Can prurigo nodularis affect pregnancy in a woman at 37?

Question

Hello doctor,

I am a 37-year-old woman struggling with severe itchy nodules on my arms and legs, which I was recently told are prurigo nodularis. The itching is so intense that it affects my sleep and daily activities.

I am worried because I also want to start planning for pregnancy soon. Still, I am not sure if this skin condition or the medicines, such as steroids or immunosuppressants, could affect my fertility or harm the baby. I also have irregular periods and wonder if a hormonal imbalance could be linked to my skin condition.

Could my nodules worsen during pregnancy or breastfeeding?
Is it safe to use topical or systemic treatments while trying to conceive or during IVF (in vitro fertilization)?
Would stress, which I feel has increased after these symptoms, worsen this condition?
Should I avoid specific contraceptive methods, like IUDs (intrauterine devices) or hormonal pills, because of immune involvement?
Are there any particular diets or lifestyle modifications that can help reduce flare-ups, especially during menstrual cycles?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

I know living with prurigo nodularis can be very challenging, not just because of the itching and skin discomfort but also the emotional impact, especially when you are thinking about pregnancy and long-term health.

Regarding fertility, the condition itself does not directly affect fertility, but some of the stronger medicines, such as oral steroids or immunosuppressants, can influence pregnancy or affect the baby. If you are planning to get pregnant, it is best to review your treatment plan with your dermatologist. Most topical creams are considered safe during pregnancy when used for short periods on small areas; however, oral or systemic medications require careful evaluation.

Irregular periods are often related to stress or hormonal changes rather than prurigo itself, though hormonal fluctuations can sometimes influence flare-ups, especially around the menstrual cycle. Pregnancy can affect prurigo differently in each person; for some, symptoms flare up, while for others, they improve due to immune changes during pregnancy. Most topical creams remain safe to use, but always double-check with your doctor.

If you are planning IVF (in vitro fertilization) or fertility treatments, make sure your fertility specialist is aware of your skin condition and medications so they can coordinate with your dermatologist to ensure everything remains safe.

When it comes to contraception, most IUDs (intrauterine devices) and hormonal methods are generally acceptable and do not worsen prurigo. If you are sensitive to hormones, non-hormonal options like the copper IUD are also suitable.

Investigations:

Review current medications and dosages.
Basic hormone profile if periods remain irregular.
Rule out other systemic causes if they have not already been checked.

Stress is a major trigger that can worsen itching and flare-ups. Light exercise, relaxation techniques, mindfulness, and short walks can help calm your system. While no specific diet cures prurigo, maintaining a balanced diet, staying hydrated, avoiding harsh soaps or hot showers, and using daily moisturizers can make a big difference. Antihistamines or short courses of medication might be needed if the itching becomes severe. Some women notice that their skin flares around their period, so tracking your cycle can help your doctor adjust treatment timing if needed.

You are taking the right approach by asking questions and planning. Working closely with both your dermatologist and gynecologist is the best way forward. If your itching is preventing sleep or becoming worse, please reach out to your doctor to review your treatment. I am happy to explain any medicine or treatment option in more detail if you need it.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.