The National Psoriasis Foundation published guidelines in 2011 regarding the treatment of psoriasis during the pregnancy.
New recommendations released by the National Psoriasis Foundation Medical Board suggest that women with psoriasis who are pregnant or breastfeeding should use topical treatment (those applied to the skin) as the first-line therapy for psoriasis.
The guidelines suggests that moisturizers and emollients, such as Vaseline, be used initially as there are no adverse effects to these products. Further recommendations include:
- After use of moisturizers and emollients, low to moderate dose topical corticosteroids may be used, followed by high potency topical steroids only as needed in the second and third trimester.
- Narrowband ultraviolet light B (UVB) phototherapy or light therapy should be the second-line treatment for pregnant women. If narrowband UVB is not available, then broadband UVB, which exposes the skin to more ultraviolet light, may be used.
- Lastly, TNF inhibitors, a category of biologic medication 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.
In addition, 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 to the side effects of certain medications and the ethical concerns of placing this patient population in clinical trials,” said Dr. Mark Lebwohl, chair of the National Psoriasis Foundation Medical Board.
Studies suggest that pregnant women with psoriasis have increased risk of poor birth outcomes, including 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.
Dr. Lebwohl added that “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.”