Is Postpartum Psoriasis Normal? Flares and Management | MyPsoriasisTeam

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Is Postpartum Psoriasis Normal? Flares and Management

Medically reviewed by Kevin Berman, M.D., Ph.D.
Posted on May 2, 2023

Psoriasis can be a challenging condition during the best of times, but for those who are pregnant or postpartum, it can be even more difficult. These periods of physical and emotional change can cause variations in psoriasis symptoms, leaving many people wondering how to manage their skin while taking care of a newborn.

One study found that around 88 percent of women with psoriasis experienced postpartum flare-ups — most within four months of delivery. Although psoriasis doesn’t make it more difficult for a couple to conceive, pregnancy can affect psoriasis.

MyPsoriasisTeam members have experienced this firsthand. 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 should understand what postpartum psoriasis looks like, why it happens, and how to manage it.

What Does Postpartum Psoriasis Look Like?

The postpartum period begins right after giving birth and lasts for about six weeks while the mother’s body begins to recover back to the pre-pregnancy state. During this time of change, some people experience more severe psoriasis symptoms than they had during their pregnancy.

Increased Psoriatic Body Surface Area

Some people have an increased percentage of their body surface area (BSA) affected by psoriasis lesions during the postpartum period.

Just over half of women with psoriasis experience an improvement in symptoms while they’re pregnant, especially in the first and second trimesters. One study from JAMA Dermatology found among pregnant women with more than 10 percent psoriatic BSA, their lesions decreased by more than 80 percent during their pregnancy. This decrease is probably due to the ratio of estrogen to progesterone.

However, in the postpartum period, psoriasis symptoms can return to the same levels as before pregnancy. The same JAMA Dermatology study found that psoriatic BSA doubled during the period from the 30-week pregnancy mark through the first six weeks after giving birth.

Although psoriasis severity may change during and after pregnancy, pregnancy doesn’t appear to make psoriasis worse in the long term. Most people return to the same severity of psoriasis they had before their pregnancy.

Psoriasis on Areas of Injured Skin

Psoriasis flare-ups can be triggered by injury or trauma to the skin — known as the Koebner phenomenon. Giving birth vaginally or by a cesarean section (C-section) will cause new skin injuries, which can cause psoriasis to develop in these areas. The most common type of psoriasis to develop in the genital area is called inverse psoriasis. This type of psoriasis is more common in skin folds and usually appears as patches of red or darker-colored smooth, shiny skin.

Giving birth vaginally or via a C-section can cause skin trauma, which in turn can cause psoriasis symptoms to develop or worsen in the affected area. (CC BY-NC-ND 3.0 NZ/DermNet)

A MyPsoriasisTeam member asked, “How bad were your flare-ups after giving birth? I’m mainly concerned about getting inverse psoriasis of the genitals if I give birth naturally.”

Breastfeeding may also trigger new psoriasis plaques to develop on the nipples. A MyPsoriasisTeam member shared, “My worst problem was with breastfeeding, as my cracked nipples developed psoriasis, which lasted for years and years.”

People with psoriasis may experience flare-ups while lactating, causing symptoms to appear on the nipple due to skin trauma. (CC BY-NC-ND 3.0 NZ/DermNet)

Emotional Impact

About 1 in 7 women experience postpartum depression. Psoriasis can also increase a person’s risk of developing depression. Women with psoriasis, in particular, are more likely to experience stress and loneliness than men with psoriasis, according to the International Journal of Women’s Dermatology.

Studies from the journal Cureus have shown that psoriasis symptoms make depression symptoms worse, and vice versa. It is possible that postpartum depression can worsen the effects of psoriasis, and psoriasis symptoms may worsen postpartum depression.

A MyPsoriasisTeam member shared, “My psoriasis causes depression, and I’m not taking any medications because I’m nursing my daughter. Having bouts with postpartum depression is really taking a toll on my skin, digestion, joints, etc.”

What Causes Postpartum Psoriasis?

Researchers aren’t sure exactly why psoriasis can flare up in some people during the postpartum period. Some women can develop psoriasis for the first time once the baby is born. Women with psoriasis can experience new-onset psoriatic arthritis. Several theories may help to explain the phenomenon.

Hormone Changes

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 psoriasis improvements during pregnancy are related to higher estrogen to progesterone levels.

After giving birth, estrogen levels naturally decrease. With less estrogen, a person’s psoriasis may worsen.

Additionally, levels of the hormone progesterone increase during pregnancy, which may improve psoriasis. This hormone blocks T cells, the immune cells primarily responsible for attacking the skin in psoriasis.

On rare occasions, some expectant mothers develop pustular psoriasis during pregnancy. It typically appears during the third trimester and resolves once they’ve given birth. (CC BY-NC-ND 3.0 NZ/DermNet)

Notably, some people develop pustular psoriasis during pregnancy, though this is a rare occurrence. Pustular psoriasis typically develops during the third trimester and quickly disappears after delivery. Scientists aren’t sure why some people develop this type of psoriasis during pregnancy, but it could be triggered by increased progesterone levels, hypocalcemia (low calcium levels), low vitamin D levels, or hypoparathyroidism (low levels of the hormone parathyroid).

Immune System Changes

During pregnancy, an expectant mother’s immune system changes to protect the developing fetus. In general, they have fewer white blood cells that can cause inflammation. Pregnant people also have naturally higher levels of glucocorticoids, which suppress the immune system. These changes to the immune system can help reduce psoriasis inflammation during pregnancy.

After giving birth, the immune system returns to its normal state and is no longer suppressed. This change may lead to an increase in inflammation that causes psoriasis symptoms.

Genetics

The genes you inherit from your parents can affect how pregnancy and giving birth affect your psoriasis. An example of this is the human leukocyte antigen (HLA) gene, which is involved in the immune system. One study found that women with a particular variation of the HLA gene — known as HLA-Cw*0602 — were more likely to experience symptom improvement during pregnancy. However, these women may have an increased risk of the Koebner phenomenon, which may lead to postpartum psoriasis.

Changes in Treatment

Your treatment options change during pregnancy to avoid harm to the baby. For example, you may have to stop or change your treatment if you become pregnant.

Some medications used in the treatment of psoriasis shouldn’t be used during pregnancy, such as:

Biologics (medications made from living cells) aren’t considered first-line treatment during pregnancy because scientists haven’t studied their effects on babies. Certolizumab (trade name Cimzia) appears to be the safest for a pregnant woman. Stopping a biologic before pregnancy or during the first trimester may worsen psoriasis symptoms during and after pregnancy.

Diagnosis

A psoriasis flare-up is diagnosed by a doctor specializing in treating skin conditions, called a dermatologist. Make sure to let your dermatologist know how long ago you gave birth and whether you’re breastfeeding.

Your doctor will diagnose postpartum psoriasis by looking at your skin and asking questions about your symptoms. A biopsy may be done to determine the diagnosis if it is not clear by exam.

Managing Postpartum Psoriasis

You should work with your obstetrician (a doctor specializing in pregnancy) and your dermatologist to manage your psoriasis symptoms after giving birth. If you stopped your treatment while you were pregnant, you might be able to restart it or modify your treatment plan after giving birth.

Breastfeeding

If you decide to breastfeed, talk to your dermatologist about which medications are safest for you and your baby. There aren’t any studies that say which psoriasis treatments potentially pass into human breast milk.

The safest options include the following treatments. These are not taken orally or by injection, so they have a smaller chance of getting into breast milk:

  • Topical corticosteroids
  • Calcipotriene (Dovonex)
  • Phototherapy with UVB
  • Moisturizers

If you’re using a topical treatment (applied directly to the skin), it’s important not to apply it to your breast or nipple, to reduce your baby’s risk of coming into contact with it.

Talk to your health care team about the potential risks and benefits of psoriasis treatment during the postpartum period. If your symptoms require systemic medication (taken orally or injected into the body), talk to your dermatologist about which ones are less likely to get into breast milk.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 116,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Did you have psoriasis flare-ups after giving birth? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on May 2, 2023
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Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Amanda Jacot, PharmD earned a Bachelor of Science in biology from the University of Texas at Austin in 2009 and a Doctor of Pharmacy from the University of Texas College of Pharmacy in 2014. Learn more about her here.

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