Is it Safe to Take Psoriasis Medication While Pregnant or Breastfeeding?

The good news about pregnancy and psoriasis? Many women with the condition experience an improvement in their symptoms during pregnancy, studies suggest. This is believed to be due to a rise in the hormone progesterone, which weakens the overactive immune response that triggers psoriasis symptoms. But that’s not the case for everybody.

“While psoriasis does tend to improve for about half of patients during their pregnancy, some find [their condition] worsening and the options for medications are somewhat limited,” says Ava Shamban, M.D., a board-certified dermatologist in Santa Monica, California.

If you need to take psoriasis medication during pregnancy or while breastfeeding, it’s important to work with your doctor and dermatologist to manage your symptoms in the safest way possible. Although some treatments are completely safe, others come with serious risks and should be avoided.

Topical Treatments

Most topical psoriasis treatments are thought to be safe during pregnancy if used appropriately, says Alia Ahmed, M.D., a psycho-dermatologist practicing in the U.K. One exception to this is any topical containing tazarotene (Tazorac), because it hasn’t been studied well enough to determine whether it’s safe to use while pregnant.

Corticosteroids have been used extensively and safely in patients during pregnancy without any reports of causing problems in exposed infants, Shamban says.

Some corticosteroids, such as prednisone (Deltasone) and methylprednisolone (Medrol), can be used safely during lactation, but Ahmed recommends avoiding the possibility of transferring it to your baby’s skin, just to be on the safe side. That’s because corticosteroids should only be applied to an infant under the advice and direction of a doctor. If you have psoriasis on your breasts, wash any steroid cream off thoroughly before nursing.

Most moisturizers and emollients are safe during pregnancy and breastfeeding, but always read the packaging before use.

Oral Medications

Generally, oral immunosuppressants for psoriasis and pregnancy/breastfeeding don’t go together. Two commonly prescribed oral medications are methotrexate (Trexall) and cyclosporine (Neoral), neither of which are recommended during pregnancy or breastfeeding. Methotrexate has been linked to miscarriage and birth defects like cleft palate and can also cause chromosomal problems, so it has a recommended three-month washout period before pregnancy. In other words, both men and women should stop taking it at least three months before trying to conceive.

In fact, some oral medications aren’t recommended for women of childbearing age at all. “The oral retinoid acitretin (Soriatane), which has a three-year washout period, is absolutely contraindicated in pregnancy due to the risk of birth defects,” Ahmed says.

Phototherapy

If topical treatments aren’t controlling your psoriasis symptoms during pregnancy or breastfeeding, narrow-band ultraviolet light B (UVB) phototherapy is another safe option. The National Psoriasis Foundation (NPF) advises wearing sunscreen on your face during phototherapy to prevent melasma, a condition common in pregnant women that causes the appearance of brown spots on the skin.

Combination treatments of UVB with tar or anthralin (called Goeckerman or Ingram regimens, respectively) are also considered safe during pregnancy, according to the NPF.

However, another type of phototherapy treatment, PUVA therapy, isn’t recommended during pregnancy or breastfeeding. That’s because PUVA is a combination of ultraviolet A (UVA) phototherapy and a drug called psoralen. Psoralen can pass into a mother’s breast milk and cause light sensitivity in her baby.

Biologics

There is ongoing research into the effects of biologic drugs (biologics), which are protein-based drugs created from living cells in a laboratory, during pregnancy and breastfeeding. These are administered either by injection or an intravenous (IV) infusion into the vein.

“Biologics work in a more selective way than other psoriasis treatments,” Shamban says. “They target specific proteins in the immune system that have been proven to be associated with psoriasis. For this reason, they have fewer side effects than less targeted treatments.”

However, studies and clinical trials are limited and there have been some conflicting results. “Biologics during pregnancy should be considered based on clear medical need,” Shamban says. If you’re considering them, talk it over carefully with your doctor. The benefits of taking the biologics should outweigh any potential risks.

Adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) are just a few of the biologics that aren’t safe to take during pregnancy and while breastfeeding.

However, some are considered to be safer. “The injectable medication certolizumab pegol (Cimzia) isn’t contraindicated in pregnancy because there’s little to no transfer across the placenta, and it’s very low or undetectable in breast milk,” Ahmed says.

Another possible option is ustekinumab (Stelara), a human monoclonal antibody that works by binding to two specific proteins on cells. “It has been found in limited clinicals not to interfere with gestation,” Shamban says.

Of course, always find out what’s safe for you to take directly from your doctors. “Following your primary care physician and OB/GYN recommendations is still key to determining medication protocol while pregnant or breastfeeding,” says Shamban.

The Bottom Line

If you take any oral drugs to manage your psoriasis symptoms and you want to become pregnant, take care to wait until you’ve gone through the required washout period. And if you have an unplanned pregnancy, let your doctor know right away.

If you treat your psoriasis with topicals or biologics, your dermatologist will carry out a risk assessment to figure out the best treatment plan while you’re pregnant and/or breastfeeding.

“The effect of medications in pregnant women and nursing mothers is relatively understudied, which is why recommendations for use vary,” she adds. “It’s extremely important to consult your dermatologist about your individual treatment plan in pregnancy—including if you are planning to get pregnant—and if you are breastfeeding.”

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