Medication for moms-to-be: Managing skin conditions in pregnancy

AMERICAN ACADEMY OF DERMATOLOGY EXPERT

Information provided by Jenny Eileen Murase, MD, FAAD, assistant clinical professor of dermatology, University of California, San Francisco.

ECZEMA When women become pregnant, Dr. Murase says, they experience an immune system shift that may trigger atopic dermatitis, or eczema, in patients who have previously experienced the condition. "Atopic dermatitis is the most common rash dermatologists see in pregnancy," she says. "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, Dr. Murase says. Mild or moderate topical corticosteroids are preferred to more potent formulations, which should only be used for a short period of time if the initial treatment is unsuccessful. Dr. Murase recommends that her pregnant patients dilute topical corticosteroids with a moisturizer, which can contribute to healing while reducing the amount of medication used.

PSORIASIS

According to Dr. Murase, 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," she says.

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 their condition. Breastfeeding mothers should be cautious in applying high-potency topical corticosteroids to the nipple area in order to avoid passing the medication on to their baby.

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

If psoriasis patients discontinue or change their treatment regimen during pregnancy, Dr. Murase recommends that they restart their pre-pregnancy 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 U.S. Food and Drug Administration's new labeling requirements, she advises these patients to 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, Dr. Murase says, and it may be used in combination with the topical antibiotic clindamyacin.

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

AMERICAN ACADEMY OF DERMATOLOGY EXPERT ADVICE

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