When you become pregnant, every psoriasis treatment you use needs to be reviewed — not just the prescription ones. Some ingredients that are safe for general use carry real risks during pregnancy. Others are well-studied and considered low risk. And a small number are absolute contraindications that must have been stopped before conception. This guide gives you a comprehensive treatment-by-treatment breakdown so you can have an informed conversation with your dermatologist and OB-GYN rather than discovering a problem after the fact. It does not replace that conversation — it prepares you for it.
The Underlying Principle
The goal during pregnancy is the lowest effective treatment burden — meaning the gentlest treatment that adequately controls your symptoms. This is not the same as using no treatment, which can lead to poorly controlled psoriasis with its own implications for maternal health. It means working with your care team to match treatment intensity to disease severity, using systemic exposure only when clearly necessary, and defaulting to topical and non-pharmacological options wherever possible.
No treatment decision during pregnancy should be made unilaterally. Every item in this guide should be discussed with your dermatologist and OB-GYN before use or discontinuation.
Complete Treatment Safety Reference
| Treatment | Safety Status | Key Information |
|---|---|---|
| Fragrance-free emollients | Safe | The foundation of all pregnancy psoriasis management. Use generously and consistently throughout pregnancy and postpartum. No systemic exposure risk. |
| Low-potency topical corticosteroids | Safe — limited use | Safe for localized, short-term use on small areas under dermatologist guidance. Avoid high-potency formulations and application over large surface areas — absorption risk increases with coverage. Do not apply under occlusion (bandaging) without medical guidance. |
| Narrowband UVB phototherapy | Safe | No systemic drug exposure. Well-studied during pregnancy and considered one of the safest options for moderate to severe psoriasis. Requires regular clinic attendance. Folic acid supplementation is recommended as UVB degrades folate. |
| Colloidal oatmeal baths | Safe | Soothes itch and reduces inflammation with no systemic risk. Use lukewarm — not hot — water. |
| Salicylic acid | Caution | Acceptable in limited use on small areas under physician guidance. Avoid widespread or prolonged application — salicylic acid is absorbed systemically and can accumulate. Not recommended for use over large body surface areas during pregnancy. |
| Coal tar | Caution | Limited evidence. Classified as pregnancy category C — animal studies show some risk, human data insufficient. Some dermatologists consider limited use of coal tar shampoo acceptable; others advise avoiding entirely. Use only under explicit physician recommendation. Avoid broad body application. |
| Vitamin D analogues (calcipotriene) | Caution | Small-area use may be acceptable under close medical supervision. Systemic absorption is a concern with widespread use. Discuss specifically with your dermatologist. |
| High-potency topical corticosteroids | Caution — avoid large areas | Associated with fetal growth restriction in studies involving large-area use. Acceptable for small, localized areas under dermatologist supervision. Not for use on the face, skin folds, or under occlusion without specific guidance. |
| Biologics (adalimumab, etanercept, etc.) | Specialist guidance required | Safety varies by agent and trimester. Some TNF inhibitors are considered relatively low risk in the first and second trimester under specialist supervision. All biologics cross the placenta to varying degrees — implications for infant immune function need to be discussed with your specialist. Never stop or continue a biologic without specialist review. |
| PUVA (UVA + psoralens) | Avoid | Psoralens are mutagenic and are not safe during pregnancy. Narrowband UVB is the appropriate phototherapy alternative. |
| Methotrexate | Contraindicated | A known teratogen causing birth defects and miscarriage. Must be discontinued at least 3–6 months before conception in both women and men. This washout timeline is not negotiable — discuss with your dermatologist well before trying to conceive. |
| Acitretin (oral retinoid) | Contraindicated | Severe teratogen. Acitretin persists in body tissue — women must avoid pregnancy for at least 3 years after the last dose. Requires careful advance planning if pregnancy is anticipated. |
| Cyclosporine | Generally avoid | Limited human data. Not recommended as first-line during pregnancy. May be used in severe, refractory cases under close specialist supervision as a last resort — risk/benefit must be explicitly discussed. |
| Systemic corticosteroids (oral) | Caution — specialist only | Associated with gestational diabetes, hypertension, and premature delivery with prolonged use. Reserved for severe acute flares under specialist supervision only. Not appropriate for routine psoriasis management during pregnancy. |
What to Do When Treatments Must Be Stopped
One of the most common scenarios for pregnant women with psoriasis is that their usual treatment needs to be paused or discontinued — and symptoms return as a result. This is a predictable challenge worth planning for rather than being caught off guard by.
The most practical approach is a preconception dermatology appointment — before trying to conceive — where you and your dermatologist map out a pregnancy-safe management plan. This allows time to safely transition from treatments that require washout periods, establish which pregnancy-safe alternatives work for your skin, and have a plan ready for if and when a flare occurs during pregnancy.
If you are already pregnant and your treatment has been stopped without a clear alternative plan, contact your dermatologist promptly rather than waiting for symptoms to worsen. Poorly controlled psoriasis during pregnancy is not without risk — early intervention with a pregnancy-safe option is preferable to prolonged uncontrolled disease.
If you are using narrowband UVB phototherapy during pregnancy, discuss folic acid supplementation with your OB-GYN. UVB light degrades folate, and adequate folate is critical during pregnancy for neural tube development. Most prenatal vitamins include folic acid, but the dose may need to be confirmed with your care team.
A Note on Nopsor During Pregnancy
Nopsor Shampoo and Pomade contain coal tar, salicylic acid, and an 8-herb blend. Both coal tar and salicylic acid fall into the "use with caution" category during pregnancy — neither is an absolute contraindication, but broad application or prolonged use of either during pregnancy is not recommended without physician approval. If you currently use Nopsor and are pregnant or planning to become pregnant, bring the product to your dermatologist or OB-GYN for review before continuing. For scalp psoriasis specifically, a limited-use coal tar shampoo may be acceptable under physician guidance — the key is confirming this explicitly with your care team rather than assuming it is fine.
Related reading:
Nopsor — Steroid-Free Psoriasis Relief
Coal tar, salicylic acid, and 8 medicinal herbs. Always consult your doctor before using any topical treatment during pregnancy.
See the Nopsor Treatment Set →40-day money-back guarantee for purchases at nopsor-usa.com or Amazon · No prescription needed
References
- American Academy of Dermatology. Can a woman treat psoriasis while pregnant or breastfeeding? aad.org
- National Psoriasis Foundation. Treatment and pregnancy. psoriasis.org
- U.S. Food and Drug Administration. Pregnancy and lactation labeling (drugs) — final rule. fda.gov
- Murase JE, et al. Safety of dermatologic medications in pregnancy and lactation: An update — Part I: Pregnancy. Journal of the American Academy of Dermatology. 2024. jaad.org
This article is for educational purposes only and does not replace medical advice. Always consult your dermatologist and OB-GYN before starting, stopping, or adjusting any treatment during pregnancy.
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