Pregnancy and Psoriasis Questions from the 2003 Conference
First posted Sept. 16, 2003
At the National Psoriasis Foundation 2003 National Conference, many valuable topics were addressed at the workshops, including the Pregnancy and Psoriasis workshop. Some attendees' questions were more specific than we were able to address. We have researched and assembled your questions here.
In general, we can say that the effect of pregnancy on psoriasis is unpredictable. Most patients do improve, but some don't and some get worse. Even in those patients who do improve with pregnancy often find their disease gets worse when the pregnancy is over, or discontinue breastfeeding.
Birth control pills�what is the effect on psoriasis and psoriatic arthritis?
Because birth control pills affect hormones in the body, they can have a good or bad effect on psoriasis and/or psoriatic arthritis depending on the individual. Unfortunately, the effect of birth control pills is not consistent or predictable.
C-section�flared afterward, but hadn't flared as badly with natural childbirth. Is there a correlation?
Koebner phenomenon. Also effects of anesthesia, antibiotics or other medications used during the C-section could have an effect on the psoriasis. Any stress the woman might have been under prior to delivering might also be responsible for the flare.
Is age of onset determined by heredity?
Yes; however, other factors can also play a role. For example, overall health, immune function, stress can also "trigger" psoriasis.
When auto-immune diseases are carried in the family is that the connection to psoriasis or is psoriasis the disease that is carried? What is the connection between other auto-immune diseases and psoriasis?
The genetics of immunity and immune diseases is not fully known at this time. It is possible that some genes are specific for psoriasis, while others might affect the immune system in a more general way that predisposes to auto-immune disease in general.
Is there a connection between genital psoriasis (female) and problems conceiving?
There shouldn't be a connection.
Is there data on the use of Enbrel for rheumatoid arthritis during pregnancy?
Yes, but it is very limited. So far, no major problems have been identified.
What is the safety of using biologics with breastfeeding?
Unknown.
Is there data on biologics and pregnancy?
Some, mostly for TNF inhibitors. So far, major problems have not been identified.
What can you take while you are pregnant?
Nothing is 100% safe. The potential risk factor to the baby versus the risk factor of a severe flare in the mother (the need to treat the symptoms) must be weighed. This ultimately becomes a question of is the treatment worse than the potential side effects. Generally, moisturizers and UVB phototherapy are safe, topical corticosteroids and Dovonex can probably be used in a limited manner for small bothersome areas. Of the systemic treatments, oral retinoids and methotrexate are very bad, while cyclosporine and etanercept (Enbrel) are relatively safer. No treatment should be undertaken without the counsel of the OB doctor.
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