The National Psoriasis Foundation Medical Board has released new recommendations for the treatment of psoriasis in pregnant and lactating women.
The recommendations call for topical treatment as the first-line therapy for psoriasis—a chronic, genetic disease of the immune system that appears on the skin, causing it to crack, itch and bleed. Specifically, the medical board recommends that moisturizers and emollients, such as petroleum jelly, be used initially as there are no known adverse effects to these products. View the information at www.psoriasis.org.
Additionally, the Psoriasis Foundation Medical Board suggests that:
- After use of moisturizers and emollients, low to moderate dose topical steroids may be used, followed by high-potency topical steroids only as needed in the second and third trimesters.
- Narrow band ultraviolet light B (UVB) phototherapy or light therapy should be the second-line treatment for pregnant women. If narrow band UVB is not available, then broadband UVB, which exposes the skin to more ultraviolet light, may be used.
- Lastly, TNF inhibitors, a class of drugs that suppress the immune system, may be used with caution, as well as the immunosuppressant drug cyclosporine in the second and third trimesters. Specific strategies may be used to minimize risk and exposure.
- Breastfeeding while taking medications should be avoided due to the lack of long-term and population-based studies.
“Treating psoriasis in women who are pregnant or breastfeeding presents special challenges due the side effects of certain medications and the ethical concerns of placing this patient population in clinical trials,” said Mark Lebwohl, MD, chair of the National Psoriasis Foundation Medical Board. “It’s important for women to work with their doctor to determine what treatment is appropriate for them during pregnancy and to consider the precautions for each.”
Psoriasis can be unpredictable in pregnancy. Some women see an improvement in the severity of their psoriasis during pregnancy, while others report their psoriasis gets worse. Changes in severity of psoriasis vary by individual and from pregnancy to pregnancy.
Studies also suggest that pregnant women with psoriasis have increased risk of poor birth outcomes, such as preterm births and preeclampsia. Women with severe psoriasis were also found to have a higher incidence of low birth weight babies compared to those without the disease.
Learn more about treating psoriasis in pregnancy and nursing at www.psoriasis.org/pregnancy/nursing.