What if I am pregnant?
Psoriasis is not necessarily a barrier to pregnancy. Nor does it affect a woman's ability to raise children.
Many people who have psoriasis are afraid of passing it on to their children. As psoriasis is not a contagious disease, there is no risk of passing it on to a child through cuddling or breastfeeding. However, there is a genetic predisposition towards psoriasis. According to research, there is an 8% to 15% risk of transmitting it when one of the parents has psoriasis and a 50% to 60% risk when both partners are affected.
Women with psoriasis often worry about becoming pregnant. They ask themselves if the baby will develop normally. Will they be able to breastfeed? Will their psoriasis get worse during pregnancy? Are the treatments they are using safe for the baby?
The treatment of pregnant women is problematic, especially if they have severe psoriasis. They need to stop most systemic medication as it may lead to congenital abnormalities.
Women should tell their dermatologist early on if they are planning to become pregnant. The dermatologist will then be able to assess if their psoriasis treatment can be continued during pregnancy and prescribe a new medication if necessary.
Women who suffer from psoriatic arthritis sometimes feel greater pain because of pregnancy-related weight gain.
Most studies involving pregnant women show that pregnancy affects psoriasis.
An American study* on 248 women with psoriasis aimed at identifying hormonal changes which appear during pregnancy and the menopause and which may have an impact on psoriasis.
The study showed that 30% to 40% of female patients surveyed had experienced an improvement in their psoriasis during their pregnancy, the majority during the first trimester. 20% of them reported that the condition had worsened and the others did not notice any change. This study also showed that the age of patients and the severity of their psoriasis were not related to any improvement or exacerbation of the condition. Other studies report an improvement in up to 63% of women. Some women experience a significant improvement as their lesions whiten during pregnancy.
The improvement or exacerbation of psoriasis during a first pregnancy can be used to predict what will happen in subsequent pregnancies. The study quoted above showed that 87% of women who had several children had experienced the same response during each pregnancy.
Although we do not know exactly why psoriasis may improve during pregnancy, several hypotheses have been put forward. Some researchers believe that the greater amounts of oestrogen and progesterone secreted by the body protect it against psoriasis. These hormones exert a temporary immunosuppressive effect which has beneficial effects on the autoimmune processes occurring in psoriasis.
Other scientists stress the beneficial role of cortisone. During pregnancy, the body secretes more cortisone, which has an anti-inflammatory action on psoriatic lesions (acting in the same way as a cortisone cream).
It is certain that multiple factors lead to psoriatic lesions improving in pregnant women. The improvement is probably primarily due to increased levels of cortisol as this hormone is secreted by both the adrenal glands of both the mother and the foetus. However, it is most certainly also due to other substances which have yet to be identified.
In certain cases (in less than one woman in four), psoriasis worsens during pregnancy.
Once again, the reasons for this exacerbation are not known, but it is thought to be due to changes in hormonal metabolism which are probably associated with stress factors.
Some women experience their first flares of psoriasis during pregnancy.
Impetigo herpetiformis is a form of generalised pustular psoriasis which typically appears during pregnancy.
This is an extremely severe form of psoriasis, but fortunately it is rare. It most commonly appears during the last trimester or in the period immediately following childbirth.
One third of women who suffer from impetigo herpetiformis have a family or personal history of psoriasis.
It is postulated that hormonal factors and/or a disturbance in vitamin D metabolism during pregnancy may cause flares of pustular psoriasis.
The eruption often begins in the skin creases. Red plaques, which sometimes cause itching, spread symmetrically across the abdomen and groin. Mucous membranes are sometimes involved. Pustules appear around the edges of lesions.
Impetigo herpetiformis is accompanied by deterioration in the patient's general health. Among other symptoms, she may experience nausea, fever and mental disturbance.
Corticosteroids are often ineffective, and so antibiotics are frequently used.
This serious condition also has consequences for the foetus as it leads to miscarriage in one case out of two.
Pregnancy-related pustular psoriasis most often disappears after the child is born. In 82% of cases, it affects women who are pregnant for the first time. However, there is a risk of relapse during subsequent pregnancies.
In the first three months following childbirth, the majority of women with psoriasis experience renewed eruptions, including those who had noticed an improvement during pregnancy. Results vary from one study to another.
Some studies note that nearly 88% of women report a relapse in the four months after they have given birth.
The American study quoted above shows that 41% of women surveyed reported that their psoriasis worsened during the period immediately after childbirth, but 55% noticed no change.