New mothers with psoriasis may be concerned about breastfeeding. They may wonder how to balance psoriasis treatment with their baby’s health. Working closely with health care providers, mothers can identify the best way to treat their psoriasis and breastfeed their babies if desired.
Psoriasis is a long-term skin disorder that causes scaly, itchy patches. It is triggered in part by an overactive immune system. In pregnant women, the immune system is much less active, so it is not surprising that over half of women report an improvement in their psoriasis during pregnancy. However, for reasons that are still not understood, almost one-quarter of pregnant women report that their psoriasis worsens.
After pregnancy, the immune system returns to its normal level of function and can act as a triggering factor for psoriasis flares. A majority of women report a worsening of symptoms in the postpartum period. “My skin was clear and amazing when I was pregnant,” a mother on MyPsoriasisTeam wrote. “But after I stopped breastfeeding, I was in the biggest flare-up and still am for the past year. I was warned of this by my doctors, but that doesn’t make it any easier.”
During the postpartum period, there is also an increase in the occurrence of psoriatic arthritis. Psoriatic arthritis (PsA) causes swelling and joint pain. Women who have given birth should be extra observant for PsA symptoms, such as stiff or painful joints, or the swelling of fingers and toes, and discuss any changes with their doctor right away.
Some women with psoriasis may worry about breastfeeding and how it will affect their baby’s health. Remember that psoriasis is not contagious, nor is there a psoriasis-causing agent that could be passed through breast milk. Lactating mothers will not give psoriasis to a baby by breastfeeding.
There are many challenges in breastfeeding, and the process can be more difficult for women with psoriasis. Flare-ups on the breasts or nipples can make feeding extremely painful. Breastfeeding is very healthy for the baby and can be a rewarding, nurturing experience for both the mother and child. These benefits motivate many to continue feeding their baby despite the complications imposed by psoriasis.
Women seeking advice on how to treat their psoriasis while breastfeeding should first consult with a dermatologist or other health care provider.
The National Psoriasis Foundation offers the following guidance:
“Many health care providers recommend women avoid psoriasis treatments altogether or use only the safest forms during conception, pregnancy, and breastfeeding. Each psoriasis treatment has a different set of precautions, so it is important to work with your health care provider to decide which treatment is safest for you and your baby.”
Based on a review of treatments by the Medical Board of the National Psoriasis Foundation, the first-line options for psoriasis treatment considered safest for breastfeeding women are over-the-counter moisturizers and emollients. These are considered to be very safe but should be wiped dry before feeding. Low- to mid-strength topical corticosteroids (for example, prednisone or hydrocortisone) are generally considered low-risk treatments and are often recommended.
Treatment with UV light (phototherapy) is also considered safe and can be used during breastfeeding. There are two types of phototherapy — narrowband UVB is preferred over broadband UVB. However, there are no reports of either UV type causing harm to a breastfed baby.
In severe cases when moisturizers and phototherapy prove ineffective, consider other treatments such as biologic drugs. There are several categories of biologic drugs that are used to treat psoriasis, and some are safer than others during breastfeeding.
Always consult with your doctor to determine which treatment options are right for your situation. Let your child’s pediatrician know about any medications you take while breastfeeding.
Some women may ultimately choose to forgo breastfeeding altogether. Despite the safety of many treatments, some still feel uncomfortable breastfeeding. For others, effective management of intense, severe psoriasis may require medication that has the potential to negatively affect the baby’s health. As one MyPsoriasisTeam member succinctly put it, “I chose not to breastfeed because of what I put on my skin.”
Psoriasis management while breastfeeding is a unique and personal decision for everyone. There are several healthy, safe alternatives to breastfeeding — such as formula and pumping — for women to consider when weighing their options. Share your concerns with a lactation consultant, obstetrician, and other health care providers. You can discuss treatment possibilities to create a plan that balances symptom relief, your baby’s health, and your emotional well-being.
The Centers for Disease Control and Prevention (CDC) released findings in May 2020 indicating that 13 percent of women in the United States experience postpartum depression (PPD). Postpartum depression is a serious but common mental health condition that requires immediate attention.
Depression can be treated with counseling, antidepressant medication, or both. Postpartum depression typically improves with treatment, and most common antidepressants, such as Zoloft (paroxetine) and Pamelor (nortriptyline), are considered safe to take while breastfeeding and have minimal effect on the baby.
The American Academy of Pediatrics notes that if breastfeeding is contributing to PPD, mothers should not feel guilty about stopping and switching to another feeding method. If breastfeeding is not contributing to PPD, your health care provider should help you preserve your breastfeeding relationship when treating postpartum depression (and any other health condition).
MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. Here, more than 90,000 members from across the world come together to ask questions, share advice, and find support from others who understand life with psoriasis.
Have you had trouble breastfeeding due to your psoriasis? Will you soon be breastfeeding and have concerns about how to manage your psoriasis throughout the process? Share your experience and tips in the comments below or by posting on MyPsoriasisTeam.