“On average, psoriasis improves during pregnancy, and pregnancy isn’t affected by psoriasis,” says Mark Lebwohl, MD, professor and chairman of the Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City. But because psoriasis often starts in early adulthood — before a woman has a chance to start a family — concerns persist about having a safe pregnancy and healthy baby with the condition and the medications used to treat it. Here’s what you need to know.
Psoriasis, Fertility, and Genes
First, psoriasis in and of itself doesn’t affect a man’s or woman’s reproductive system, although a study published in December 2018 in the International Journal of Dermatology reports that rates of sexual dysfunction are higher among those with the condition. The analysis also revealed that men with untreated psoriasis have lower-than-normal levels of testosterone, which may affect their ability to produce sperm. While you can’t pass psoriasis onto your newborn through skin contact or breastfeeding, you may pass on genes that put your child at a slightly higher risk for psoriasis. According to the National Psoriasis Foundation (NPF) if one parent has psoriasis, there’s approximately a 10 percent chance of the child developing it. That increases to 50 percent if both parents have the condition. Even then, it doesn’t automatically mean your child will develop psoriasis. People also need to be exposed to specific factors that trigger their particular genes to cause psoriasis. About 10 percent of the population has one or more of the genes that predisposes them to psoriasis, but only 2 to 3 percent of the population develops it.
Psoriasis and Low-Birth-Weight Babies
A woman’s psoriasis may affect her baby in other ways. A study of pregnancy outcomes among 6,103 women with psoriasis from Denmark and Sweden published in March 2018 in the journal ActaDV found that complications such as pre-term birth or low birth weight were higher among those with the skin condition than in those without it. This risk may vary with the degree of psoriasis. “There are no specific precautions that women with psoriasis need to take during a pregnancy,” says Daniel R. Opel, MD, a dermatologist with Aurora Health in Sheboygan, Wisconsin. “Importantly, it does not affect a woman’s ability to get pregnant.” Still, more research is needed on the subject, he adds.
Psoriasis Treatment During Pregnancy
Treatment for psoriasis is usually done with a “step-up approach,” with lotions and creams applied to the skin first. These include over-the-counter moisturizers and emollients. If these are ineffective, your doctor may recommend prescription topical corticosteroids or non-steroid options. Whether these topical treatments are safe to continue during pregnancy depends on the type of medication you’re using. If you’re concerned about your psoriasis symptoms worsening, talk with your doctor about which topical agents can be used safely during pregnancy. “In general, a topical corticosteroid doesn’t increase risk of harm to a fetus,” Dr. Opel notes. Light- or laser-based treatments are the next step up, and your doctor may advise you to discontinue treatment during pregnancy, or if you’re planning to become pregnant, depending on which type of treatment you’ve been prescribed, according to the NPF. Some laser treatments have been linked to infertility in men and women and may cause birth defects if used by women during pregnancy, the NPF adds. “Both narrowband UVB and broadband UVB phototherapy are considered safe for pregnant women to use,” Opel says. For psoriasis that doesn’t respond to topical therapies or light or laser treatments, prescription drugs called biologics or systemic medications are usually recommended. “There are no well-controlled trials that have studied the effects of treatment with biologic agents during pregnancy, though most literature suggests [they] can be used … during pregnancy and breastfeeding,” Opel says. “Certain biologics would be preferred over others, depending on the severity of your psoriasis, timing during pregnancy, and long-term use of medication.” He suggests discussing all your options with a board-certified dermatologist before deciding. Systemic drugs like methotrexate and acitretin shouldn’t be used during pregnancy. “Most biologic drugs used to be classified as ‘Pregnancy Category B,’ when the US Food and Drug Administration used that system, meaning that they should only be used if the benefits outweigh the risks,” Dr. Lebwohl says. Although the FDA no longer uses these drug categories, the rule still applies in many cases, including with many systemic drugs, Lebwohl adds. Your doctor can help you find the safest drugs to use during pregnancy, given your particular psoriasis symptoms.
Psoriasis Treatment and Breastfeeding
You can breastfeed your baby as long as you avoid taking any psoriasis drugs that pass through your breast milk, according to the Psoriasis and Psoriatic Arthritis Alliance (PAPAA). Just as during pregnancy, though, only the safest treatments are advised. If you have psoriasis on your breasts or nipples, over-the-counter moisturizers, creams, and emollients can be used to help relieve your symptoms. Some prescription topical treatments may also be used. But the NPF recommends using caution when applying topical treatments around the breast or nipple area to avoid passing the medication to your baby. Ask your doctor which treatments and products are safest to use.
Psoriasis and Smart Pregnancy Planning
If possible, discuss your psoriasis treatment with your doctor when planning to become pregnant, PAPAA recommends. Work together to get your psoriasis under control as best you can before conceiving. This can help decrease your risk for pre-term delivery and a low-birth-weight baby. Although many women find their psoriasis gets better during pregnancy, it can get worse for some, especially after the baby is born. “Psoriasis can have an unpredictable course and flare, both during or after pregnancy,” Opel says. “This is mainly due to an overactive immune system.” Talk with your doctor about how to manage these flares in the weeks after giving birth, he suggests. There are some risks associated with psoriasis and pregnancy, but in most cases they can be managed by working closely with your obstetrician and the doctor you see for psoriasis during pregnancy and delivery. As long as you plan ahead, there’s no reason psoriasis should prevent you from having a safe pregnancy and a healthy baby. Additional reporting by Brian Dunleavy
