Can a woman treat psoriasis while pregnant or breastfeeding?

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Psoriasis can change during pregnancy: Many women find they have less psoriasis during pregnancy. Psoriasis may also stay the same or worsen.

Yes, it’s possible to treat psoriasis while pregnant or breastfeeding. A woman must avoid some treatments because they can harm her baby. Others can be prescribed.

Psoriasis treatment a woman can use while pregnant

If you need to treat your psoriasis while pregnant, your dermatologist will think carefully about how best to control your psoriasis without affecting your baby. Treatment options considered the safest for pregnant women are:

Moisturizers and emollients: These cannot clear psoriasis, but they can:

  • Protect your skin from chaffing
  • Reduce your risk of a flare-up if you injure or irritate your skin

There are no known risks to using moisturizers and emollients while pregnant.

Corticosteroids that you apply to your skin: When a woman needs to treat psoriasis while pregnant, a low- to mid-strength corticosteroid is often the first medicine prescribed.

These do not appear to increase the risk of birth defects or cause a baby to be born early. This medicine may increase the risk of a woman developing stretch marks. 

If a strong corticosteroid is needed, it should be used for the shortest time possible.

Phototherapy: If a woman needs stronger psoriasis treatment, a type of light treatment called narrowband UVB phototherapy is often prescribed. Two types of phototherapy are considered safe for pregnant women to use:

  • Narrowband UVB
  • Broadband UVB

If you use phototherapy while pregnant
You should:

  • Protect your face from the sun: Using phototherapy while pregnant increases the risk of developing melasma (patches of darker skin on the face).

  • Ask your doctor about taking a folic acid supplement: Both narrowband and broadband UVB can deplete folic acid in your body. A deficiency of folic acid during your first trimester increases the risk of birth defects involving the brain, spine, and spinal cord.


If you need stronger treatment, your dermatologist will weigh the risks and benefits of possible treatments.

Most of what we know about treating psoriasis during pregnancy comes from pregnancy registries. These registries collect health information from women who take prescription medicine or get a vaccine while pregnant. Researchers compare this information with information about pregnant women who have not taken the medicine (or gotten the vaccine).

While information from pregnant registries is helpful, there are still a lot of unknowns about safety.

Psoriasis treatment to avoid during pregnancy

We know that a few psoriasis medicines can cause severe birth defects or make a woman lose the baby. Psoriasis medicines known to do this are:

  • Acitretin (a-se-TRET-in)
  • Methotrexate (meth-oh-trex-ate)
  • Tazarotene (taz-AR-oh-teen)

To prevent possible problems with a pregnancy, a woman should also stop taking these medicines before becoming pregnant.

Medicine 
 How long to stop taking before becoming pregnant
Acitretin
 3 years
Methotrexate, tazarotene  At least 1 menstrual cycle (period)


Due to the risks, women who want to have children may want to avoid these psoriasis treatments until they finish having children.

A man should stop taking methotrexate for 3 months before trying to get a woman pregnant.

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Psoriasis medicine a woman can use while breastfeeding

Shortly after giving birth, many women find that their psoriasis flares. Women often ask their dermatologist what treatment they can safety use while breastfeeding.

This can be a difficult question to answer. No studies look at what medicines pass into a mother’s milk. What we know comes from reports of babies developing problems when nursing mothers use a psoriasis treatment.

For breastfeeding mothers, these are considered the safest options:

Corticosteroids that you apply to your skin: Babies’ exposure to this medicine is minimal. If you are using a strong corticosteroid, avoid applying it on (or near) your nipple. One baby developed high blood pressure from a strong corticosteroid applied to a mother’s nipple.

Calcipotriene: This is a manmade form of vitamin D that you apply to the psoriasis. If it part of your treatment plan, ask your dermatologist what dose is considered safe.

Phototherapy: Two types of phototherapy, narrowband UVB and broadband UVB, can be used while breastfeeding. There have been no reports of UVB phototherapy harming a baby while the mother is breastfeeding. With a newborn, however, getting phototherapy may be difficult. You must go to a treatment center 2 or 3 times per week.

You make the final decision

The decision to treat psoriasis while pregnant or breastfeeding is a personal one. If your psoriasis improves while you are pregnant, stopping treatment is certainly an option. Should you need treatment, your dermatologist can recommend treatment options that are best for you.


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References
Bae YC. Van Voorhees AS, et al. “Review of treatment options for psoriasis in pregnant or lactating women: From the Medical Board of the National Psoriasis Foundation.” J Am Acad Dermatol. 2012 Sep;67:459-77.
Bangsgaard N, Rørbye C, et al. “Treating psoriasis during pregnancy: Safety and efficacy of treatments.” Am J Clin Dermatol. 2015 Oct;16:389-98.
Butler DC, Heller MM, et al. “Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation.” J Am Acad Dermatol. 2014 Mar;70(3):417.e1-10.
Callen JP. “Does paternal exposure to methotrexate affect birth outcomes?” (summary and comment). Journal Watch: NEJM. 2011 Jun 11. Last accessed October 27, 2015. 
Horn EJ, Chambers CD, et al. “Pregnancy outcomes in psoriasis: Why do we know so little?” J Am Acad Dermatol. 2009 Aug;61(2) :e5-8.
Lebwohl M. “A clinician's paradigm in the treatment of psoriasis.” J Am Acad Dermatol. 2005 Jul;53(1 Suppl 1):S59-69.
Menter A, Korman NJ, et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis Section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents.” J Am Acad Dermatol2009;61:451-85.
Murase JE, Heller MM, et al. “Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy.” J Am Acad Dermatol. 2014 Mar;70(3):401.e1-14.