Dermatologists can provide pregnant patients with safe, effective treatments for eczema, psoriasis, and acne.

By Jenny Eileen Murase, MD, FAAD
Assistant Clinical Professor of Dermatology
University of California, San Francisco

Expectant mothers take many steps to maintain their good health and pro­mote the health of their babies. A pregnant wom­an with chronic skin conditions may fear that treating these conditions could compromise her baby’s health, but a board-certified dermatolo­gist can develop safe and effective treatment plans for such patients.

Eczema

When women become pregnant, they experience an immune system shift that may trigger atopic dermatitis, or eczema, in those who have previous­ly experienced the condition. Atopic dermatitis is the most common rash that dermatologists see in pregnan­cy; expectant mothers often see their existing eczema get worse or have a flare for the first time in many years.

Topical corticosteroids are an ap­propriate treatment option for preg­nant women with eczema. Mild or moderate topical corticosteroids are preferred over more-potent formula­tions, which should be used only for a short period of time if the initial treatment is unsuccessful. Pregnant patients should dilute topical corti­costeroids with a moisturizer, which can contribute to healing while reduc­ing the amount of medication used.

Psoriasis

The same immune system shift that leads to eczema flares in preg­nant patients can sometimes result in the clearing of psoriasis—often to the point where no treatment is required to manage the condition. About half of pregnant women experience a dramatic improve­ment that may allow them to tem­porarily discontinue treatment.

Unless there is a clear medical need, pregnant women should avoid biologics and other systemic medi­cations for psoriasis. These patients may use topical treatments like mois­turizers, emollients, and low- to mod­erate-dose corticosteroids to manage the condition. To avoid passing the medication on to her baby, a breast­feeding mother should be cautious when applying high-potency topical corticosteroids to the nipple area.

If additional treatment is neces­sary, phototherapy may be used. Nar­rowband ultraviolet B therapy is the best option for pregnant and nurs­ing women; broadband ultraviolet B therapy may also be considered. Pso­ralen with ultraviolet A (PUVA) treat­ment should be avoided, as psoralen, the parent compound in a family of natural products known as furocou­marins, may enter breastmilk and lead to light sensitivity in babies.

If psoriasis patients discontinue or change their treatment regimen during pregnancy, they should re­start their prepregnancy regimen as soon as possible after giving birth, as their condition may flare once the pregnancy is over. While many med­ications are safe for breastfeeding mothers, as outlined in the US Food and Drug Administration’s new la­beling requirements, these patients should consult their doctor before stopping or starting any treatments.

Acne

There are a variety of treatment op­tions available for acne, and several are suitable for pregnant patients. Topical benzoyl peroxide is a good option for these women, as it is both safe and widely available, and it may be used in combination with the topical antibiotic clindamycin.

Moderate to severe acne cases may be treated with antibiotics in conjunc­tion with topical therapy, but antibi­otics should be used for only a lim­ited period of time, as overuse could contribute to bacterial resistance. The best antibiotic options for expectant mothers are those in the cephalospo­rin family, whereas erythromycin and azithromycin also may be acceptable for these patients. Pregnant women should avoid tetracycline antibiotics.

Take-Home Message

Ultimately, if there is a way to man­age a skin condition without med­ication during pregnancy, that is the preferred option. If you have a condition that does require med­ication, however, a board-certi­fied dermatologist can help you identify a treatment that is safe for both you and your baby.

Headquartered in Schaumburg, Illinois, the American Academy of Dermatology (AAD), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 18,000 physi­cians worldwide, the AAD is committed to advancing the diagnosis and medical, sur­gical, and cosmetic treatment of the skin, hair, and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and en­hancing patient care for a lifetime of health­ier skin, hair, and nails. For more informa­tion contact the AAD at 888-462-DERM [3376] or aad.org. Follow the Academy on Facebook (American Academy of Derma­tology), Twitter (@AADskin), and You­Tube (AcademyofDermatology).

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