From the Guidelines
For a 20-week pregnant patient with a rash or skin condition, the safest treatment options include topical emollients and low to medium potency topical corticosteroids, such as hydrocortisone 1% or triamcinolone 0.1%, as they have established safety profiles during pregnancy 1. When considering treatment options, it is essential to prioritize maternal symptom relief while minimizing potential risks to the developing fetus.
- Topical emollients are considered safe during pregnancy and lactation, with a small risk of contact dermatitis 1.
- Topical corticosteroids, such as hydrocortisone 1% or triamcinolone 0.1%, can be used for the treatment of moderate to severe psoriasis, with the combination of salicylic acid and topical corticosteroids being a viable option for patients with a body surface area (BSA) of involvement ≤20% 1.
- Salicylic acid appears to be a safe choice for the control of localized psoriasis in pregnancy, but it should not be combined with other salicylate drugs, and systemic absorption can occur when applied to more than 20% of BSA or in patients with abnormal hepatic or renal function 1. Some treatment options, such as anthralin, are categorized as pregnancy category C, and their use should be approached with caution 1. The recommended treatment approach should prioritize the use of topical emollients and low to medium potency topical corticosteroids, with careful consideration of the potential risks and benefits of other treatment options, such as salicylic acid and anthralin, under the guidance of a dermatologist and obstetrician 1.
From the Research
Treatment Options for a 20-Week Pregnant Patient with a Rash or Skin Condition
The safest treatment options for a 20-week pregnant patient with a rash or skin condition include:
- Topical corticosteroids, which are the most frequently prescribed dermatological treatment and have been found to be safe for use during pregnancy 2
- Mild to moderate potency topical corticosteroids, which have been associated with a decreased risk of fetal death 2
- Systemic corticosteroids, which can be used to control clinically active maternal illness, but may be associated with an increased risk of premature rupture of amniotic membranes and low birthweight babies 3
Considerations for Corticosteroid Use During Pregnancy
When considering corticosteroid use during pregnancy, the following factors should be taken into account:
- The potency of the corticosteroid, with mild to moderate potency topical corticosteroids being preferred over potent or very potent topical corticosteroids 2
- The route of administration, with topical and inhaled corticosteroids being associated with lower systemic exposure than systemic corticosteroids 4
- The duration of use, with long-term corticosteroid use being associated with increased maternal and fetal adverse outcomes 5
Potential Risks and Benefits of Corticosteroid Use During Pregnancy
The potential risks and benefits of corticosteroid use during pregnancy include:
- Benefits: control of clinically active maternal illness, treatment of fetal conditions such as neonatal lupus-associated carditis, and induction of fetal lung maturation 3, 6
- Risks: premature rupture of amniotic membranes, low birthweight babies, preeclampsia, preterm premature rupture of membranes, pyelonephritis, and venous thromboembolisms 3, 5