From the Guidelines
The treatment for atopic eruption of pregnancy should focus on symptom relief while ensuring safety for both mother and fetus, with first-line therapy including liberal use of emollients and moisturizers, and mild to moderate topical corticosteroids such as hydrocortisone 1% or triamcinolone 0.1%. However, the provided evidence primarily discusses pemphigus vulgaris in pregnancy, not atopic eruption of pregnancy. Despite this, the general principle of using corticosteroids for skin conditions in pregnancy can be applied, as seen in the guidelines for pemphigus vulgaris 1.
Key Considerations
- The use of oral corticosteroids, such as prednisolone, is common in pregnancy for various dermatological conditions, with evidence suggesting no significant increased risk of stillbirth, preterm delivery, or congenital malformations 1.
- For atopic eruption of pregnancy, the goal is to control symptoms while minimizing risks to the fetus, which aligns with the approach for managing pemphigus in pregnancy, where prednisolone alone is often used 1.
- Given the lack of direct evidence on atopic eruption of pregnancy in the provided studies, the approach should be cautious, focusing on the least invasive and safest treatments first, such as topical corticosteroids and emollients.
Treatment Approach
- First-line therapy should include liberal use of emollients and moisturizers to maintain skin hydration and repair the skin barrier.
- Mild to moderate topical corticosteroids can be applied to affected areas twice daily for 1-2 weeks to reduce inflammation and itching.
- Oral antihistamines may be considered for pruritus control, with options like cetirizine or diphenhydramine, the latter being useful at night due to its sedating effects.
- For severe cases, a short course of oral prednisone may be considered in the second or third trimester, under close medical supervision, given its use in other pregnancy-related dermatological conditions 1.
Monitoring and Follow-Up
Regular follow-up is crucial to monitor treatment response and adjust therapy as needed throughout pregnancy, ensuring both the mother's and fetus's safety and well-being.
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 also 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 generally considered safe during pregnancy 3, 4, 5
- Extensive use of high-potency corticosteroids may be associated with low birth weight 4, 5
- There is no causal association 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 5
- 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 of topical corticosteroids throughout the pregnancy is very large 5
Considerations for Treatment
- Pregnant women should be offered adequate and safe treatments, preferably on an individual basis 6
- Discussion of potential risks and benefits is important 4
- Clinical practice suggests a tendency toward undertreatment in pregnant women due to concerns about potential effects on obstetric and fetal outcomes 6