You’re ready to get pregnant, and you're wondering if your psoriasis could be a problem. Will you need to change your treatment? Might your psoriasis get worse, clear up, or stay about the same?
Every pregnancy -- and case of psoriasis -- is unique, but there are a few things to know and things you’ll want to do to prepare yourself before baby’s on board.
Psoriasis doesn’t affect your chances of getting pregnant. But like any other condition, it’s smart to tell your OB or midwife if you’ve had psoriasis in the past. It’s also a good idea to discuss your pregnancy plans with the doctor who treats your psoriasis -- probably, that’s your dermatologist. Your medical team can help answer any questions you have about skin care before and during pregnancy.
All the healthy things that you do to feel your best will help improve your chances of a flare-free pregnancy. Avoid your psoriasis triggers as best you can, especially stress.
Ask your doctor whether you or your partner need to stop certain medications while you’re trying to conceive. Some psoriasis treatments aren’t safe to take before you’re pregnant, during pregnancy, or while you’re breastfeeding.
Steer clear of these treatments:
Oral retinoids. The chance of your baby being born with birth defects goes up a lot if you take these meds by mouth. Doctors usually don’t recommend them as treatment for women in their childbearing years, so you probably aren’t taking any of them.
You should never take acitretin (Neotigason, Soriatane) before or during pregnancy. Doctors recommend waiting 3 years after you stop the medication before you try to get pregnant
Isotretinoin (Amnesteem, Myorisan, Sotret) is another psoriasis treatment that can cause birth defects. It clears out of your body faster than acitretin, so you only have to wait 1 month after stopping it before trying to conceive.
Topical retinoids. Topical retinoids go on your skin. They aren’t as risky during pregnancy as oral retinoids, but you should especially avoid tazarotene (Avage, Tazorac) when you’re trying to get pregnant, since it can cause severe birth defects. You should give it at least 2 weeks to clear out of your system before trying to get pregnant.
Methotrexate (Rheumatrex). This treatment can cause parts of your baby’s body to grow incorrectly. It can also cause a miscarriage, and in men a low sperm count. You and your partner should both be clear of the medicine for at least 12 weeks before getting pregnant.
Psoralen plus ultraviolet A (PUVA). Doctors don’t know how this light/medication combo treatment affects babies in the womb. But some research has shown that it could cause abnormal growth. So your doctor will take you off this treatment if you get pregnant.
Calcipotriene (Calcitrene, Dovonex, Sorilux). Similar to PUVA, doctors don’t have clear data on how this skin cream affects babies before birth. But they’re concerned enough about the risks that they recommend avoiding it as a treatment during pregnancy.
Some treatments may be OK to keep taking when you’re pregnant, but check with your doctor first if you take:
- Coal tar
- Strong doses of steroids that you put on your skin
If you take biologic treatments such as risankizumab-rzaa (Skyrizi), guselkumab (Tremifa), tildrakizumab-asmn (Ilumya), or Taltz (ixekizumab) and Cosentyx (secukinumab), your doctor may want you to stop during pregnancy. But sometimes stopping a relatively safe treatment can make your symptoms severe enough that stopping them could cause more problems. Your doctor can help you decide whether you should continue your treatments or find other options.
These treatments are usually considered safe to use during pregnancy:
- Moisturizers and skin products like petroleum jelly or mineral oil
- Mild steroids that you put on your skin (avoid the breast area if you breastfeed)
- Phototherapy with UVB light
Will Your Symptoms Change?
Unfortunately, there’s no way to predict how your psoriasis will act while you’re expecting. Studies show that around half of women with chronic plaque psoriasis see their condition get better during pregnancy, especially in the first and second trimester. But 10%-20% of women find that it gets worse after they get pregnant.
It’s likely that any improvement you see in your psoriasis during pregnancy will go away after your baby is born. Usually, around 6-12 weeks after you give birth your psoriasis will go back to how it was before your baby was born. It probably won’t get worse than it was before you got pregnant.
If you have a C-section, you might get what doctors call the Koebner phenomenon -- a flare up of psoriasis symptoms near an injury (in this case, the C-section) on the body. You may also have breastfeeding problems if the skin on or around your breasts is affected.
Some women get psoriasis for the first time after pregnancy. If you already have it and get pregnant, there’s a chance that you may develop psoriatic arthritis after your baby is born. So let your doctor know if you notice any new symptoms, just in case.