Key takeaways

  • Psoriasis may or may not improve during pregnancy. Some studies show that symptoms improve for some people, while others experience no change or worsening of symptoms.
  • Certain psoriasis treatments, including systemic and biologic drugs, may not be safe during pregnancy, so it is important to consult with a doctor to determine a suitable treatment plan.
  • Although psoriasis itself cannot be passed to the baby, delivery may increase the risk of a psoriasis flare due to delivery-related triggers.

There has been little research into how psoriasis affects pregnancy, but scientists believe that hormonal and immune system factors may play a role when changes occur.

People may need to change their treatment plan while pregnant or breastfeeding.

This article looks at how pregnancy affects psoriasis and how it may affect treatment options.

The use of binary terms such as “male” and “female” or “men” and “women” in this article reflects the language of the sources we’ve used. Unless otherwise noted, it’s unclear whether the research we reference included participants with expansive gender identities.

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A 2016 review noted that some studies have suggested that psoriasis can increase the risk of experiencing adverse effects during pregnancy.

Overall, evidence suggests that it does not, but changes in the hormonal and immune systems during pregnancy may change the way psoriasis affects someone at this time.

Previous research from 2005 has suggested that around 55% of women with psoriasis see an improvement in their psoriasis symptoms during pregnancy, while the other 45% experience either no change or a worsening of symptoms. The reaction will vary from person to person.

Pustular psoriasis of pregnancy

People with a personal or family history of psoriasis may be at a higher risk of a rare condition called pustular psoriasis of pregnancy (PPP) during pregnancy. However, a person with no history of psoriasis can also have it.

If it develops, it tends to do so early in the third trimester.

A person with PPP will have areas of inflamed skin with pustules on top, usually in skin folds, such as under the breast and in the groin and armpits.

After around a day, the pustules can join together, creating large plaques.

Symptoms may spread to various areas of the skin but do not usually affect the face, palms of the hands, or soles of the feet.

People experiencing symptoms of PPP should seek medical treatment, as it is not only potentially life threatening to the pregnant person but can also be dangerous to the fetus. Treatment is available.

The National Psoriasis Foundation notes that individuals with psoriasis are more likely to develop a related health condition, or comorbidity. Examples of these comorbidities include:

Smoking may be a trigger for psoriasis. Research from 2020 also suggests that tobacco exposure during pregnancy may increase the risk of psoriasis in childhood. People should avoid smoking during pregnancy as it increases the risk of reduced fetal weight, miscarriage, and other health problems.

A 2021 review found that pregnant people with psoriatic diseases have an increased risk of the following in comparison to people without psoriatic diseases:

However, the authors also noted that there were no statistically increased risks of fetal complications in pregnant people with psoriatic diseases.

Some regular treatment options for psoriasis may not be suitable during pregnancy.

Options will depend on the type and severity of the psoriasis, personal preference, and the doctor’s recommendations.

People should work with their doctor to determine a suitable treatment plan during pregnancy and while breastfeeding.

Topical treatments

Many topical applications, such as creams and ointments, may be safe to use during pregnancy, especially if the person only uses them on small areas of the body. Most moisturizers and emollients are also safe.

A 2020 review noted that topical corticosteroids, especially those of mild to moderate strength, are unlikely to cause any fetal abnormalities. However, there was a probable association between cumulative exposure to potent-to-super-potent topical corticosteroids and low birth weight.

People should ask their doctor for advice on suitable topical treatments to use during pregnancy.

Light therapy

Light therapy, or phototherapy, appears to be safe to use during pregnancy, although some healthcare professionals are concerned that ultraviolet (UV) light exposure can decrease serum folate levels. Therefore, a doctor will monitor a person’s serum folate levels while they are undergoing light therapy.

Psoralen plus UVA (PUVA), another type of light therapy — in which a person takes medication to increase UV absorption — is not suitable for use during pregnancy.

Systemic and biologic drugs

Doctors usually advise people to avoid systemic and biological medication during pregnancy or breastfeeding, except where there is a clear medical need that outweighs any risk to the fetus.

There is evidence to suggest that the following systemic medications are not safe to use during pregnancy:

Biologics are an emerging class of medications that target the underlying cause of psoriasis by affecting specific parts of the immune system.

According to research from 2021, tumour necrosis factor alpha inhibitors, such as certolizumab, may be the safest type of biologic medication for people with psoriasis to use during pregnancy. However, more research is needed to confirm the safety of many of these drugs.

Additionally, doctors only prescribe them during pregnancy or breastfeeding after conducting a benefit and risk analysis.

Safe treatment options for psoriasis during pregnancy include:

Reducing stress

Stress may trigger a psoriasis flare. Lowering stress during pregnancy can help reduce the risk of a flare.

Getting enough sleep, regularly exercising, and participating in yoga or meditation may also help. Before starting an exercise regimen, a person should discuss it with their doctor.

Taking oatmeal or Dead Sea salt baths

Oatmeal baths may help soothe the skin. People should always use water that is warm but not hot and avoid rubbing the skin while washing or drying.

The National Psoriasis Foundation also notes that Dead Sea salt baths may help relieve the symptoms of psoriasis.

Using moisturizers

A pharmacist can recommend a moisturizer or emollient. A person should apply this after finishing their bath or shower.

Genetic factors play a role in psoriasis, and it can run in families. However, not everyone with psoriasis-specific genetic features will develop the condition.

Psoriasis is not contagious. One person cannot catch it from another, and a pregnant person cannot pass it to their baby, either before or after delivery.

Most people with psoriasis develop symptoms during adulthood, and scientists believe that certain environmental factors must be present for the disease to appear.

The main risk of psoriasis during pregnancy or breastfeeding is the use of inappropriate treatment. A doctor can advise on how to avoid this problem.

According to a 2005 study, delivery may increase the risk of experiencing a psoriasis flare.

Delivery-related triggers for psoriasis may include:

  • surgery, such as for a cesarean delivery, as skin trauma is a key trigger for psoriasis
  • hormonal changes, such as those that occur after giving birth

Experiencing psoriasis during pregnancy is unlikely to pose a risk to the fetus, but it can affect each individual differently, possibly due to hormonal changes.

People with psoriasis who wish to become pregnant or who are pregnant should speak to their doctor about treatment options.

A healthcare professional can advise on how to avoid a flare or how to manage one should it arise.