CLINICAL OBSTETRICS AND GYNECOLOGY Volume 58, Number 1, 112–118 Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
Dermatologic Therapy in Pregnancy KELLY H. TYLER, MD, FACOG The Ohio State University, Division of Dermatology, Columbus, Ohio Abstract: Patients present during pregnancy with a variety of dermatologic conditions, most of which can be treated conservatively with topical medication by a primary obstetrician if he or she is familiar with common treatment options. Patients with moderate to severe forms of dermatologic disease or those requiring systemic therapy should be treated in consultation with a dermatologist. Dermatologic surgery can be performed safely in the second trimester using local anesthesia if needed. Key words: pregnancy, dermatologic therapy, systemic medications, topical medications, dermatologic surgery, medication safety
Drug Classification for Pregnancy All obstetricians should be familiar with the Food and Drug Administration (FDA) Pregnancy and Lactation Categories, which were developed after birth defects in the mid-20th century were related to the maternal use of diethylstilbestrol and thalidomide.1 Before it is released, each drug is assigned 1 of 5 categories, which are outlined in Table 1.2 Despite the fact that this is the most commonly used classification system, many of the ratings are based on limited animal data and case reports, and updates of the ratings are often slow.3 Therefore, cross-referencing with other medication safety resources such as Reproductive Toxicology Service (http:// www.reprotox.org), US Pharmacopeial Dispensing Information,4 and Drugs in Pregnancy and Lacatation by Briggs et al5 may be the best method for confirming the most up-to-date information on drug safety in pregnancy.
Introduction Pregnant women often present during routine prenatal visits with a variety of new or pre-existing skin complaints. Although some patients may eventually require management in consultation with a dermatologist, the primary obstetrician can treat most patients safely and effectively if he or she has a working knowledge of treatment options for common dermatologic conditions. The goal of this review is to ensure that obstetricians are comfortable prescribing basic dermatologic therapies to their pregnant patients and understand when consultation with a dermatologist may be warranted.
Dermatologic Medications During Pregnancy For dermatologic conditions in pregnancy, topical therapies are generally first line, as they are minimally absorbed and have the least potential to affect the fetus.
Correspondence: Kelly H. Tyler, MD, FACOG, 540 Officenter Place, Suite 240, Gahanna, OH. E-mail: [email protected] The authors declare that they have nothing to disclose. CLINICAL OBSTETRICS AND GYNECOLOGY
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Dermatologic Therapy in Pregnancy TABLE 1.
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US Food and Drug Administration Pregnancy Risk Categories
Category Description
A B C D X
Controlled studies show no fetal risk No risk to human fetus despite possible animal risk; or no risk in animal studies and human studies not performed Risk cannot be ruled out; human studies have not been performed; animal studies may or may not show risk; potential benefits may justify potential risk Positive evidence of risk to human fetus, but benefits may outweigh risks of drug Contraindicated in pregnancy
Outlined below are the most common dermatologic conditions and recommended treatment options for pregnant patients based on current FDA drug classifications. Table 2 summarizes the dermatologic medications and pregnancy safety classifications for each condition. ACNA AND ROSACEA
Even though sebaceous gland activity increases late in pregnancy, there is not a predictable worsening of acne in all patients, and acne is generally considered to be unaffected.3,6 There are a plethora of topical medications that are excellent choices for pregnant patients with acne, although the safe choices for systemic medications are more limited. Many topical nonantibiotic antiacne products are available and can be used safely during pregnancy. Benzoyl peroxide is category C because human studies have not been conducted, but it is safe and considered a treatment of choice for acne in pregnancy.3,7,8 Azeleic acid is category B, and
Dermatologic Therapy in Pregnancy KELLY H. TYLER, MD, FACOG The Ohio State University, Division of Dermatology, Columbus, Ohio Abstract: Patients present during pregnancy with a variety of dermatologic conditions, most of which can be treated conservatively with topical medication by a primary obstetrician if he or she is familiar with common treatment options. Patients with moderate to severe forms of dermatologic disease or those requiring systemic therapy should be treated in consultation with a dermatologist. Dermatologic surgery can be performed safely in the second trimester using local anesthesia if needed. Key words: pregnancy, dermatologic therapy, systemic medications, topical medications, dermatologic surgery, medication safety
Drug Classification for Pregnancy All obstetricians should be familiar with the Food and Drug Administration (FDA) Pregnancy and Lactation Categories, which were developed after birth defects in the mid-20th century were related to the maternal use of diethylstilbestrol and thalidomide.1 Before it is released, each drug is assigned 1 of 5 categories, which are outlined in Table 1.2 Despite the fact that this is the most commonly used classification system, many of the ratings are based on limited animal data and case reports, and updates of the ratings are often slow.3 Therefore, cross-referencing with other medication safety resources such as Reproductive Toxicology Service (http:// www.reprotox.org), US Pharmacopeial Dispensing Information,4 and Drugs in Pregnancy and Lacatation by Briggs et al5 may be the best method for confirming the most up-to-date information on drug safety in pregnancy.
Introduction Pregnant women often present during routine prenatal visits with a variety of new or pre-existing skin complaints. Although some patients may eventually require management in consultation with a dermatologist, the primary obstetrician can treat most patients safely and effectively if he or she has a working knowledge of treatment options for common dermatologic conditions. The goal of this review is to ensure that obstetricians are comfortable prescribing basic dermatologic therapies to their pregnant patients and understand when consultation with a dermatologist may be warranted.
Dermatologic Medications During Pregnancy For dermatologic conditions in pregnancy, topical therapies are generally first line, as they are minimally absorbed and have the least potential to affect the fetus.
Correspondence: Kelly H. Tyler, MD, FACOG, 540 Officenter Place, Suite 240, Gahanna, OH. E-mail: [email protected] The authors declare that they have nothing to disclose. CLINICAL OBSTETRICS AND GYNECOLOGY
112 | www.clinicalobgyn.com
/
VOLUME 58
/
NUMBER 1
/
MARCH 2015
Dermatologic Therapy in Pregnancy TABLE 1.
113
US Food and Drug Administration Pregnancy Risk Categories
Category Description
A B C D X
Controlled studies show no fetal risk No risk to human fetus despite possible animal risk; or no risk in animal studies and human studies not performed Risk cannot be ruled out; human studies have not been performed; animal studies may or may not show risk; potential benefits may justify potential risk Positive evidence of risk to human fetus, but benefits may outweigh risks of drug Contraindicated in pregnancy
Outlined below are the most common dermatologic conditions and recommended treatment options for pregnant patients based on current FDA drug classifications. Table 2 summarizes the dermatologic medications and pregnancy safety classifications for each condition. ACNA AND ROSACEA
Even though sebaceous gland activity increases late in pregnancy, there is not a predictable worsening of acne in all patients, and acne is generally considered to be unaffected.3,6 There are a plethora of topical medications that are excellent choices for pregnant patients with acne, although the safe choices for systemic medications are more limited. Many topical nonantibiotic antiacne products are available and can be used safely during pregnancy. Benzoyl peroxide is category C because human studies have not been conducted, but it is safe and considered a treatment of choice for acne in pregnancy.3,7,8 Azeleic acid is category B, and
