific factors, or triggers, to be at risk for an outbreak.
Try not to worry that your baby will develop psoriasis if you have it. Talk to your pediatrician about your medical history after you give birth, and stay up-to-date with your routine wellness visits so she can check your baby for any signs or symptoms of the condition.
How do you treat psoriasis during pregnancy?
Treatment for psoriasis during pregnancy will depend on how severe your particular case is. Options include:[2]
Topical treatments. For moms-to-be whose psoriasis involves less than 5 to 10 percent of the body, topical remedies (lotions or creams applied to the skin), emollients (such as Vaseline), moisturizers or low-dose topical corticosteroids and Vitamin D ointment are recommended treatments. Your doctor will likely advise you to apply a thick layer of moisturizer after your daily shower, while your skin is still wet, to keep it well-hydrated. If your doctor recommends using topical corticosteroids, be sure to use an amount and frequency of application as directed.
UV light treatments. If your psoriasis is more extensive and topical creams aren’t enough, UVB phototherapy (light therapy that suppresses the inflammation that causes your skin symptoms) is the preferred treatment. Natural sunlight can also improve your symptoms and is a good alternative if UVB light therapy isn’t an option for you. Do keep in mind that phototherapy may reduce your folate levels, so be sure you're getting enough folic acid in your prenatal vitamin to keep your baby healthy. Ask your practitioner if you need an additional supplement.
Systemic medications. Most expectant moms with psoriasis can be treated with topical therapy or phototherapy, but moms-to-be with severe psoriasis might need to be treated with medication. Because not all of the medications typically prescribed for psoriasis are safe for use during pregnancy, your doctors will have to choose those that present the least risk for your pregnancy and your baby-to-be. Some choices may include TNF-inhibiting biologics such as adalimumab and infliximab (which need to be tapered off before the third trimester) or cyclosporine (which carries the risk of premature birth and a small-for-gestational-age baby). Certain medications often used in the treatment of psoriasis (such as methotrexate, tazarotene and acitretin) are not safe for use during pregnancy because of the risk of birth defects and miscarriage.
One more thing to consider: Talk with your doctor about getting your vitamin D levels checked. Vitamin D deficiency may worsen psoriasis symptoms — so if you’re falling short, taking a supplement (especially a topical one) could be helpful.
Finally, since stress often increases psoriasis symptoms, it’s important that you work to proactively lower any external triggers such as getting adequate sleep, along with going to bed and waking up at the same time. A healthy pregnancy lifestyle that includes eating well, exercising and practicing relaxation techniques can help do just that.
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