Psoriasis and Pregnancy: What to Expect
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Psoriasis behaves unpredictably during pregnancy — it can improve, worsen, or stay the same — and postpartum flares are common. Here's what the research shows and how treatment is typically managed.
How Psoriasis Changes During Pregnancy
The data varies somewhat across studies, but the general pattern is consistent: a meaningful share of women — roughly 33–60% in various studies — see their psoriasis improve during pregnancy, likely related to pregnancy's natural shift toward a less inflammatory immune profile. A smaller group, around 20–25%, see their psoriasis worsen, and the remainder stay roughly stable.
The postpartum period tells a different story. Flaring after delivery is common — reported in as many as 65% of women in some studies — as the immune and hormonal changes of pregnancy reverse relatively quickly after birth.
Why This Happens
Pregnancy involves a natural shift toward a Th2-dominant immune profile, which tends to suppress the Th1 and Th17 immune pathways that drive psoriasis. Elevated estrogen and progesterone during pregnancy also have direct anti-inflammatory effects. After delivery, these hormone levels drop rapidly, and the immune system reconstitutes — often in a more pro-inflammatory direction — which helps explain the common postpartum flare pattern.
Which Treatments Are Considered Safe
Treatment decisions during pregnancy always require an individual conversation with your doctor, but general patterns include:
- Generally considered safer options — moisturizers, mild topical corticosteroids (avoiding the breast area if breastfeeding), and narrowband UVB phototherapy, which is considered safe before conception, during pregnancy, and during breastfeeding
- Medications to avoid entirely — oral retinoids like acitretin (highly teratogenic, and must be avoided for three years prior to conception) and methotrexate (also highly teratogenic)
- A more nuanced category — biologic medications, where data is more limited and sometimes conflicting; some TNF-inhibitor biologics can cross the placenta from the second trimester onward, so this requires careful, individualized discussion with your dermatologist about risks and benefits
Never stop or start a psoriasis medication without professional guidance — for women planning pregnancy, this conversation is best had in advance, since some medications need to be discontinued months before conception.
Managing Postpartum Flares
Because postpartum flares are so common, it's worth planning ahead rather than being caught off guard. Discuss with your dermatologist which treatments are compatible with breastfeeding if that's part of your plan, and don't hesitate to reach out promptly if symptoms worsen after delivery — early management tends to be more effective than waiting.
Frequently Asked Questions
Will psoriasis affect my baby's health?
Most people with psoriasis have healthy pregnancies, and the condition itself typically doesn't harm the baby — the main considerations relate to medication safety, not the disease itself.
Can I use natural remedies instead of medication during pregnancy?
Be cautious — unproven natural remedies or supplements aren't automatically safer during pregnancy, and some may carry their own risks. Always clear any new treatment, including natural ones, with your healthcare provider first.
Next Steps
For a full overview of psoriasis management, see our complete beginner's guide to psoriasis.
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor about medication safety during pregnancy and breastfeeding.