From the Guidelines
Rosacea in pregnant women can be safely managed with topical metronidazole or azelaic acid, prioritizing gentle skincare and trigger avoidance to minimize risks to the fetus. The treatment approach should focus on reducing inflammation and redness while ensuring the safety of both the mother and the fetus.
Key Considerations
- Topical metronidazole (0.75-1% cream applied once or twice daily) is considered safe during pregnancy and has been shown to be effective in reducing inflammatory lesions and perilesional erythema associated with rosacea 1.
- Topical azelaic acid (15-20% cream or gel applied twice daily) is also considered safe and can reduce inflammation and redness, with studies demonstrating its efficacy in improving rosacea symptoms 1.
- Oral medications like tetracyclines (doxycycline, minocycline) should be avoided due to potential effects on fetal bone and tooth development, and isotretinoin is contraindicated due to the risk of severe birth defects.
- A phenotype-led treatment algorithm, as suggested by the global rosacea consensus panel, can guide treatment decisions based on the specific features and severity of rosacea 1.
Treatment Approach
- First-line treatment should include gentle skincare practices such as using mild cleansers, broad-spectrum sunscreen, and avoiding triggers like spicy foods, alcohol, and extreme temperatures.
- Topical treatments like metronidazole or azelaic acid can be used to reduce inflammation and redness.
- Regular consultation with both a dermatologist and an obstetrician is crucial to monitor the condition and ensure treatment safety throughout pregnancy.
- Physical treatments like gentle laser therapy may be postponed until after pregnancy to minimize potential risks.
From the Research
Rosacea in Pregnant Women
- Rosacea fulminans (RF) is a rare dermatological condition that occurs exclusively in women, characterized by a sudden onset of painful papules, pustules, cysts, and nodules on the face 2.
- RF can occur during pregnancy, and its treatment poses a significant challenge due to limited evidence regarding potential adverse fetal effects of many rosacea treatments 3.
- Hormonal factors may be a trigger for RF, especially when it occurs during pregnancy or in women taking oral contraceptive pills 4.
Treatment Options
- Topical metronidazole has been used to treat RF during pregnancy, either alone or in combination with other therapies 3, 4.
- Azithromycin is considered a safe oral rosacea therapy for pregnant patients and has been used to treat RF 3.
- Permethrin cream (5%) has been suggested as a potential treatment for rosacea in pregnant women, although more research is needed to confirm its efficacy and safety 2.
- Systemic corticosteroids have been used to treat RF during pregnancy, but their use should be carefully considered due to potential side effects 4.
Challenges and Future Directions
- There is a need for further studies to determine the efficacy and safety of various rosacea treatments during pregnancy 3, 5, 6.
- The majority of studies on rosacea treatments are at high or unclear risk of bias, highlighting the need for well-designed, adequately-powered randomized controlled trials 5, 6.