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.
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.
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.
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.
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  or aad.org. Follow the Academy on Facebook (American Academy of Dermatology), Twitter (@AADskin), and YouTube (AcademyofDermatology).