Managing Psoriasis in Women of Childbearing Age: A Comprehensive Clinical Review

In the intricate web of psoriasis, the interplay with the female reproductive system is continuously unfolding, presenting persistent clinical challenges. Dermatologists and pharmacists are navigating the complex decision-making required to manage this condition, balancing treatment efficacy with reproductive safety.

Hormones that significantly impact psoriasis also influence reproductive potential, connecting skin changes to reproductive health, which in turn shapes the timing and selection of therapies around conception and pregnancy. Research shows that women of childbearing age with psoriasis face unique challenges, with hormonal fluctuations altering skin conditions.

Hormonal shifts not only alter skin conditions but also reproductive cycles, influencing treatment outcomes. Psoriasis manifests uniquely due to these hormonal changes, leading to variations in presentation and management strategies. This highlights the necessity of aligning treatment options with reproductive health considerations, including contraception counseling and planning the timing of systemic therapy around conception when appropriate.

Topical therapies and non-drug options are first-line for patients who are pregnant or planning pregnancy, with safety varying by agent (for example, low-to-medium potency topical corticosteroids are generally considered low risk, while tazarotene should be avoided); among biologics, selective use may be considered when needed, with certolizumab supported by accumulating pregnancy data. Findings from the literature and practice resources emphasize prioritizing maternal and fetal safety while achieving adequate disease control, with practical recommendations on first-line topicals, phototherapy, and selective biologic use. The evolving landscape of psoriasis treatment in this demographic encourages ongoing research and adaptation, with evidence for newer biologic classes (such as IL‑17 and IL‑23 inhibitors) still developing.

Recent data indicate increasing use of select biologics with accumulating pregnancy safety information—particularly for agents such as certolizumab—while others require case-by-case assessment based on disease severity and available evidence. In this context, “preference” reflects utilization trends rather than proven efficacy in pregnancy; observational cohorts generally report maternal and fetal outcomes for certain TNF inhibitors that are comparable to background rates, though effect sizes vary and are limited by study design.

Given hormone-driven disease fluctuations, for women feeling the impact of these changes, balancing skin health with fetal safety becomes paramount. Clinicians should monitor disease activity across trimesters and adjust therapy as hormones fluctuate.

As hormonal changes affect skin conditions, appropriate management—including non-pharmacologic options such as narrowband UVB phototherapy and, when needed, carefully selected pharmacologic therapies—becomes essential. Yet, not every treatment suits pregnant women, emphasizing the need for tailored options. Clinicians must evaluate treatment plans to align with both treatment efficacy and patient safety.

Psoriasis can negatively impact reproductive health through inflammatory and hormonal pathways, and through medication-related risks (for example, teratogenicity with retinoids and folate antagonism with methotrexate). If treatment becomes necessary during pregnancy, careful planning is essential to maintain health. Building on registry findings and pharmacokinetic insights into placental transfer, emerging opportunities offer hope for safer, more personalized treatment plans.

Advances in care include selective use of biologics with supportive pregnancy data (for example, certolizumab and some TNF inhibitors), while certain systemic agents should be avoided because of known risks (such as methotrexate and acitretin), reinforcing the need for individualized plans; data gaps remain for newer agents, underscoring the importance of shared decision-making and ongoing registry participation. Multidisciplinary care and detailed counseling are crucial for women experiencing both psoriasis and pregnancy.

Key Takeaways:

• Management for patients who are pregnant or planning pregnancy should prioritize non-systemic options first, including emollients, low-to-medium potency topical corticosteroids, and narrowband UVB phototherapy.
• Select biologics may be considered when indicated for moderate-to-severe disease—particularly agents with supportive pregnancy data—after shared decision-making and risk–benefit assessment.
• Care should integrate reproductive planning (e.g., contraception counseling and timing of systemic therapy) and close monitoring across trimesters.
• Evidence for newer biologic classes continues to evolve; ongoing registries and guideline-aligned practice help balance maternal control with fetal safety.