From the Guidelines
The primary treatment for atopic eruption of pregnancy should focus on topical corticosteroids as the mainstay of treatment, with an emphasis on using the least potent preparation required to keep the eczema under control, as recommended by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1. When managing atopic eruption of pregnancy, it's crucial to balance the need for effective symptom relief with the safety of both the mother and the fetus. Key considerations include:
- The use of topical corticosteroids, which are considered safe for use during pregnancy, with the goal of using the lowest potency necessary to control symptoms, as outlined in the management of atopic eczema workshop 1.
- Regular application of emollients and moisturizers to maintain skin hydration and support the skin barrier.
- For mild to moderate cases, the application of mild topical corticosteroids such as hydrocortisone 1% to affected areas, typically for short periods.
- Avoiding triggers that can exacerbate symptoms, including harsh soaps, hot showers, and known allergens.
- Considering oral antihistamines for itching, with a preference for non-sedating options to minimize risks to the fetus. Given the potential for undertreatment due to fears about steroid use, it is essential to educate patients on the benefits and risks of topical corticosteroids, as well as the importance of adherence to the recommended treatment plan 1. This approach aims to effectively manage symptoms of atopic eruption of pregnancy while prioritizing the safety and well-being of both mother and fetus.
From the Research
Treatment Options for Atopic Eruption of Pregnancy
- Emollients are the basis of therapy for atopic eruption of pregnancy 2
- Topical corticosteroids and calcineurin inhibitors are safe treatment options 2
- Ultraviolet therapy can be added if required 2
- Cyclosporin A is possible for systemic therapy during pregnancy, but safety data on new drugs such as biologics approved for atopic dermatitis are limited to small case series 2
Safety of Topical Corticosteroids in Pregnancy
- Mild to moderate potency topical corticosteroids are preferred over potent/very potent ones due to the associated risk of fetal growth restriction with the latter 3
- 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 4
- However, there may be a probable association between low birth weight and maternal use of potent to very potent topical corticosteroids, especially when the cumulative dosage is very large 4
- Maternal use of mild to moderate potency topical steroids may be associated with a decreased risk of fetal death 4
Management of Atopic Dermatitis in Pregnancy
- The management of concomitant bacterial and viral infections is also important in the treatment of atopic dermatitis in pregnancy 5
- Clinical practice suggests a tendency toward undertreatment in pregnant women due to concerns about potential effects on obstetric and fetal outcomes, but pregnant women should be offered adequate and safe treatments, preferably on an individual basis 6