From the Guidelines
Low to medium potency topical corticosteroids, such as hydrocortisone 1-2.5%, desonide 0.05%, triamcinolone 0.1%, and mometasone furoate 0.1%, are recommended for treating atopic dermatitis during pregnancy. These medications should be used at the lowest effective dose for the shortest duration necessary to control symptoms, typically applying a thin layer to affected areas once or twice daily for 1-2 weeks 1. For mild cases, start with hydrocortisone; for moderate cases, consider desonide or triamcinolone; and for more severe or persistent cases, mometasone may be appropriate.
Key Considerations
- The use of topical corticosteroids during pregnancy is generally considered safe, with minimal systemic absorption when used appropriately 1.
- High-potency steroids like clobetasol should generally be avoided during pregnancy unless specifically directed by a healthcare provider.
- Moisturizing regularly with emollients and avoiding known triggers are important complementary measures to reduce the need for topical steroids.
- If atopic dermatitis symptoms worsen or don't improve after 1-2 weeks of treatment, consult with a healthcare provider for further evaluation.
Safety and Efficacy
The safety and efficacy of topical corticosteroids during pregnancy have been established in several studies, including a study published in the European Respiratory Journal in 2020 1. This study found that low to medium potency topical corticosteroids, such as hydrocortisone and triamcinolone, have minimal systemic absorption and are not associated with an increased risk of major malformations or premature birth.
Treatment Approach
The treatment approach for atopic dermatitis during pregnancy should prioritize the use of low to medium potency topical corticosteroids, with the goal of minimizing systemic absorption and reducing the risk of adverse effects. By using the lowest effective dose for the shortest duration necessary, healthcare providers can help patients manage their symptoms while minimizing potential risks.
From the FDA Drug Label
Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids. Therefore, topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Drugs of this class should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time
The recommended topical corticosteroids for atopic dermatitis in pregnancy are not explicitly stated in the provided drug labels. No conclusion can be drawn regarding the specific recommended topical corticosteroids for atopic dermatitis in pregnancy due to the lack of direct information in the drug labels 2 3.
From the Research
Recommended Topical Corticosteroids for Atopic Dermatitis in Pregnancy
- The current best evidence suggests that mild/moderate topical corticosteroids are preferred to potent/very potent ones in pregnancy, because of the associated risk of fetal growth restriction with the latter 4, 5.
- Maternal use of potent/very potent topical corticosteroids, especially in large amounts, is associated with an increase in the risk of low birthweight 4, 5, 6.
- Most studies found no causal associations between maternal exposure to topical corticosteroids of any potency and pregnancy outcomes, including mode of delivery, congenital abnormalities, preterm delivery, fetal death, and low Apgar score 6.
- The well-known topical side-effects of corticosteroids on the mother's side need to be considered as well 5.
Key Considerations
- The management of atopic dermatitis in pregnancy requires special precautions to avoid harming the fetus 7.
- Topical corticosteroids are the most frequently prescribed dermatological treatment and are often used by pregnant women with skin conditions 6.
- The presentation and histopathology of atopic dermatitis during pregnancy is identical to that of the non-pregnant individual 7.