As with many conditions, psoriasis presents special challenges to the patient and clinician when a woman becomes pregnant. While the extent of these challenges is beyond the scope of this article, we will consider a few important issues surrounding this scenario, leaving the remainder for another time. It should be noted that regardless of the information presented below, any woman who is considering becoming pregnant, currently pregnant or has recently given birth should be in continuous consultation with both her obstetrician and dermatologist during these periods.
If I have psoriasis before getting pregnant, should I stop certain treatments while trying to get pregnant?
The short answer is yes, there are definitely certain medications that are incompatible with a healthy pregnancy, including several psoriasis meds that may or may not impact its course. This is especially true of any “systemic” medications that are administered orally, intravenously or intramuscularly, and are therefore distributed throughout the body, as opposed to topical or light therapies.
There are some meds that are absolutely banned during pregnancy, such as methotrexate, a powerful immunosuppressant that has been shown to induce abortions, and is thus in “category x”. However, others such as cyclosporine (another immunosuppressant) are in “category c”, and are used with caution in certain cases, as determined by your doctor. Since there are many medications – for the treatment of psoriasis and other ailments – that fall into these categories, it is best to check with your Ob/Gyn for specifics.
If the onset of psoriasis occurs while pregnant, what are some natural remedies I could try before seeing a dermatologist (e.g., exposure to direct sunlight, etc.)?
While the Internet is littered with anecdotal evidence or claims regarding the powers of natural psoriasis remedies, unfortunately very few have been confirmed or even properly studied. According to a dermatologist friend and colleague, the only aid with actual scientific backing is exposure to a limited amount of sunlight, which slows the immune reaction driving this disorder; he cautions against putting too much faith in other claims as they are rarely objective.
However, because there is currently no cure for this disease, it seems worth it to at least offer some other possibilities for symptom mitigation, with the caveat that each patient is different and should consult her doctor(s) before proceeding. Those listed are generally harmless, but since pregnancy is a special body state, it’s better to be safe than sorry.
The first and most obvious natural remedy, as any sufferer is keenly aware, is keeping the skin highly moisturized, with aloe vera or any other comparable topical agent approved by your physician. As with any case of dry, itchy skin, this treatment will help alleviate psoriatic symptoms. Also, there are recommendations for ingestion of a number of various vitamins, minerals and other supplements, including fish oil extract (among many); and acupuncture has been advocated by some patients. Finally, reducing or quitting alcohol intake and cigarette smoking often helps reduce symptomatology, though hopefully in this case (pregnancy) such considerations are not even an issue, as no woman should be smoking (at all) or drinking excessively during this time.
How will the hormone changes during and after pregnancy affect my psoriasis symptoms?
Such changes, if they occur, are unpredictable and tend to vary widely from person to person. My dermatologist colleague said that he has never personally observed any sort of pattern or trend in signs and symptoms that could be directly attributable hormonal fluctuations; and he knows of no confirmed or proven connections.
At the same time, while unproven, a literature search did yield some evidence for hormonal effects, including a 2005 study published in the Archives of Dermatology. Based on the results of this study, the authors concluded that increased estrogen levels appeared to be correlated with a reduction in psoriasis symptoms, while there was no demonstrable effect of progesterone on patient symptomatology.
It is very important to remember – for this and all other research – a correlation is not evidence of causation. It is merely a statistical finding that when one variable (estrogen) moved in a certain direction, the other variable (psoriasis symptoms) moved in either the same or the opposite direction (positive and negative correlations, respectively). Understanding this difference is essential for doctors and patients alike in accurate interpretation of study results.
Questions for your doctor:
- Which medications I take (regularly or intermittently) for psoriasis should I stop and when?
- What is your experience with the effectiveness of natural or non-traditional (i.e. non-pharmaceutical) psoriasis remedies?
- Can you recommend any good books, articles or websites, with credible information regarding natural therapies? (These should be mostly government or university/hospital/medical sites, or sites displaying evidence-based study results. If your doctor can only offer .com or .org sites, most of which are written by patients or armchair consultants, it may be time to change doctors.)
- Can psoriasis itself (i.e. not related to medications) affect my fetus or me during pregnancy? How?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].