By Gary M. White, MD
Mild to moderate potency topical steroids may be used. Light therapy is safe during pregnancy.
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.
Because there are no studies on safety in human pregnancies, when no alternatives exist, topical use on small surfaces is permissible.
Coal Tar should be avoided because of animal data at high doses.
Small use topically is permissible. Widespread use in animals has caused hypervitaminosis D.
Not safe in pregnancy.
Best avoided in pregnancy unless the situation is critical.
Best to avoid in pregnancy. But there is some disagreement here. See JAAD 2014;71;831 for a discussion.
Light therapy is safe 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].
Best to avoid in pregnancy, but no good conclusive studies.
Fine in pregnancy. BP is metabolized to benzoic acid, a food additive.
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.
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.
Compatible with pregnancy.
Some issues so best to avoid.
Contraindicated after 15 weeks. Inadvertent first-trimester exposure is common and has not been associated with congenital malformations.
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.
Permethrin, topical sulfur, benzyl benzoate, and crotamiton are all considered safe during pregnancy. Oral ivermectin should be avoided.
Lindane is potentially neurotoxic and should not be used. Occlusive therapy with coconut oil or moisturizer is considered to be a first-line therapy.
Prednisone may cause birth defects early in the pregnancy. It may cause pregnancy issues/complications late in the pregnancy.
Safe in pregnancy and beneficial if mom has lupus.
Not contraindicated, but may cause anemia in mom and baby.
There is limited human data. Certainly avoid use after 30 weeks due to the risk of premature closure of the ductus arteriosus.
Safe in pregnancy.
Safe in small amounts.
Avoid in pregnancy.
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.
Safe in pregnancy and should be used if needed. Also valacyclovir and famciclovir appear safe.
J Am Acad Dermatol 2014;70:401.e1-14. J Drugs Dermatol 2016;15;830
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