Introduction to pregnancy and psoriasis
At five months pregnant, I am just past the near-constant morning sickness, nausea and fatigue phase and am slowly developing the so called ‘pregnancy glow’ that people often speak about – I would argue it is less of a glow, and more that I am no longer a mild shade of green! It’s been a rough start physically, mentally and emotionally, with way more to learn than I could ever anticipate including a list of do’s and don’ts longer than my arm. And that’s before I even considered the impact it would have on my psoriasis, or vice versa.
Pregnancy had come up previously in conversation with doctors and dermatologists, usually when discussing various treatment options and the possible side effects that these could have when trying to get, and during pregnancy, but I never considered the impact that the actual pregnancy would have on existing psoriasis.
Whilst on my research mission I came across a couple of interesting facts;
- It is reported that psoriasis does not affect fertility or rates of miscarriage, birth defects, or premature births, nor should it affect the time or delivery method of your baby.
- However, due to the fact that it can be inherited, a baby’s risk of developing psoriasis at some stage in their life is estimated at 28% if one parent is affected and 65% if both parents have psoriasis. This is something I have noted and plan to discuss at my next midwife appointment.
How your psoriasis reacts during pregnancy
Just as everybody’s psoriasis is different, so are the changes it goes through during pregnancy. According to research, up to 60 percent of women, including myself, find their psoriasis improved during their nine months of pregnancy. This is thought to be due to the rise in the hormone progesterone which reduces the overactive immune response that triggers psoriasis symptoms.
My skin cleared very early on in my pregnancy, leaving only a few little patches on my stomach, arms and forehead and lots of beautiful leopard spots or hyperpigmentation from where I have had patches before.
A few weeks ago I posted news of my pregnancy on Instagram, asking the mums of the psoriasis community to share their psoriasis and pregnancy journeys in order to learn more. The general response was that their psoriasis had also cleared during pregnancy but once the baby was born, their immune system kicked back in and their hormone levels changed they experienced flares, with their psoriasis returning, sometimes worse than before, within months.
Psoriasis treatment during pregnancy
Once my pregnancy was confirmed I booked an appointment with my doctor in order to discuss the treatments and products I was currently using on my psoriasis, in order to establish which I should stop using and alternatives that might be able to help. There were a few that I had to stop using, at least for the first trimester, but as the condition of my psoriasis was improving anyway this didn’t have a huge impact on me.
Topical treatments, such as moisturisers and emollients are the safest way to continue to treat your psoriasis, and as you’re encouraged to continually lather your growing belly and breasts in oils and moisturisers, it’s probably also the easiest option. If you are using steroid creams, it is best to have a treatment review with your doctor to decide on the best option for you.
For moderate to severe psoriasis, narrow-band ultraviolet light B (UVB) phototherapy under the supervision of a specialist doctor is still an option, however ultraviolet A (PUVA) therapy isn’t recommended while you’re pregnant because the drug used alongside this treatment can get into breast milk and cause light sensitivity in your baby.
It is recommended that certain treatments are at the very least limited, if not avoided, as it has not yet been determined if these are safe to use during pregnancy including certain topical treatments such as coal tar. Whilst some treatments such as oral retinoids should be avoided altogether as they can cause birth defects, especially when used in the first trimester of pregnancy, as well as systematic and biologic treatments. Remember that before starting or stopping any treatment you should always discuss this with your doctor.
As I discussed before, many of the mums I reached out to spoke of flares post-pregnancy and it reported that more than half of women have a flare-up within six weeks after delivering. Whilst this is a scary proposition to face, it’s also very useful to be aware of when planning for post-birth psoriasis. I plan to discuss this with my doctor at my next appointment, and hopefully arrange a dermatology appointment for shortly after the birth, in order to discuss treatment options and control any potential flares as quickly as possible.
Psoriasis shouldn’t affect your ability to breastfeed, but can cause additional discomfort depending on where and how many patches are present or develop post-birth. If you plan to breastfeed, you’ll need to continue to avoid going back on certain medications including all of those listed above, instead sticking to emollients, until your baby is weaned from breastfeeding. Again, the best option is always to discuss this with your doctor.
If you have psoriasis and are planning to get pregnant or are a mum-to-be then I would love to hear your experiences too, so get in touch!
This content is not intended to advise you about your health. Always seek advice from your doctor or other qualified healthcare professionals.
UK/IE MAT-07084. Date of Prep: February 2017