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Psoriasis can be challenging to live with at any time. During pregnancy or after giving birth, managing symptoms may feel even harder. These stages bring physical and emotional changes that can cause psoriasis to flare or improve. Many people wonder how to care for their skin while also adjusting to life with a newborn.
Researchers estimate that between 40 percent and 88 percent of women with psoriasis experience flare-ups after delivery. One study found that most flares occurred within four months postpartum. Although psoriasis doesn’t make it harder for a couple to conceive, pregnancy can affect psoriasis.
MyPsoriasisTeam members have described this experience. One member shared, “My psoriasis went away completely with pregnancy and then came back with a vengeance postpartum.”
If you or your loved one is pregnant or considering having a baby, you may wonder, “Can pregnancy cause psoriasis?” This article will help you understand what postpartum psoriasis looks like, why it happens, and how to manage it.
A study published in the International Journal of Women’s Dermatology reported that psoriasis symptoms improved in just over half of women during pregnancy. Symptoms worsened for about 23 percent and were unchanged for about 21 percent.
During the postpartum period, psoriasis symptoms can be more severe than during pregnancy. The postpartum period begins right after giving birth and lasts for about six weeks, while the mother’s body begins to recover to a prepregnancy state. Keep reading to learn about some of the changes seen in psoriasis symptoms during the postpartum period.
After childbirth, psoriasis symptoms may return to the same levels as before pregnancy, or get worse. A study in JAMA Dermatology found that the percentage of skin affected by psoriasis (body surface area, or BSA) about doubled between 30 weeks of pregnancy and the first six weeks after giving birth.
However, pregnancy doesn’t appear to make psoriasis worse in the long term. Most people return to the same severity they had before pregnancy.
Psoriasis flare-ups can sometimes be triggered by skin injuries, a reaction known as the Koebner phenomenon. Both vaginal and cesarean births can cause skin trauma. Irritation or wounds may lead to new psoriasis lesions.
The most common type of psoriasis in the genital area is called inverse psoriasis. This form usually appears in skin folds, where it causes smooth, shiny patches.
“How bad were your flare-ups after giving birth?” a MyPsoriasisTeam member asked. “I’m mainly concerned about getting inverse psoriasis of the genitals if I give birth naturally.”
Breastfeeding may also trigger new plaques on the nipples, as another member described: “My worst problem was with breastfeeding, as my cracked nipples developed psoriasis, which lasted for years and years.”
A StatPearls article states that about 1 in 7 people experience postpartum depression. Psoriasis can also raise the risk of depression. Women with psoriasis are more likely to experience stress and loneliness than men with psoriasis, according to the International Journal of Women’s Dermatology.
A 2020 study in the journal Cureus found that psoriasis symptoms make depression symptoms worse and vice versa. Postpartum depression may worsen the effects of psoriasis, and then psoriasis symptoms may worsen postpartum depression.
“My psoriasis causes depression, and I’m not taking any medications because I’m nursing my daughter,” a MyPsoriasisTeam member shared. “Having bouts with postpartum depression is really taking a toll on my skin, digestion, joints, etc.”
Researchers aren’t sure why psoriasis sometimes flares up during the postpartum period. Some women develop psoriasis for the first time after the baby is born, according to the journal Psoriasis: Targets and Therapy. Those who already have psoriasis can also experience new-onset psoriatic arthritis. Several theories may help explain the phenomenon.
Hormones can affect psoriasis symptoms. Scientists think that changes in estrogen levels during and immediately after pregnancy can affect psoriasis severity. Studies have shown that improvements during pregnancy are related to higher estrogen-to-progesterone ratios.
Estrogen levels naturally drop after childbirth. This hormonal change may trigger psoriasis to return or worsen.
Additionally, during pregnancy, levels of progesterone rise, which may improve psoriasis. This hormone blocks T cells — the immune cells primarily responsible for attacking the skin in psoriasis.
In rare cases, people develop pustular psoriasis during pregnancy. This type often appears in the third trimester and may clear after delivery. Scientists aren’t sure why it happens, but possible triggers include higher progesterone levels, hypocalcemia (low calcium), low vitamin D, or hypoparathyroidism (low levels of the hormone parathyroid).
During pregnancy, the immune system changes to protect the developing baby. Levels of natural steroids called glucocorticoids rise, which suppresses immune activity. These shifts may help reduce psoriasis inflammation during pregnancy.
After childbirth, the immune system returns to its normal state and is no longer suppressed. This change can increase inflammation, which may trigger psoriasis symptoms to return or worsen.
Genes you inherit from your parents can influence how pregnancy and childbirth affect psoriasis. One example is the human leukocyte antigen (HLA) gene, which helps regulate the immune system. A study in The Journal of Investigative Dermatology found that women with a particular variation called HLA-Cw*0602 were more likely to see their psoriasis improve during pregnancy. However, these women may have had an increased risk of the Koebner phenomenon, which may lead to postpartum psoriasis, including postpartum scalp psoriasis.
During pregnancy, treatment may be adjusted so there’s less risk to the baby. For example, you may have to stop or change certain medications. Some drugs used to treat psoriasis aren’t considered safe in pregnancy, including:
Biologics (medications made from living cells) might be safe, but talk with your doctor about your specific medications and situation. Stopping a biologic before pregnancy or during the first trimester may worsen psoriasis symptoms during and after pregnancy.
A psoriasis flare-up can be diagnosed by a dermatologist (a doctor who specializes in skin conditions). Be sure to tell your dermatologist how recently you gave birth and whether you’re breastfeeding.
Your doctor will diagnose postpartum psoriasis by looking at your skin and asking about your symptoms. A biopsy may be done to determine the diagnosis if it’s not clear by a physical exam.
You should work with your obstetrician (a doctor who specializes in pregnancy) and your dermatologist to manage psoriasis symptoms after giving birth. If you stopped your treatment while pregnant, you might be able to restart or modify it after giving birth.
If you choose to breastfeed, talk with your dermatologist about which psoriasis treatments are safest for you and your baby. Research is limited on which medicines can pass into breast milk.
Treatments that are topical (applied to the skin) rather than those taken orally or by injection are usually safest. Topical options may include:
If you’re using a topical treatment, avoid applying it directly to your breast or nipple. This reduces your baby’s risk of coming into contact with the medication.
Talk with your healthcare team about the risks and benefits of psoriasis treatment in the postpartum period. If your symptoms require systemic medication (taken orally or injected), such as a systemic steroid or biologic, ask your dermatologist which options are considered safest for you and your baby.
On MyPsoriasisTeam, people share their experiences with psoriasis, get advice, and find support from others who understand.
Did you have psoriasis flare-ups after giving birth? Let others know in the comments below.
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