Topical Medications as First-Line Treatment for Psoriasis in Pregnant Women

The National Psoriasis Foundation Medical Board has published new recommendations for the management of psoriasis in pregnant and lactating women.

The Board suggested the use of topical treatment as the first-line therapy for psoriasis — a chronic, painful, disfiguring and disabling skin disease that cause the skin to crack, itch and bleed. They particularly recommend the use of moisturizers and emollients, such as petroleum jelly, be used initially as there are no known harmful effects to these products.

Further to this, the Psoriasis Foundation Medical Board suggests the use of the following:

  • Low to Moderate Dose of Topical Steroids. After use of moisturizers and emollients, low to moderate dose of topical steroids may be followed. High potency topical steroids may also be followed as needed in the second and third trimesters.
  • Narrowband ultraviolet light B (UVB) phototherapy (or light therapy) should be the second-line treatment for pregnant women. If this is not available, broadband UVB, which exposes the skin to more ultraviolet light may also be used.
  • TNF Inhibitors. These are drugs that control the immune system. With careful use with immunosuppressant drug cyclosporine, TNF inhibitors can also be used in the second and third trimesters. To minimize the risk and exposure, specific strategies maybe used.

The Foundation also said that due to the lack of long-term and population-based studies, breastfeeding while taking the medications should be stopped.

Psoriasis can be unpredictable in pregnancy. Some may see the improvement of their psoriasis during pregnancy, while others report that it gets worse. Changes in severity of psoriasis vary from pregnancy to pregnancy.