Dermatoses in pregnancy provide a challenge to dermatologists when it comes to recommending treatments that are effective yet safe to the fetus. There are several dermatoses that are specific to pregnancy and current literature lacks in evidence-based studies concerning appropriate therapies.

At the American Academy of Dermatology 74th Annual Meeting, a scientific session was held to to present viable and safe treatment options for common dermatologic diagnoses, and to evaluate and manage melanocytic lesions in pregnant patients.

Session leaders presented that mild or moderate topical corticosteroids are appropriate for pregnant women with eczema. More potent formulations should only be used for a short duration if initial therapy is unsuccessful. Jenny Eileen Murase, MD, FAAD, University of California, recommended that pregnant patients dilute topical corticosteroids with a moisturizer, which can reduce the amount of medication used and help with healing.

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The panel cautioned that pregnant women should avoid biologics and other systemic medications to treat psoriasis. Instead, psoriasis patients may use topical treatments like moisturizers, emollients, and low- to moderate-dose corticosteroids to manage their condition. If additional treatment is required, phototherapy with narrowband ultraviolet B was considered best for pregnant and nursing women. However, psoralen with ultraviolet A (PUVA) treatment is to be avoided, as psoralen may pass through breastmilk and lead to light sensitivity in babies. For patients who discontinued or changed their treatment regimen during pregnancy, they are recommended to resume their pre-pregnancy regimen as son as possible after giving birth. 

For pregnant women diagnosed with acne, topical benzoyl peroxide is a safe and accessible treatment option; it may also be used in combination with clindamycin, a topical antibiotic. A combination of antibiotics with topical therapy could be considered for moderate to severe acne cases, though treatment should be limited to a shorter time as overuse can contribute to bacterial resistance in patients.

Antibiotics from the cephalosporin class are recommended for treating acne while erythromycin and azithromycin also may be suitable. Tetracycline antibiotics should be avoided in pregnant women.

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