PTP -- mother with severe psoriasis that has been previously successfully treated with Enbrel.  Baby is 7 1/2 weeks old, EBF.  Mother's psoriasis is exacerbated after the delivery of the baby.  Enbrel is listed by Hale as an L2, no oral bioavailability, molecular weight is 150,000.  The InfantRisk Center states the medication is safe for breastfeeding.

This mother's dermatologist refuses to prescribe the medication, refuses to look at the information in Hale's book.  He said to let him know when she has "breastfeeding under control."  Mom was very upset with this dermatologist.  The mother called all other dermatologists in the area, and I spoke with a friend of mine that is a dermatology physician assistant... they all say the same thing.  They will not prescribe this drug due to the FDA recommendation that "safety is unknown."  She is currently using UVB therapy without success.  Her family practice doctor and her pediatrician both feel that Enbrel would be safe for her to take during breastfeeding, but do not feel comfortable prescribing a "dermatology" drug.

Looking at the archives, suggestions include coconut oil, wheat/gluten elimination, Vitamin D supplementation to help this mother.

This mother has a lovely breastfeeding relationship and does not want to discontinue.  Are there any other suggestions for this mom so she can continue breastfeeding and get relief from her psoriasis?  As it stands now, we have exhausted her medical options for prescribing the only drug that has helped her in the past.  Thanks.

Trish Wierenga, BSN, RN, IBCLC

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