Topical medications
For pregnant women with mild psoriasis or a few localized plaques, over-the-counter topicals such as petroleum jelly or mineral oil may be the best choice.
Potential absorption of topical medications through the skin must be considered, particularly when medications are applied under occlusion (wrappings), over large areas of skin or in large quantities.
Steroids, anthralin, Dovonex and Taclonex
Topical steroids, anthralin, Dovonex (also known by its generic name calcipotriene), and Taclonex (also known by its generic names calcipotriene and betamethasone dipropionate) are classified by the FDA as category C, which means safety is not substantiated by animal or human studies. The package inserts advise that these treatments should be used only if their benefits outweigh potential risks in pregnant women.
If topical steroids are required, the amount should be limited. Topical steroids should be used with caution on the breasts to avoid passing the medication to the baby while nursing. Superpotent steroids should be used only as a last resort. Occlusion of any steroid medication should only be done under a doctor's supervision. It is noteworthy that studies of pregnant women treated with systemic steroids (those given orally or by injection) have not found an increase in birth defects, despite animal studies suggesting they cause an increased incidence of cleft palate.
No animal or human studies have examined the potential birth defects associated with the use of anthralin; however, anthralin has been used safely for decades in pregnant women.
Studies of Dovonex have shown that high doses administered orally cause birth defects in some animal models but not in others. There are no adequate studies of the topical use of Dovonex in pregnant women.
Animal studies of Taclonex have shown that high doses administered orally cause birth defects. There are no adequate studies of the topical use of Taclonex in pregnant or nursing women.
Tazorac
Pregnant women and those trying to conceive should avoid Tazorac (a topical retinoid, also known by its generic name tazarotene). Women of childbearing potential should use reliable methods of birth control during treatment with Tazorac. The medication should be stopped immediately if a woman becomes pregnant while using it.
Large doses of Tazorac caused fetal abnormalities in some animal studies, although no problems occurred in human clinical trials. However, retinoids in their oral form cause birth defects, and if Tazorac were to be used in large quantities or over large areas of skin, the drug could be absorbed internally and be harmful to the fetus.
Tazorac has no known effects on male sperm or on the ability of men being treated with the drug to father healthy children.
Updated June 2006
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