It seems pregnancy brings more than a “healthy glow.” It might also help clear psoriasis for those who have the skin disease. A study showed that psoriatic women who have high estrogen levels during pregnancy experience significant improvements of their psoriasis.
The retrospective studies suggested that from 16 percent to 63 percent of women with psoriasis improved during pregnancy and researchers theorized that progesterone was the hormone spurring the improvement.
It was also found that when the psoriasis returned at about six weeks postpartum on those who had improved during pregnancy, with the actual body surface area affected about the same as it had been at baseline.
Dr. Murase said she expected more of an “angry flare” but says patients probably feel their psoriasis is worse than baseline postpartum because they have grown accustomed to the relief from their disease during pregnancy.
The hormones that displayed the strongest correlation to psoriatic improvement were estradiol and estriol. Progesterone alone did not have any correlation. In the 50 percent who did not improve, the women’s levels of estriol were lower. In those who did improve, their estriol rose about 100-fold from their nonpregnant levels.
Treatment Options :
Nothing is 100% safe. The potential risk factor to the baby versus the risk factor of a severe flare in the mother (the need to treat the symptoms) must be weighed.
Nothing is 100% safe. The potential risk factor to the baby versus the risk factor of a severe flare in the mother (the need to treat the symptoms) must be weighed.
- UVB, going to the beach, ultraviolet B light, narrow-band UVB with moisturization is extremely effective in the treatment of psoriasis, especially during pregnancy.
- Of the systemic treatments, oral retinoids and methotrexate are very bad, while cyclosporine and etanercept (Enbrel) are relatively safer. No treatment should be undertaken without the counsel of the OB doctor.
- Avoid the use of coal tar during pregnancy and during the period of breastfeeding thereafter.
Pregnant patients are treated very conservatively. Topical corticosteroids, calcipotriene, and UVB are probably safest treatments, but patients should check with their obstetrician before starting any treatment.
Treatments to avoid:
- Methotrexate, which is teratogenic even in men, should be discontinued at least twelve weeks before trying to conceive. Possibility of chemical effect of, methotrexate on the ova cannot be ignored. Cyclosporine although not as risky, should not be used when
trying to get pregnant, during pregnancy, or while they’re breast feeding. - Avoid using PUVA during pregnancy. Reports shave indicated that some of the babies were of lower birth weight than on average.
- Biologic therapies work by the mechanism of action on the T-cell, and hold much less risk on DNA in the ova than methotrexate, and can be used in women of childbearing ages prior to conception. With regards to the pregnancy issue, almost all of the biologic therapies are category B, which means the medicines are expected to be safe to be used during pregnancy, but formal testing has not been done. Raptiva should only be given to pregnant or nursing women if there is a clear medical need, and if this decision is reached by a patient and doctor together.
- The psoriasis drugs Tegison (etretinate) and Soriatane (acitretin) may be harmful even if taken up to three years before a woman becomes pregnant.
- The effect of Amevive on pregnancy and fetal development is not known, therefore treatment is not recommended during pregnancy.
- Oral retinoids should never be prescribed for pregnant women or women of childbearing age who intend to become pregnant within three years of discontinuation of therapy.
Note: Check with your health care provider before taking any over-the-counter drugs (including aspirin) or herbal teas, pills or other supplements.