For pregnant women with mild psoriasis, over-the-counter topicals such as petroleum jelly or mineral oil are a good choice for treatment. Potential absorption of topical medications through the skin must be considered, particularly when medications are applied under occlusion, over large areas of skin or in large quantities.
Topical steroids, and topical non-streroids, including anthralin, Dovonex (calcipotriene), Taclonex (calcipotriene and betamethasone dipropionate) and Vectical(calcitriol) ointment are classified by the Food and Drug Administration as Category C, meaning that it has not been tested for safety during pregnancy in animal or human studies.
If topical steroids are required, the amount should be limited. Use caution when applying topical steroids 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 health care provider's supervision.
Studies of pregnant women treated with systemic steroids 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, which 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, Taclonex, or Vectical ointment in pregnant women. All of these medications should only be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus and only if they are recommended by a health care provider.
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.
Large doses of Tazorac caused fetal abnormalities in animal studies, although no problems have been observed in human clinical trials. However, retinoids in their oral form cause birth defects. Tazorac used in large quantities or over large areas could be absorbed through the skin and harm the fetus. The drug has no known effects on sperm.
Treatment With Systemics
It is preferable to avoid systemic medications systemic medications during the first trimester of pregnancy.
According to NPF recommendations for psoriasis treatment in pregnant and breastfeeding woman, breastfeeding while taking medications should be avoided due to the lack of long-term and population-based studies.
Biologics 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.
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.