Do you have psoriasis/psoriatic arthritis? Are you pregnant or breastfeeding? Dr. Eichenfield, a pediatric and adolescent dermatologist with Rady Children's Hospital in San Diego, explains what's known about psoriasis and pregnancy. He tells you how some medications to treat psoriasis can affect you and your developing baby. However, doctors are still trying to learn more.
Psoriasis is a skin condition in which skin cells grow faster than normal leaving dry thick patches on the skin. Psoriasis is triggered by the immune system, although the exact cause or causes are not known. It is likely that a combination of inherited genetic factors and environmental factors combine to cause psoriasis. You cannot give psoriasis to other people as it is not contagious. The severity of psoriasis varies from person to person. For some people there is only a small area of the body that is mildly affected while others may experience more discomfort and itching by having large areas of the body affected. Additionally, in a subset of people, psoriasis can lead to swollen joints (this is called psoriatic arthritis).
Psoriasis is a relatively common condition with various estimates indicating that 1 in 33 to 1 in 100 persons have this condition (Huerta et al. 2007). Psoriasis is just as likely to occur in women as men, and many women will have this condition during the child-bearing years. Women with moderate to severe psoriasis will likely need treatment to control itching and related symptoms, so a medicine discussion with your doctors is especially important for women with psoriasis who are planning a pregnancy or have learned they are pregnant.
Pregnancy outcomes in women with psoriasis have not been well studied. One study suggested that psoriasis increases the risk for pregnancy complications, such as high blood pressure and the need for cesarean delivery, although another study did not confirm this (Ben-David et al. 2008, Seeger et al. 2007). More recently, OTIS reported that pregnant women with psoriasis were more likely to report that they were overweight, had depression, smoked in the first trimester and did not take multivitamins/prenatal vitamins or folic acid around the time of conception compared to women without psoriasis (Bandoli et al. 2010). The authors noted that these are factors that could potentially be changed to improve pregnancy outcomes.
Many women will experience improvement in psoriasis symptoms during pregnancy. However, most will experience an increase in symptoms after delivery. In a study of 91 pregnancies, 56% of women reported that symptoms improved, about 18% reported symptoms stayed the same, and 26% reported that symptoms worsened (Raychaudhuri et al. 2003). This is similar to other studies that have suggested psoriasis improved in about 30-60% of women but worsened in 4-18% (Raychaudhuri et al. 2003).
While it is encouraging that twice as many women will improve rather than worsen, it still leaves a significant number of women who will not improve during pregnancy and will likely need to continue some form of treatment for psoriasis (Murase et al. 2005). Doctors are not able to predict for any one woman whether her symptoms will improve, stay the same, or worsen during pregnancy. Therefore, an open discussion with your treating doctors about preferred pregnancy treatments for psoriasis is important for optimal maternal and fetal health during pregnancy.
Bandoli et al. (2010) Potentially modifiable risk factors for adverse pregnancy outcomes in women with psoriasis. Br J Dermatol. [Epub ahead of print]
Ben-David G, et al. (2008) Pregnancy outcome in women with psoriasis. J Reprod Med 53(3):183-7.
Huerta C, et al. (2007) Incidence and Risk Factors for Psoriasis in the General Population. Arch Dermatol 143(12):1559-1565.
Murase JE, et al. (2005) Hormonal effect on psoriasis in pregnancy and post partum. Arch Dermatol 141(5):601-6.
Raychaudhuri SP, et al. (2003) Clinical course of psoriasis during pregnancy. Int J Dermatol 42(7):518-20.
Seeger JD, et al. (2007) Pregnancy and pregnancy outcome among women with inflammatory skin diseases. Dermatol 214(1)32-9.
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