How would you manage active severe psoriasis in a patient planning pregnancy, who also has psoriatic arthritis with well-controlled joint symptoms on certolizumab pegol (anti-TNF therapy)?

If the psoriasis was sufficiently limited in area that topicals were a practical solution, I'd first try to assure that the prescribed topical steroids were being used well. Poor adherence is a common issue with topical treatment.

Phototherapy might be my next choice.

I feel comfortable prescribing ...

I agree with Dr. @Dr. First Last - but while we may be overall comfortable (based on post-approval registry data) that we aren't seeing any major issues with newer biologics, the developing fetus will be exposed to some level of drug as opposed to certolizumab. There have been at least several dozen...