Psoriasis and Breastfeeding
pdf of this information available
Every time I see a doctor whether it be for me or the kids, they point it out. They will not give me anything for it until I stop feeding. Even had a 10-minute discussion about T-gel which I have now used so much it does nothing for me. I am so conscious of it xx
I have psoriasis myself, during the latter stages of my pregnancy it almost cleared. But was back the same as before within 12 weeks. My worst affected areas are my legs with smaller patches across my torso. I have noticed a few patches across breasts. I presume as a result of mild trauma from little hands. My daughter is 18 months ok now and still nurses.
UVB therapy helped me the first time and it cleared for months now it just makes it more manageable. I have only suffered with psoriasis for about 5 years. Steroid creams do not suit so I tend to use just moisturiser. Summer is awful as I still live in trousers as not comfortable to wear dresses or skirts.
My dermatologist refused everything last year when I went for a check. My daughter was 4 months old and I was told to just stop nursing. Needless to say, I refused, I am just itchy and scaly all the time.
I have suffered with psoriasis for 18 years. I had a difficult start to breastfeeding, but by week 7 things were starting to improve. I could actually enjoy feeds, instead of wincing in pain. Until one day I was in excruciating pain again. My psoriasis, for the first time in my life, had started to appear on my nipples and areola. No amount of lanolin cream helped. Feeds were so painful. So many tears! A GP told me to stop breastfeeding, I said it was not an option. So instead prescribed me a mild steroid and to stop feeding for a week and to exclusively pump instead. I had only JUST got my baby latching properly, I did not want to introduce a bottle and ruin it all! Luckily, a friend recommended coconut oil and within 2 days the psoriasis was clearing up and becoming less painful. Within 2 weeks it was gone!
I seriously thought my breastfeeding journey was over because of my condition. So many tears, so much ‘Mom guilt’. We are 6.5 months in now and only have to apply the oil once a week! I have also started Cimzia injections, which are safe for breastfeeding mothers. 6 weeks in and it is starting to clear up over the rest of my body too.
Description
Psoriasis is an epidermal thickening and scaling, frequently associated with silvery scales. The extensor surfaces – elbows, knees and lower back and scalp are commonly affected. Pitting of the nails occurs in 50% of patients. It may also develop on the genitalia. It cannot be transmitted by contact, but many people are wary of exposing plaques for fear that they may be stigmatised.
Some 2% of the population are affected and it most commonly begins < 35 years (peaking between 20 and 30 years). It is equally common in males and females but more common in the white population. Normally skin cells are replaced every 3-4 weeks, however, in psoriasis this occurs every 3-7 days leading to build up and plaque areas. It is believed to be an auto-immune condition.
Psoriasis may be triggered by certain drugs e.g. hydroxychloroquine, NSAIDs, beta blockers and ACE inhibitors. It may also be affected by hormonal changes — high levels of disease activity may be seen during puberty, post-partum, and during the menopause. Psoriasis typically improves during pregnancy, but in 10–20% of pregnant women psoriasis can worsen. It may also be triggered by trauma including tattoo or piercings, smoking and alcohol use (CKS Psoriasis 2018).
Treatment
Emollients help dryness, scaling and cracking of skin: compatible with breastfeeding
Shampoos with less contact time than creams and ointments are generally compatible with breastfeeding e.g. T gel ™ Alphosyl ™, Nizoral™, Selsun™
Salicylic acid: Keratolytic useful if there is significant scaling: No information is available on the clinical use of salicylic acid on the skin during breastfeeding. However, it is unlikely to be appreciably absorbed and so appear in breastmilk. It is considered compatible with breastfeeding
Topical steroids; Eumovate™, Betnovate™, Dermovate ™Dovobet (with betamethasone) ™: compatible with breastfeeding when applied in normal amounts
Coal Tar preparations. One study showed levels in baby’s urine, but absorption appeared to be due to contact with the products on skin rather than through breastmilk which showed no traces of coal tar (Scheeper 2009).
Dithranol, not to be used on flexures or the face. No data on levels in breastmilk
Vitamin D analogues: calcipotriol (Dovonex™), tacalcitol, and calcitriol (Silkis™): poorly absorbed after topical application, so probably a low risk to the nursing infant and is generally considered acceptable. Dovobet™ should not be applied to the nipples but can be applied elsewhere ( https://www.e-lactancia.org/breastfeeding/dovobet/tradename/).
Topical calcineurin inhibitors –
tacrolimus: presents a low risk to the nursing infant because it is poorly absorbed after topical application Ensure that the baby’s skin does not come into direct contact with the areas of skin that have been treated.
pimecrolimus: used in infants, poorly absorbed after topical application and plasma concentrations after topical so low risk to the nursing infant. Ensure that the baby’s skin does not come into direct contact with the areas of skin that have been treated
Vitamin A analogue (Tazarotene): Topical tazarotene has not been studied during breastfeeding.
Photochemotherapy (UVA) involves psoralen no data in breastfeeding
References
Scheepers PT, van Houtum JL, Anzion RB et al. Uptake of pyrene in a breast-fed child of a mother treated with coal tar. Pediatr Dermatol. 2009; 26:184-7
Further information
The Psoriasis and Psoriatic Arthritis Alliance www.papaa.org
Travel Sickness and Breastfeeding
Copy of this information is available as a pdf
As the summer season and travels begin, my mind has turned to travel sickness and breastfeeding. I suffer badly personally!
I hope this helps you enjoy your travels rather than dread them
Causes of travel sickness
Travel sickness or motion sickness happens when the body, the inner ear, and the eyes send conflicting signals to the brain. This most often happens when you are in a car, boat, or airplane, but it may also happen on flight simulators or amusement park rides.
It is more common in children and in women. Sitting in the back of the car can also be a trigger for many people or a on a coach. I personally find the new trains which are faster much harder to deal with as they seem to sway much more.
It is difficult as a breastfeeding mother to deal with your own travel sickness as well as a baby or children. You may be able to drive rather than be a passenger. If not ,then there are medications which you can take which wont reduce your supply (because only being used short term) or affect your baby. Some temporary drowsiness is possible with any medicine which makes you drowsy.
Symptoms of travel sickness
Symptoms can come on very suddenly but rapidly escalate:
- Nausea and vomiting
- Pale skin
- Cold sweats
- Dizziness
- Headache
- Increased salivation
- Fatigue
- Difficulty concentrating
- Rapid breathing
These are symptoms not dissimilar to panic.
Medication
- If you are breastfeeding and need to care for a baby you may prefer one that is less likely to cause drowsiness – e.g. cinnarizine (Stugeron™)
- Hyoscine (Kwells ™, Joy Rides™) is usually regarded as the most effective medicine for motion sickness taken 30-60 minutes before the journey.
- Prochlorperazine (Buccastem™, Stemetil™)
- Cyclizine might be prescribed for you but is no longer available over the counter.
- Hyoscine patch can be prescribed. These are applied behind the ear 5-6 hours before travelling.
- Metoclopramide and domperidone may be useful to slow gastric emptying but are generally not prescribed for travel sickness.
- Homeopathic remedies e.g. Nelson’s Travella has limited research but is not harmful to the breastfed infant if it is a remedy which the mother finds useful.
- Antihistamines which cause drowsiness e.g. promethazine (Phenergan™, chlorpheniramine (Piriton ™) may be useful for children who struggle with travel sickness although it is rare before the age of 2 years.
Acupressure Bands
Some studies suggest that acupressure may help reduce symptoms of motion sickness in the same way as acupuncture. Acupressure bands are available commercially to help prevent motion sickness. Studies suggest these bands may help delay the onset of symptoms.
Traditionally, the acupuncture point known as Pericardium 6 is said to help relieve nausea. It is on the inside of the wrist, about the length of 2 fingernails up the arm from the centre of the wrist crease.
To reduce risk of travel sickness without medication
https://www.nhs.uk/conditions/motion-sickness/
- sit in the front of a car or in the middle of a boat.
- look straight ahead at a fixed point, such as the horizon rather than at a book, phone screen or portable device.
- fresh air e.g. open a car window
- close your eyes and breathe slowly while focusing on your breathing.
- distract children by talking, listening to music or singing songs.
- break up long journeys to get some fresh air, drink water or take a walk.
- some people recommend ginger, as a tablet, biscuit or tea but if you have had significant sickness in pregnancy this may bring back memories!
- Avoid heavy or fatty meals.
Fear of flying
One of the questions I have had frequently at this time of year has been about supporting the breastfeeding mother who has a fear of flying. I know this feeling myself so can empathise. I have always wanted to keep my headphones on and focus on breathing and listening to my music/relaxation most just when you are coming in to land and are told to take them off. I resort to counting backwards from a thousand.
However, diazepam as one or two low doses can be prescribed during breastfeeding. At worst the baby may temporarily be a little drowsy, but in practice this doesn’t seem to happen ( they are often too busy looking round and being social!)
Don’t forget to pack plastic bags or bowls ( just in case), wipes and cold water if the worst happens.
