Systemic treatments
To be absolutely safe, women should generally avoid the use of systemic medications (those taken by mouth or injection) for psoriasis when trying to conceive a child. Men should avoid internal medications as well.
All systemic medications for psoriasis should be avoided when nursing. These agents could be secreted in the breast milk and ingested by the infant.
Biologics
It is unknown what effect biologics may have on pregnant women or a developing fetus—or if the medication passes into breast milk in nursing women. Long-term animal studies conducted with Enbrel (also known by its generic name etanercept), Humira (generic name adalimumab), Remicade (generic name infliximab) and Amevive (generic name alefacept) revealed no evidence of harm to the fetus. Raptiva (generic name efalizumab) has not been used in any animal reproduction studies. Because of limited information, these drugs should be used during pregnancy only if there is a clear medical need, and if this decision is reached by a patient and doctor together.
Women considering pregnancy, and pregnant women who use these drugs, should talk to their doctor about enrolling in a pregnancy registry.
Cyclosporine
Cyclosporine is a systemic medication generally used to treat moderate to severe psoriasis. A worldwide registry of transplant patients (cyclosporine is used in organ transplant patients) treated with the drug during pregnancy did not show an increased rate of birth defects, although low birth weight and premature birth were traced to cyclosporine use.
Cyclosporine should only be used during pregnancy if the potential benefit outweighs the potential risk. The drug is not known to affect a man's fertility.
Methotrexate
Methotrexate is a systemic medication generally used to treat moderate to severe psoriasis. It is capable of causing miscarriages or fetal malformations. Both men and women should discontinue using methotrexate at least 12 weeks before trying to conceive.
Methotrexate poses little or no risk to pregnancies that occur after it is discontinued. There have been studies on hundreds of women who were treated with high doses of methotrexate for uterine cancer. The women gave birth to healthy babies after having discontinued their use of methotrexate.
Methotrexate does not harm a man's or a woman's long-term potential of conceiving a healthy child; however, men treated with methotrexate are cautioned not to father a child for at least three months after treatment is stopped, and women should not become pregnant for at least 12 weeks.
Methotrexate also may lower sperm count temporarily, but it then returns to normal.
Oral retinoids
Oral retinoids are synthetic derivatives of vitamin A used to treat psoriasis and other dermatologic diseases. While effective in many cases, all retinoids also carry a very high risk of causing birth defects if taken by a woman who is pregnant or trying to conceive.
Soriatane (also known by its generic name acitretin) is approved for the treatment of psoriasis, however it should never be taken during pregnancy. Women of childbearing potential who take Soriatane must use reliable methods of birth control during treatment, but they have the option of becoming pregnant three years after they stop taking the medication.
Both during treatment and for two months after, women taking Soriatane must avoid consuming any alcohol (including cough syrups, etc.) because it can cause acitretin to convert into a substance called etretinate in the bloodstream that stays in the body indefinitely. Etretinate is known to cause birth defects. It's not certain how much alcohol will trigger this reaction, how much acitretin is converted or how long the etretinate will stay in the body. Given these uncertainties, many doctors avoid prescribing Soriatane for women of childbearing potential.
Isotretinoin is a member of the retinoid family that is sometimes used to treat psoriasis. It is better known as a treatment for severe cystic acne, and it is not usually as effective for psoriasis as other oral retinoids.
Isotretinoin can cause birth defects if a woman takes it at the time of conception, so reliable birth control must be used for one month before treatment, during treatment and for at least one month after. But isotretinoin leaves the body more quickly than acitretin, so a woman may safely get pregnant two months after she stops taking this drug. The iPLEDGE program is a risk-management program designed to eliminate fetal exposure to isotretinoin. The doctor prescribing isotretinoin must enter patient information in the iPLEDGE system before a pharmacist can dispense medication.
Oral retinoids for men
Oral retinoid treatment does not appear to have any effect on male fertility. Soriatane is not a mutagen for men. No reports have indicated changes in a man's ability to father healthy children, either while taking the drug or afterwards.
Updated June 2006
| 
