Psoriasis During Pregnancy and Menopause: What to Know

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In this edition of "Dr. Tell Me," dermatologist Jennifer Soung, M.D., answers questions about pregnancy, menopause, and lifespan.

Q: Is it safe to conceive if you’re on certain medications?

A: It’s really important to share with your doctor if you’re considering starting a family because that is definitely going to alter your treatment options. In general, most systemic medication should be stopped before trying to conceive, and this is an absolute must with methotrexate. Women who are taking another oral medicine for psoriasis called Soriatane (acitretin) must use reliable methods of birth control and wait three years after discontinuing the medicine to become pregnant. Another medication called isotretinoin must be stopped two months before conception.

Q: Can I stay on my psoriasis treatment throughout pregnancy?

A: Systemic medications, generally speaking, should be avoided while pregnant or breastfeeding, unless there’s a clear medical need. Certain medicines can cause fetal abnormalities, and Tazorac (tazarotene) is one of them. Oral retinoids are derivatives of Vitamin A, and Vitamin A is known to cause birth defects, as are PUVA treatments, in which you take an oral medication before going into light therapy. Light therapy is generally safe during pregnancy. The NPF Medical Board suggests that TNF-alpha inhibitors (in biologics) may be used with caution in the second and third trimesters. In fact, I do have patients who are pregnant, and because of a previous pregnancy, they know they have flared, and we’ve made a decision to proceed with continuing the biologic during their pregnancy. Specific strategies may be used to reduce the risk and exposure to your baby, and many of the pharmaceutical companies maintain registries for pregnant women to better understand the effects of a particular biologic on the mother and the baby.

Q: Could a post-delivery psoriasis flare trigger postpartum depression?

A: After you have the baby, your immune system reverts back to its normal state, and that, unfortunately, tends to bring out psoriasis. Talk to your doctor about any depression symptoms you have after the delivery. These include thoughts of hopelessness, harming yourself and the baby, guilt, anxiety, irritability, or an inability to feel pleasure. These aren’t just common to women who have psoriasis, but any woman who has a baby and experiences postpartum depression. Remember, you’re not alone. The National Psoriasis Foundation does an amazing job of helping patients connect to other patients.

Q: For those with psoriasis on the nipple, is it safe to breastfeed?

A: The psoriasis itself does not affect the baby. As long as the baby doesn’t care, and you’re not having any pain, or it’s not exacerbating the psoriasis, there is no urgent need to treat it right away. If women do prefer to treat, I usually tell them to use no more than a medium-strength topical steroid two hours before or two hours after nursing. That can be really tough in the beginning, when sometimes your baby is nursing every two to three hours, so it has to be tailored to the individual patient.

Q: How does menopause affect psoriasis?

A: It’s different for every patient. For some patients, as they get older, their psoriasis may be more quiet. For other patients, as they get older, hormones can become more active. That’s the hard thing about psoriasis — we don’t know what the natural course is. So, at this time, there is actually no research or no known relationship between hormones, or specifically menopause, and psoriasis.

Q: If a woman is older, does psoriasis have a bearing on her projected lifespan?

A: That’s a hard question. We do know that there is lots of data coming from registry studies in Europe that severe psoriasis can affect your lifespan. Psoriasis comes with a lot of comorbidities, such as heart disease, diabetes, and hypertension. So as you can imagine, with all those other health problems, severe psoriasis not only affects the quality of your life, but also your lifespan.

Portions of this interview were edited for clarity and brevity.

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