Understanding Family Planning Concerns in Patients with Psoriasis

New research is shedding light on psoriasis patients' perspectives and experiences with family planning and pregnancy.¹ A study from Barenbrug et al. is a foundation for increasing awareness and improving information delivery in this vulnerable patient population.

Background

The onset of psoriasis can raise concerns in patients of reproductive age due to medication effects, safety, disease activity, and genetic inheritance. Previous data has shown that 55% of psoriasis patients saw improvement, 21% did not see any change, and 23% had worsened disease during pregnancy, with an increased risk of flares postpartum.² The pregnancy rate is also lower in patients with psoriasis.³ Patients interested in family planning have little to no information and seek more structured guidelines from dermatologists and health care providers to help make key decisions.

Methods & Materials

A cross-sectional questionnaire was given to 102 adult female (70%) and male (30%) patients with psoriasis to better understand their preferences. The survey included questions on disease and treatment characteristics, medications and other experiences during pregnancy, and needs regarding information provision. It remained active from December 2023 to May 2024 and was distributed through the Dutch Psoriasis Patient Association’s social media, website, and magazine, along with in-person distribution at an outpatient dermatology clinic in the Netherlands.

Responses from Female Psoriasis Patients

Overall, 16.2% of females chose not to have children because of their disease. Of the female patients with children, 8 hesitated to have another child due to their condition and concerns about how psoriasis would affect pregnancy and vice versa. They wanted to know more about the course of psoriasis during and after pregnancy/breastfeeding. In almost 20% of the pregnancies, oral medications were discontinued before pregnancy. None of the surveyed patients used these therapies while pregnant.

Over 43% searched for information on pregnancy and psoriasis from the internet, family and friends, or their health care providers (dermatologists, general providers, gynecologists, midwives, and pharmacists). In their searches, females received information on fertility, disease course, heredity of psoriasis, medication use during pregnancy, and breastfeeding while taking psoriasis therapies.

In this study, disease activity during pregnancy improved in 61.7% (n = 37), worsened in 18.3% (n = 11), and remained unchanged in 18.3% (n = 11). Post-partum disease activity increased in 46.7% (n = 28), decreased in 3.3% (n = 2), and remained unchanged in 38.3% (n = 23) of the pregnancies.

Responses from Male Psoriasis Patients

No males chose not to have children due to their psoriasis diagnosis but 15.4% did have some hesitations. A common concern was the discontinuation of medication that could potentially be required during the period of trying to conceive. Approximately 30% of male respondents discussed their psoriasis drug use with their dermatologist before conceiving. Twenty-nine percent searched for further information on family planning and psoriasis from the internet, family and friends, or their health care providers. They typically looked for guidance on fertility, heredity of psoriasis, and the use of medication when trying to conceive.

Further Results

Almost half of males and females had biological children at the time of the survey, while 1 female was pregnant for the first time. About 55% patients would like to, or would have liked to, receive information about family planning. This was more frequently reported in females with children. They preferred to receive these resources from a health care provider and would like to have reference materials such as a website or flyer for easy access and updated info. Psoriasis patients would like to receive information regarding family planning at the moment of diagnosis (57.1%), when medication is changed (41.1%), and/or when they clearly express a need for it (44.6%).

“Nevertheless, it remains important to consider that some information, especially regarding certain aspects of medication use during the period of trying to conceive or pregnancy, can be patient-specific,” the authors noted.

Clinical Tips & Guidance

With these findings, the authors suggest developing a protocol and encouraging multidisciplinary collaboration between dermatologists, gynecologists, and other health care providers. Additionally, introducing family planning into regular patient conversations is also a good idea, as some of reproductive age may hesitate to bring up the topic themselves. The researchers strongly believe that this study is a first step in creating hands-on, comprehensive guidance for clinicians to improve care for patients of childbearing age with psoriasis.

References

1. Barenbrug L, van Ee I, van der Molen RG, de Jong EMGJ, van den Reek JMPA. Family planning and pregnancy among patients with psoriasis: incorporating the patients' voice in healthcare practice and information provision. J Dermatolog Treat. 2025;36(1):2532676. doi:10.1080/09546634.2025.2532676

2. Murase JE, Chan KK, Garite TJ, Cooper DM, Weinstein GD. Hormonal effect on psoriasis in pregnancy and post partum. Arch Dermatol. 2005;141(5):601-606. doi:10.1001/archderm.141.5.601

3. Gottlieb AB, Ryan C, Murase JE. Clinical considerations for the management of psoriasis in women. Int J Womens Dermatol. 2019;5(3):141-150. Published 2019 Apr 10. doi:10.1016/j.ijwd.2019.04.021