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Management of psoriasis in pregnancy

Miriam Keltz Pomeranz, MD
Bruce E Strober, MD, PhD
Section Editors
Robert P Dellavalle, MD, PhD, MSPH
Louise Wilkins-Haug, MD, PhD
Kristina Callis Duffin, MD
Deputy Editor
Abena O Ofori, MD


Psoriasis is a chronic skin disorder characterized by well-demarcated erythematous papules and plaques with a silver scale, although atypical or nonclassic forms also exist. It commonly occurs on the extensor surface of the elbows or knees, or the scalp (picture 1A-C). Psoriasis commonly occurs in women of reproductive age because three-quarters of patients develop the disease before reaching age 40 years [1]. (See "Epidemiology, clinical manifestations, and diagnosis of psoriasis".)

The management of psoriasis in pregnant women will be reviewed here. The general treatment of psoriasis and pustular psoriasis of pregnancy, a severe pustular form of psoriasis, is discussed separately. (See "Treatment of psoriasis in adults" and "Dermatoses of pregnancy".)


The presence of psoriasis in a woman who is pregnant raises unique considerations. Examples include the impact of maternal psoriasis on the fetus, therapeutic restrictions during pregnancy, and the effects of pregnancy on psoriasis severity.

Impact of psoriasis on pregnancy outcomes – Few studies have investigated the impact of psoriasis on pregnancy outcomes, leaving the relationship between psoriasis and pregnancy outcomes unclear [2]. A systematic review of observational studies that evaluated the relationship between psoriasis and pregnancy outcomes found that four of the nine included studies reported increased risk for at least one adverse fetal outcome (spontaneous abortion, caesarean delivery, low birth weight, macrosomia, large-for-gestational age, or a composite outcome that included prematurity and low birth weight) [2]. However, study results were inconsistent.

Impact of pregnancy on treatment choices Choosing drug therapies that pose the least risk to the fetus is the major issue in managing the pregnancies of affected women. Ideally, women should try to plan pregnancy when they are in remission and they are off medication or are taking the minimum effective dose of medications that have the best fetal safety profiles. Because many women with moderate to severe psoriasis do not achieve complete remissions, postponing pregnancy until a period of remission often is unrealistic in this population. The selection of treatments with good fetal safety profiles is particularly important for these patients. (See 'Treatment principles' below.)

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Literature review current through: Dec 2017. | This topic last updated: Oct 03, 2016.
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  1. Barker JN. Genetic aspects of psoriasis. Clin Exp Dermatol 2001; 26:321.
  2. Bobotsis R, Gulliver WP, Monaghan K, et al. Psoriasis and adverse pregnancy outcomes: a systematic review of observational studies. Br J Dermatol 2016; 175:464.
  3. Murase JE, Chan KK, Garite TJ, et al. Hormonal effect on psoriasis in pregnancy and post partum. Arch Dermatol 2005; 141:601.
  4. Dunna SF, Finlay AY. Psoriasis: improvement during and worsening after pregnancy. Br J Dermatol 1989; 120:584.
  5. Boyd AS, Morris LF, Phillips CM, Menter MA. Psoriasis and pregnancy: hormone and immune system interaction. Int J Dermatol 1996; 35:169.
  6. Lam J, Polifka JE, Dohil MA. Safety of dermatologic drugs used in pregnant patients with psoriasis and other inflammatory skin diseases. J Am Acad Dermatol 2008; 59:295.
  7. Bae YS, Van Voorhees AS, Hsu S, et al. Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2012; 67:459.
  8. Danesh MJ, Murase JE. The new US Food and Drug Administration pregnancy and lactation labeling rules: Their impact on clinical practice. J Am Acad Dermatol 2015; 73:310.
  9. Weatherhead S, Robson SC, Reynolds NJ. Management of psoriasis in pregnancy. BMJ 2007; 334:1218.
  10. Tauscher AE, Fleischer AB Jr, Phelps KC, Feldman SR. Psoriasis and pregnancy. J Cutan Med Surg 2002; 6:561.
  11. Chi CC, Lee CW, Wojnarowska F, Kirtschig G. Safety of topical corticosteroids in pregnancy. Cochrane Database Syst Rev 2009; :CD007346.
  12. Chi CC, Wang SH, Mayon-White R, Wojnarowska F. Pregnancy outcomes after maternal exposure to topical corticosteroids: a UK population-based cohort study. JAMA Dermatol 2013; 149:1274.
  13. Mahadevan U, Wolf DC, Dubinsky M, et al. Placental transfer of anti-tumor necrosis factor agents in pregnant patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2013; 11:286.
  14. Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol 2014; 70:401.e1.
  15. Heller MM, Wu JJ, Murase JE. Fatal case of disseminated BCG infection after vaccination of an infant with in utero exposure to infliximab. J Am Acad Dermatol 2011; 65:870.
  16. Cheent K, Nolan J, Shariq S, et al. Case Report: Fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn's disease. J Crohns Colitis 2010; 4:603.
  17. Leachman SA, Reed BR. The use of dermatologic drugs in pregnancy and lactation. Dermatol Clin 2006; 24:167.
  18. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation, 7th ed, Williams and Wilkins, Baltimore 2005.
  19. Menter A. Pharmacokinetics and safety of tazarotene. J Am Acad Dermatol 2000; 43:S31.
  20. www.reprotox.org (Accessed on December 18, 2007).
  21. Maier H, Hönigsmann H. Concentration of etretinate in plasma and subcutaneous fat after long-term acitretin. Lancet 1996; 348:1107.
  22. Franssen ME, van der Wilt GJ, de Jong PC, et al. A retrospective study of the teratogenicity of dermatological coal tar products. Acta Derm Venereol 1999; 79:390.
  23. Hoeck HC, Laurberg G, Laurberg P. Hypercalcaemic crisis after excessive topical use of a vitamin D derivative. J Intern Med 1994; 235:281.
  24. Andrulonis R, Ferris LK. Treatment of severe psoriasis with ustekinumab during pregnancy. J Drugs Dermatol 2012; 11:1240.
  25. Sheeran C, Nicolopoulos J. Pregnancy outcomes of two patients exposed to ustekinumab in the first trimester. Australas J Dermatol 2014; 55:235.
  26. Alsenaid A, Prinz JC. Inadvertent pregnancy during ustekinumab therapy in a patient with plaque psoriasis and impetigo herpetiformis. J Eur Acad Dermatol Venereol 2016; 30:488.
  27. Rocha K, Piccinin MC, Kalache LF, et al. Pregnancy during Ustekinumab Treatment for Severe Psoriasis. Dermatology 2015; 231:103.
  28. Galli-Novak E, Mook SC, Büning J, et al. Successful pregnancy outcome under prolonged ustekinumab treatment in a patient with Crohn's disease and paradoxical psoriasis. J Eur Acad Dermatol Venereol 2016; 30:e191.
  29. Fotiadou C, Lazaridou E, Sotiriou E, Ioannides D. Spontaneous abortion during ustekinumab therapy. J Dermatol Case Rep 2012; 6:105.
  30. Yiu ZZ, Warren RB, Mrowietz U, Griffiths CE. Safety of conventional systemic therapies for psoriasis on reproductive potential and outcomes. J Dermatolog Treat 2015; 26:329.