Pregnancy and Breastfeeding

Last reviewed on  by the National Psoriasis Foundation

Pregnancy is often a time of joy, anticipation and planning. For people living with chronic illness, like psoriasis and/or psoriatic arthritis, the addition of worrying about experiencing a flare and planning for treatments that are safe and effective during and after pregnancy can feel stressful. The good news is that there are many treatment options available and working with your doctor to create a plan that works for you through each stage of this journey is possible.

How psoriatic disease changes during and after pregnancy

Pregnancy and breastfeeding are typically quite safe for people living with psoriatic disease. There is much we still don’t know about the connection between pregnancy, birth and psoriatic disease but researchers have found that some women experience changes in their psoriatic disease during times of significant hormonal shifts like pregnancy, birth and menopause.

Life with psoriasis and/or psoriatic arthritis (together called psoriatic disease) is different for each person. This variation in symptoms and severity is also true during and after pregnancy. Many women see an improvement in the severity of their  psoriatic disease during pregnancy, some see no change in symptoms, while others report their symptoms gets worse.

Many women report a flare in their psoriasis and/or psoriatic arthritis shortly after delivery. Unfortunately, there’s no way to know ahead of time what your experience will be. It’s important to work with your obstetrician and psoriasis specialist (dermatologist and/or rheumatologist) to have a treatment plan in place in case you do experience a postpartum flare.

Psoriatic disease and birth

Be sure to let your obstetrician know that you have psoriasis and/ or psoriatic arthritis and inform them of any treatments you’re on. A study published in the Journal of the American Academy of Dermatology found that women with severe psoriasis are at a higher risk of having a low birth weight baby than women without psoriasis. In contrast, women with mild psoriasis do not face this higher risk.

It's also important to discuss with your obstetrician if you have genital psoriasis so they can be mindful of the sensitivity of your skin. With both vaginal and c-section births it is possible to experience the Koebner [KEB-ner] phenomenon. This is a flare in psoriasis symptoms in areas where the skin has been injured.

Treating psoriasis while pregnant or breastfeeding

Many psoriasis treatments require special precautions before and during pregnancy. It is important to consult with your doctor to verify your psoriasis treatments are safe for pregnancy and breastfeeding. When considering treatment options it’s important to look at the benefits, risks, and how you feel about your options. Treatment decisions are ultimately yours to make, in consultation with your healthcare providers, and it is worthwhile to take the time to create a treatment plan that works well and you feel comfortable with.

The most common treatment options for women with psoriasis who are pregnant or breastfeeding include topical treatments and phototherapy. For women with moderate to severe psoriasis and/or psoriatic arthritis, some oral and biologic medications may also be recommended on a case-by-case basis.

Topicals

Topicals are often a recommended treatment option for women with psoriasis who are pregnant or breastfeeding. Options include limited use of low- to moderate-dose topical steroids or vitamin D derivatives. Over-the-counter products, such as moisturizers, can also help manage symptoms.

If you are breastfeeding, it is advised to use caution when applying topical treatments to the breasts to avoid passing the medication to the baby.

It is not recommended that pregnant women use Tazorac (tazarotene), which is a topical vitamin A derivative, due to concern about possible birth defects.  

Phototherapy

Treatment with UVB phototherapy is generally safe during pregnancy and is a commonly prescribed treatment for pregnant and breastfeeding women. Wearing a covering or sunscreen on the face is recommended to prevent melasma (a condition common in pregnant women that causes the appearance of brown spots).

A type of phototherapy called PUVA (light sensitizing medication psoralen and UVA light exposure) should be avoided by men and women trying to conceive and by women who are pregnant due to the potential for birth defects.

Biologics or oral treatments

Biologic or oral treatments may be appropriate for pregnant or breastfeeding women. For some treatments, there is research available to support or discourage their use in pregnant or breastfeeding women. For other treatments, researchers and doctors want to learn more about how they affect pregnant or breastfeeding women.    

Methotrexate and Soriatane (acitretin) are both oral treatments that are known to cause birth defects and should be avoided during pregnancy. Both men and women should avoid taking methotrexate for 3 months prior to trying to conceive. Due to the high rate of birth defects and length of time it stays in your system, it is recommended that women discontinue using Soriatane for 3 years before becoming pregnant. If you are taking methotrexate or Soriatane and are considering pregnancy, it is important to talk with your doctor.

For other oral treatments and biologics, there is less information available about safety during pregnancy and breastfeeding. Women considering pregnancy and pregnant women should work closely with their doctor to weigh the benefit and the risks of using these treatments.

Small studies have been done on pregnant women using biologics that showed no increased risk for low birth weight or birth defect. Researchers and providers are working hard to gain more information on the use of these treatments for women who are pregnant and breastfeeding.

Pregnancy registries

Women considering pregnancy and pregnant women who are on medication(s), should talk to their doctor about enrolling in a pregnancy registry. A pregnancy registry is maintained to track women that are on a drug during pregnancy to better understand the effects of a particular drug on the mother and fetus.

You may also be interested in:

Mother to Baby is a website that offers a robust amount of information on the safety of medications during pregnancy and breastfeeding. They have fact sheets on many of the treatments for psoriatic disease and the ability to call, chat or email with an expert in the field at no cost.

Do you have additional questions?

NPF’s Patient Navigation Center is the world's first, personalized support center for psoriatic disease. Our Patient Navigators can answer your questions about pregnancy and psoriatic disease and help you prepare for appointments with your providers. For free and confidential assistance, contact our Patient Navigators »