Acitretin is absolutely contraindicated in pregnancy due to its association with major birth defects. To prevent inadvertent exposure, its use should be avoided in women of child-bearing age. Additionally, pregnancy is contraindicated for no less than 3 years after discontinuing acitretin. Their topical counterparts (e.g., tazarotene) are also contraindicated in pregnancy.

Our patient was advised to discontinue methotrexate at a minimum of 3 months before attempting to conceive a child. The patient was also informed of the potential risks of continuing adalimumab during pregnancy. She ultimately discontinued adalimumab before becoming pregnant and opted to use mid-potency topical steroids concurrently with narrowband UVB phototherapy for maintenance therapy.