Psoriasis treatments keep your skin clear — but are they safe when you're pregnant and breastfeeding? Pregnancy can affect your psoriasis symptoms and change your treatment. But you can take steps to reduce your psoriasis while keeping your baby safe.

During pregnancy, psoriasis symptoms can worsen for a small number of women. But most women have clearer skin or no change in their psoriasis symptoms.

After delivery, it's common for psoriasis to flare. And some women newly develop a psoriasis-related arthritis (psoriatic arthritis).

In general, it's best to stop taking any psoriasis medicines that aren't necessary while you're pregnant. Some psoriasis treatments may cause birth defects. Treatments that aren't recommended during pregnancy or breastfeeding include:

  • Oral retinoids, such as acitretin (Soriatane).
  • Oral corticosteroids, such as prednisone.
  • Methotrexate (Trexall), a drug that may be taken orally or through an injection in the muscle. Don't take this medicine if you're trying to conceive (this applies to men and women), pregnant or breastfeeding.
  • Tazarotene (Tazorac, Avage), a topical treatment.
  • Psoralen plus ultraviolet A (PUVA) phototherapy, because it's unknown how the drug that's taken with this light therapy affects the baby.

If you have mild psoriasis, you can often manage symptoms with topical treatments while you're pregnant and breastfeeding. Some oral and injected medicines may also be safe. Your health care provider might suggest:

  • Moisturizers and emollients to keep skin hydrated.
  • Topical corticosteroids, though your doctor might recommend less frequent applications of a low-strength option to be careful.
  • Narrowband ultraviolet B (UVB) phototherapy, if topical treatments don't provide relief.
  • Cyclosporine, an oral medicine likely safe during pregnancy, though experts don't fully understand the risks.
  • Biologic drugs, including infliximab (Remicade), etanercept (Enbrel) and adalimumab (Humira) are likely safe, though their effect in pregnant and breastfeeding women is unknown. Your health care provider might recommend stopping biologics toward the end of the pregnancy to protect your newborn from a possible increased risk of infection. If you have very severe psoriasis, discuss with your health care provider the benefits and risks of continuing biologic therapy during your pregnancy.

With some precautions, some psoriasis treatments also can be used safely when breastfeeding.

  • Mild topical corticosteroids and moisturizers are the safest treatments while breastfeeding. Don't apply the topical corticosteroid just before breastfeeding if you have psoriasis on your breasts. Apply it after your baby has finished feeding. And clean it off before the baby's next feeding.
  • Oral corticosteroids are also safe if topical medicines don't work for you, because very little reaches the breast milk. Just make sure that you wait about four hours after taking the oral corticosteroid before breastfeeding.

Whether you're pregnant or breastfeeding, discuss the risks and benefits of your psoriasis treatment options with your health care provider. In addition to medical treatments, you can help control your psoriasis symptoms with self-care measures. Use a daily moisturizer, follow a gentle skin care routine, reduce stress, and avoid any of your known psoriasis triggers.

Feb. 15, 2023