MEDICATIONS IN PREGNANCY

By Gary M. White, MD


Psoriasis in Pregnancy

Mild to moderate potency topical steroids may be used. Light therapy is safe during pregnancy.

Topical Corticosteroids

There is no evidence of malformations associated with use of topical steroids. The use of steroids with mild to moderate potency is preferred with short courses of potent topical steroids if needed. In one large study, there was no association of maternal topical corticosteroid exposure with orofacial cleft, preterm delivery, fetal death, low Apgar score, or mode of delivery. The main issue that remains is that the risk of low birth weight seems to correlate with the quantity of topical corticosteroid exposure [JAMA Dermatol. 2013;149(11):1274-1280]. Specifically, there was a significantly increased risk of low birth weight when the dispensed amount of potent or very potent topical corticosteroids exceeded 300 g during the entire pregnancy.

Another review of the best evidence by the European Dermatology Forum [JEADV 2017;31;760] found no association between the use of topical steroids of any potency and the following adverse pregnancy outcomes: mode of delivery, birth defects, preterm delivery and fetal death. However they did find the use of potent/very potent topical steroids, especially in large amounts, associated with an increase risk of low birthweight.

Topical Calcineurin inhibitors

Because there are no studies on safety in human pregnancies, when no alternatives exist, topical use on small surfaces is permissible.

Coal Tar

Coal Tar should be avoided because of animal data at high doses.

Calcipotriene

Small use topically is permissible. Widespread use in animals has caused hypervitaminosis D.

Methotrexate

Not safe in pregnancy.

Cyclosporine

Best avoided in pregnancy unless the situation is critical.

TNF Agents

Best to avoid in pregnancy. But there is some disagreement here. See JAAD 2014;71;831 for a discussion.

UVB

Light therapy is safe in pregnancy.

Acne in Pregnancy

Benzoyl peroxide, erythromycin, clindamycin and Blue light are all appropriate in pregnancy. Azeleic acid is pregnancy category B. Oral agents that may be considered include erythromycin, azithromycin, and cephalexin [Drugs. 2013 Jun;73(8):779-87].

Topical Retinoids

Best to avoid in pregnancy, but no good conclusive studies.

Benzoyl Peroxide

Fine in pregnancy. BP is metabolized to benzoic acid, a food additive.

Penicillin Antibiotics

Safety data support the use of amoxicillin for severe acne rosacea and cefadroxil for severe acne vulgaris. Cefadroxil (Duracef) for skin infection is 1 gram Qday or 500 mg BID.

Erythromycin

Most data show safe in pregnancy. One study showed a low incidence of cardiac defects. Still preponderance of data okay. Also azithromycin and clarithromycin okay in pregnancy.

Clindamycin

Compatible with pregnancy.

Sulfa

Some issues so best to avoid.

Tetracyclines

Contraindicated after 15 weeks. Inadvertent first-trimester exposure is common and has not been associated with congenital malformations.

Warts in pregnancy

Cryotherapy is safe and should be first line therapy. TCA is okay as well. There is no data showing teratogenicity for imiquimod. Podophyllin should be avoided due to data showing potential malformation.

Scabies in Pregnancy

Permethrin, topical sulfur, benzyl benzoate, and crotamiton are all considered safe during pregnancy. Oral ivermectin should be avoided.

Lice in Pregnancy

Lindane is potentially neurotoxic and should not be used. Occlusive therapy with coconut oil or moisturizer is considered to be a first-line therapy.

Miscellaneous

Prednisone

Prednisone may cause birth defects early in the pregnancy. It may cause pregnancy issues/complications late in the pregnancy.

Hydroxychloroquine

Safe in pregnancy and beneficial if mom has lupus.

Dapsone

Not contraindicated, but may cause anemia in mom and baby.

Diclofenac

There is limited human data. Certainly avoid use after 30 weeks due to the risk of premature closure of the ductus arteriosus.

IVIG

Safe in pregnancy.

Lidocaine and epinephrine

Safe in small amounts.

Minoxidil

Avoid in pregnancy.

Antihistamines

As a general rule, antihistamines at moderate doses are appropriate in pregnancy. There is more safety data on first generation than second generation antihistamines. Loratidine remains the first choice and cetirizine the second choice among second-generation antihistamines.

Acyclovir

Safe in pregnancy and should be used if needed. Also valacyclovir and famciclovir appear safe.

References

J Am Acad Dermatol 2014;70:401.e1-14. J Drugs Dermatol 2016;15;830

RegionalDerm

Homepage | FAQs | Use of Images | Contact Dr. White


It is not the intention of RegionalDerm.com to provide specific medical advice, diagnosis or treatment. RegionalDerm.com only intends to provide users with information regarding various medical conditions for educational purposes and will not provide specific medical advice. Information on RegionalDerm.com is not intended as a substitute for seeking medical treatment and you should always seek the advice of a qualified healthcare provider for diagnosis and for answers to your individual questions. Information contained on RegionalDerm.com should never cause you to disregard professional medical advice or delay seeking treatment. If you live in the United States and believe you are having a medical emergency call 911 immediately.