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Pregnancy and Psoriasis

Hormonal Changes are Beneficial, but Watch Medications

By Betsy Lee-Frye

Updated June 26, 2008

(LifeWire) - Women with psoriasis generally progress through conception, pregnancy and birth just like anyone else. The disease, which affects about 2% of Americans, does not affect the reproductive system. Expectant mothers who suffer from psoriasis, though, should be aware of the hereditary nature of this condition, the effect of hormonal changes and tips for ease in breastfeeding.

Before Pregnancy: Review Medications

Most obstetricians recommend that women preparing to conceive visit the doctor to talk about everything from diet to genetic risk factors. For women with a chronic illness, such as psoriasis, prepregnancy is a perfect time to talk about treatments that will be safe during pregnancy and breastfeeding.

The consensus is that women considering pregnancy should stop taking all medications, including Over-The-Counter (OTC) drugs. If psoriasis symptoms are severe enough, however, a physician can recommend treatments that are the safest for the fetus. For example, drugs such as Humira (Adalimumab) have caused no ill effects in long-term animal studies, but medications like Soriatane (Acitretin) have been shown to cause birth defects, according to the National Psoriasis Foundation. In fact, with Soriatane, the National Institutes of Health states that women should not take this medication if they plan to become pregnant within 3 years.

For a list of psoriasis medications and their safety ratings by the US FDA, visit the National Psoriasis Foundation website.

Ultraviolet light wavelength B (UVB) therapy is an extremely effective psoriasis treatment that's considered safe during pregnancy. This treatment involves visiting a physician's office to expose the affected area to UV light by using a light box. One 2003 study found that 66% of the psoriasis patients studied were "90% clear after a maximum of 10 treatments." It should be noted, though, that this treatment can cause skin cancer and skin aging.

Couples may also be concerned about their children inheriting psoriasis, which most experts agree runs in families. According to the National Psoriasis Foundation, "If one parent has psoriasis, a child has about a 10% chance of having psoriasis. If both parents have psoriasis, a child has approximately a 50% chance of developing the disease."

Although this knowledge may be helpful for new parents, it is by no means a reason to avoid conceiving. Psoriasis is a highly manageable condition, and with treatment, it should be taken seriously. The disease itself is not considered a serious ailment.

Pregnancy and Delivery

Every patient is different, but research indicates that nearly 75% of women will see no change in their symptoms, which even includes no improvement. One study of 47 pregnant women with psoriasis found that 55% saw an improvement in their symptoms, but 23% reported that their symptoms worsened. In women who had psoriasis affecting 10% or more of their body, the same study found that psoriatic lesions were reduced by nearly 84%. Experts believe the hormonal changes associated with pregnancy improve overall skin condition, including the symptoms of psoriasis.

Women who experience an increase in psoriasis symptoms or continue to have bothersome symptoms should talk to their doctors about the safest remedies first. Although many alternative therapies exist, such as these examples compiled by the National Psoriasis Foundation, pregnant women should always ask their doctors about possible consequences for the fetus.

There is some debate about how psoriasis and other dermatological conditions affect the risk of miscarriage. Several small studies indicate a relationship between miscarriage and psoriasis. A recent large-scale study, published in 2007 in the medical journal Dermatology, however, followed approximately 3,100 pregnancies and found that the risk of miscarriage was similar to those without psoriasis.

Postpartum Concerns

While pregnancy may mean an improvement in psoriasis symptoms, the same study cited above found that many women see an increase in symptoms after delivery. The 2005 study of 47 women found that during the postpartum period "only 9% of patients reported improvement, 26% reported no change and 65% reported worsening."

Women who choose to breastfeed should continue to limit their use of medications. There is a chance that even topical medications can be absorbed into the bloodstream and then secreted in the breast milk. Be sure to talk to a physician prior to delivery about what medications are safe during nursing.

If the psoriatic lesions should appear on the nipples while breastfeeding, don't worry about the rash harming the infant. Lanolin -- often used to treat sore nipples -- can be an irritant to people with psoriasis.

If psoriasis on the nipple is making breastfeeding uncomfortable, you may consider using a nipple shield. This device is typically made from silicone and rests over the nipple, allowing milk to flow through holes at the tip. The nipple is protected and the infant is still able to breastfeed. Babies, though, can become dependent on using a nipple shield, and these are linked to a decreased milk supply and increased risk of infection. Therefore, talk to a doctor or lactation consultant before considering the use of a nipple shield.

For those who are feeling brave and/or have a secluded location to do a little topless sun bathing, this might just do the trick. Although sun exposure is not recommended for those using some topical medications, the National Psoriasis Foundation reports that direct sunlight can improve symptoms, although sunburn can worsen psoriasis. For more about the sun and psoriasis, visit the National Psoriasis Foundation website.

Sources:

"Acitretin." MedlinePlus Drug Information: Acitretin. 2007. National Institutes of Health. 20 May 2008 <www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601010.html>.

"Conception, pregnancy and psoriasis." Psoriasis.org. 2008. National Psoriasis Foundation. 20 May 2008 <www.psoriasis.org/about/psoriasis/pregnancy/>.

"Genetic aspects of psoriasis." Psoriasis.org. June 2006. National Psoriasis Foundation. 20 May 2008 <www.psoriasis.org/about/psoriasis/pregnancy/genetic.php>.

Gerber, W., B. Arheilger, T.A. Ha, J. Hermann, H.M. Ockenfels. "Ultraviolet B 308-nm Excimer Laser Treatment of Psoriasis: A New Phototherapeutic Approach." The British Journal of Dermatology. 149. 6. Dec. 2003. 1250-8. 9 May 2008. <http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2133.2003.05709.x?prevSearch=allfield%3A%28Laser+Treatment+of+Psoriasis%29

Murase, Jenny, Kenneth Chan, Thomas Garite, Dan Cooper and Gerald D. Weinstein. "Hormonal Effect on Psoriasis in Pregnancy and Post Partum." Archives of Dermatology 141. 5. May 2005 601-606. 20 May 2008 <archderm.ama-assn.org/cgi/content/full/141/5/601>.

Parkes, Kathy . "Nipple Shields . . . Friend or Foe?" La Leche League International. 14 Oct. 2007. La Leche League International. 20 May 2008 <www.llli.org/llleaderweb/LV/LVJunJul00p39.html>.

Seeger, J.D., L.L. Lanza, W.A. West, C. Fernandez and E. Rivero. "Pregnancy and pregnancy outcome among women with inflammatory skin diseases." Dermatology 214. 1. 2007 32-39. 20 May 2008 <www.ncbi.nlm.nih.gov/pubmed/17191045?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>.

"Sunlight and Other Psoriasis Treatments." Psoriasis.org. Oct. 2005. National Psoriasis Foundation. 21 May 2008 <www.psoriasis.org/treatment/psoriasis/sun/interactions.php>.

"Table of FDA-Approved Psoriasis Treatments and Pregnancy Categories." Psoriasis.org. June 2006. National Psoriasis Foundation. 20 May 2008 <www.psoriasis.org/about/psoriasis/pregnancy/treatment/table.php>.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Betsy Lee-Frye is an independent journalist living in Kansas City, Mo. Her work has appeared in The Dallas Morning News, Better Homes and Gardens Special Interest Publications and the St. Joseph News-Press.

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