Pregnant women can often times develop skin disorders. Some develop these skin diseases for the first time in their pregnancies and some have pre-existing skin diseases that continued into their pregnancies.

 

All these diseases need treatment with topical and oral medications.

 

 

Medications during Pregnancy

 

Medications used during pregnancies might affect the mothers and the unborn babies. The risks to the unborn babies are the most feared. Thus, medications used in pregnancies can be categorized into five categories.

 

• Category A is drug that has no risk to the unborn baby and can be used safely in pregnancy.
• Category B is drug that causes no harm in human foetus but might possess some risk to the animal foetus and can be used safely in pregnancy.
• Category C is drug that might cause some risk to the human foetus and can be used in pregnancy as the potential benefit far outweighs the risk.
• Category D is drug that is known to cause risk to the human foetus and can be used in pregnancy only if the benefit of using this drug outweighs the risk it possesses eg. in emergency of life saving situation.
• Category X is drug that is totally banned in pregnancy. This categorization of risks is based on the recommendation by the United States Food and Drug Administration (USFDA).

 

 

Topical Treatment

Topical treatment is the safest mode of treatment during pregnancy. The most commonly used topical agent in pregnancy is the moisturizer. Moisturizers are safe in pregnancy and is categorized as category B.

 

 

• Topical steroids are also safe in pregnancy. This medication is frequently used for the treatment of inflammatory skin diseases like pruritic urticarial papules and plaques of pregnancy (PUPPP), eczema and psoriasis. It is categorized as category C as there is a very small possibility of causing low birth weight baby if used in excessive amount during the third trimester of pregnancy. This excessive amount of medication is usually used in experimental setting and virtually never been used in real life setting. This excessive amount of steroid cream applied on the whole body can theoretically cause absorption into the blood stream leading to poor birth weight of the baby. In real life setting, the amount of cream applied is usually only a small amount and virtually never cause low birth weight baby. The steroid alternative medications eg pimecrolimus and tacrolimus are thought to be safe in pregnancy with a category C. However, due to lack of long term data on this medication and also the limited data on human, I would usually avoid using these medications in pregnant women.

 

• Topical antibiotic creams like clindamycin cream, fucidin cream and gentamicin cream are safe in pregnancy. These drugs are in the category B. Topical antibiotics are usually used in the treatment of infection of the skin. Pregnant mothers with skin infection can use these medications safely without hesitation as it will not cause problem with their unborn babies. Those with acne flare up during pregnancy can also use antibiotic cream like clindamycin cream safely. However, retinoids (vitamin A derivatives) creams like tretinoin cream and Adapalene cream must be used with caution in pregnant mothers with acne. This is because oral retinoids are well known to cause defects in unborn babies and categorized as category X.

 

• Topical retinoids must be used with caution during the first trimester because of this concern of birth defects. Although they are classified as category C, I usually do not advise pregnant women to use these topical creams. I would classify this medication as category X.

 

• Topical antifungals such as clotrimazole, miconazole and econazole are safe in pregnancy. They are in category B. They can be safely used in the treatment of fungal infection such as ringworm infection. Scabies treatment using permethrin is also very safe in pregnancy. It is categorized as category B. However, benzylbenzoate is not recommended.

 

Treatment of psoriasis with vitamin D analogues eg. Calcipotriol ointment and cream is safe in pregnancy with a category C. It is categorized as C because the possible bone defects found in animal studies but not in human babies. Topical calcipotriol in combination with steroids are commonly used in the treatment of psoriasis. Use of tar in pregnancy is also safe with a category C.

 

So, in summary topical creams are fairly safe in pregnancy. Most creams are in the category B and C. Thus, mothers with skin problem in pregnancy can use topical treatment without much fear of their potential side effects to their unborn babies.

 

 

Oral Medication

 

Oral medications are also sometimes prescribed to pregnant women with skin conditions. Most pregnant mothers with skin diseases usually shun away from taking oral medications in the fear that these medications will cause birth defects in their babies. This fear is founded as some of the oral medications are in the category D and X.

 

The most commonly prescribed oral medications in pregnancy for skin diseases are antihistamines. Antihistamines are used for the control of itch. Antihistamines are categorised as category B. Although all antihistamines are grouped as category B. I will always recommend the older generation antihistamines such as chlorpheniramine. This is because I feel more comfortable as these medications have been used for a very long time without any birth defects. I will be more reluctant to prescribe the newer antihistamines such as desloratadine because of the lack of long term data. The good side of these newer medications are that they are non sedative and thus pregnant mothers do not feel drowsy after taking them.

 

Oral antibiotics including the penicillin group such as amoxycyillin, cephalosporine group such as cephalexin and macrolide group such as erythromycin are safe in pregnancy with category B. These medications are usually used for the treatment of skin infections including acne vulgaris.

 

One common drug used for the treatment of acne, doxycycline cannot be used in pregnancy. It is in category D. This medication causes teeth staining and gum defect in unborn babies. It can also cause liver problem in pregnant mothers. Thus, doxycycline and medications related to these medications including minocycline and tetracycline are prohibited in pregnancy. Similarly, oral retinoids such as isotretinoin used to treat acne is contraindicated in pregnancy. This medication is in category X. It causes ear defects, cleft palate, heart and brain defects in unborn babies.

 

Corticosteroids, used in the treatment of inflammatory skin diseases are in the category C as described above in the topical section. This medication is sometimes prescribed for a short period of time in mothers with severe skin inflammation including eczema and PUPPP.

 

Thus, oral anti-itch medications, most antibiotics and corticosteroids are relatively safe in pregnancy. Pregnant mothers given this medication should not worry too much regarding their safety for the unborn babies. However, it is advisable that pregnant mothers consult their doctors first before taking oral medications. Buying these oral medications over the counter without proper consultation with the attending doctor might spell trouble.

 

In summary, topical medications and some oral medications are safe in pregnancy and can be consumed by pregnant mothers without much side effects. However, these medications must be used after a thorough consultation with the medical doctor. All medications including creams should not be used by pregnant mothers without the doctors’ prescription.