How Does Psoriasis Affect Pregnancy?

Pregnancy can significantly impact many chronic health conditions; however, psoriasis can improve with the hormonal changes that occur during pregnancy.

Psoriasis is a chronic skin condition where dry, flaky, and often painful plaques form across your body. There is no cure for this condition, but many treatments are available.

This article explores how pregnancy can affect psoriasis, safe and effective treatments during pregnancy, and how to protect your fetus from the adverse effects of treatments while pregnant or breastfeeding.

How Does Pregnancy Affect Psoriasis?

More than half of the estimated 7 million adults affected by psoriasis in the United States are women—and most of them are in their childbearing years. This statistic suggests that many women with psoriasis may need to manage both their psoriasis and a healthy pregnancy.

Between 9,000 and 15,000 live births in the United States each year are to people who face moderate-to-severe psoriasis. Although autoimmune conditions like psoriasis are linked to problems during pregnancy, many people with psoriasis report an improvement in their psoriasis symptoms and overall condition during pregnancy.

One study estimates that 60% of people see improvement in their psoriasis during pregnancy, 20% report no change, and 20% see their condition worsen. There are a few reasons for this variation. In general, psoriasis is believed to affect more women because people assigned female at birth have immune systems that are more sensitive to hormonal stimulation.

Cytokines (small proteins that help signal cell activity) can positively affect autoimmune inflammation that psoriasis triggers. During pregnancy, cytokine levels fluctuate due to pregnancy hormones, contributing to a reduction in psoriasis symptoms in some people.

Can Pregnancy Cause Psoriasis?

Most of the research describing psoriasis during pregnancy focuses on pre-existing cases of psoriasis, but this doesn't mean that it's impossible to develop a new autoimmune condition during pregnancy.

Several autoimmune conditions are known to be triggered by pregnancy, including:

• Rheumatoid arthritis
• Lupus
• Myasthenia gravis
• Antiphospholipid syndrome
• Immune thrombocytopenia

Pregnancy doesn't typically trigger psoriasis, except for one specific form of the skin condition known as "pustular psoriasis of pregnancy."

Pustular Psoriasis of Pregnancy

Pustular psoriasis of pregnancy (PPP) is a rare condition primarily affecting people in their third trimester. It's also known as impetigo herpetiformis and can cause inflamed, itchy, or crusted lesions to form on the skin—especially in skin folds.

If left untreated, this condition can lead to problems during pregnancy for the birthing parent and baby. It can develop in people with or without a family history of psoriasis. Although this form of psoriasis usually resolves within days of giving birth, severe cases may be treated during pregnancy with medications like steroids and antibiotics.

If you develop PPP with one pregnancy, you are more likely to have a recurrence with additional pregnancies.

Which Medicines Are Safe to Take for Psoriasis During Pregnancy

There is limited information about the safety of some medications during pregnancy simply because testing the effects of new medicines on pregnant people and their developing fetuses is unethical.

The safety of medications during pregnancy is usually determined based on how easily the medication can be transferred from the pregnant person's system to the fetus through the placenta and the effect these medications can have on a developing fetus.

Medications, such as steroids and immunosuppressants, used to treat various conditions and have been around for a long time tend to have the most data. These medications are sometimes used during pregnancy but carry the risk of reduced fetal growth, and healthcare providers typically recommend the smallest possible dose.

Certain psoriasis medications can be used during pregnancy, though they can affect the fetus. The medications include the following:

• Prednisone
• Cyclosporine
• Tacrolimus

Talk to your dermatologist and obstetrician about the efficacy and risks associated with psoriasis medications before using them during pregnancy or while breastfeeding.

Which Medicines Should You Avoid While Pregnant?

While some of the medications above are used for severe cases of psoriasis under a healthcare provider's guidance, there remain several other psoriasis medications that are unstudied in pregnancy or are known to pose a significant risk of congenital abnormalities.

Biologics are a newer class of medications used to treat psoriasis and other autoimmune conditions. While effective in treating certain diseases, biologics have not been studied and proven safe during pregnancy. While research suggests that some biologics are likely safe to use during pregnancy without risk to the pregnant person or fetus, healthcare providers do not currently recommend these medications for use during pregnancy.

Other medications that are not recommended or strictly prohibited for use in pregnancy include:

• Methotrexate
• Retinoids
• Tazarotene
• Acitretin
• Coal tar
• Salicyclic acid
• Phototherapy or light therapy

This list is not exhaustive. These medications—and others—are proven to or highly likely to cause severe congenital abnormalities, premature birth, or even fetal death. If you take any of these medications and become pregnant or are planning to become pregnant, talk to a healthcare provider about when to stop taking them and when they are safe to resume after delivery.

Other Safe Treatment Options for Psoriasis During Pregnancy

Several non-pharmaceutical or over-the-counter (OTC) treatments may help relieve psoriasis symptoms during pregnancy without putting you or the fetus at risk.

Reduce Stress

Stress can trigger psoriasis and cause flare-ups. Reducing stress can help you control your psoriasis. Stress relief can take many forms, including meditation, massage, or acupuncture. Talk to a healthcare provider about other pregnancy-safe strategies for stress management. If you use massage or acupuncture, make sure your therapist is trained in treating pregnant people.

Take an Oatmeal or Dead Sea Salt Bath

Bathing is an excellent way to deliver exfoliation and moisture to the body. Various bath products are created specifically to exfoliate and moisturize, but you don't need high-end products to achieve psoriasis relief with a bath.

Dead sea salts and colloidal oatmeal bath soaks help relieve psoriasis symptoms such as flaking and itching. They are considered safe during pregnancy and widely found in generic formulas.

Use Moisturizers After Bathing

Moisturizers can also help calm irritated or inflamed skin, even without additional medications. Many use topical creams and ointments containing ingredients like petroleum jelly, mineral oil, or oatmeal-based creams to help manage psoriasis.

These topical treatments can help at any time, but they may be particularly effective after showering or bathing because they help seal moisture into the skin.

Will the Baby Have Psoriasis Too?

Not every case of psoriasis is genetic, but it can be passed through families. If you or your partner have psoriasis, your baby is more likely to develop the condition at some point.

How to Protect Your Baby

You can't change your genetics, but you can help protect your growing fetus from the toxic effects of some psoriasis treatments. Talk to a dermatologist and obstetrician about the best treatment options for psoriasis during pregnancy.

If you don't already have psoriasis before pregnancy, discuss any new skin conditions with your obstetrician or primary care provider.

Psoriasis Flare-Ups Right After Delivery

If you notice a change in your psoriasis during pregnancy—especially if your symptoms improve—it's very likely that these changes won't last long after delivery. Your psoriasis may return as your body returns to its baseline function after delivery.

If you developed psoriasis during your pregnancy and didn't have it before, there is a chance that your condition was PPP and will resolve after you have your baby.

Summary

Psoriasis is a chronic, autoimmune disease that causes flaky and sometimes painful patches on your skin. Many women report their psoriasis improves during pregnancy, but it won't go away completely.

If you use prescription medications to treat your psoriasis, you may need to talk to a healthcare provider about the safety of these medications during pregnancy. You may be able to continue some psoriasis medications throughout pregnancy, but others can be highly toxic or even fatal to a developing fetus.