Effect of pregnancy on Eczema
25% of pregnant women with eczema improve but more than 50% deteriorate.
Deterioration occur at anytime but more common in second trimester.
Effect of Eczema on pregnancy
Generally eczema doesn't affect fertility or the pregnancy.Genetic & environmental factors determine the development of eczema in a child.It is important to recognize & treat eczema herpeticum as this could lead to serious maternal mortality & morbidity.Aciclovir should be commenced on clinical suspicion and the diagnosis can be confirmed by viral swab.
(i)Optimize the control of eczema by avoiding the irritants & allergens,using emollients & topical steroids.
(ii)Patients who had systemic treatment should ensure adequate drug free interval
Example conception should be avoided for three months after methotrexate (males & females)
The following are safe treatments options :
emollients,topical steroids (mild, moderate, or potent),Ultraviolet B
These options are relatively contraindicated:very potent topical steroids,oral steroids,Ciclosporin,azathioprine,topical calcineurin inhibitors
The following options are contraindicated:methotrexate,psoralens plus ultraviolet A (PUVA)
ciclosporin crosses the placenta but data from transplant patients indicate it is relatively safe.These patients need regular assessment of full blood count,renal function & blood pressure.
Azathioprine crosses the placenta but the fetal liver lacks the enzyme to convert it into active metabolite.Patients on azathioprine has to have regular full blood count & liver function tests.
More information on topical calcineurin inhibitors
Example :tacrolimus and pimecrolimus
Systemic therapy is teratogenic but absorption from topical treatment is very small.The patient should be counseled about the risk.
Eczema of nipple
Emollients & low to moderate potency steroids are first line treatment.These are applied after breast feeding and should be washed away just before the next feed.
Ultraviolet B is safe but methotrexate & ciclosporin should be avoided.
What are emollients? more information on emollients?
Cochrane review on topical steroids in pregnancy
An excellent article on common skin disorders in pregnancy
A link on skin diseases in pregnancy
(1)Treatment of Recurrent Eczema Herpeticum in Pregnancy With Acyclovir Richard A. Lattacorresponding author1 and David A. Baker2 .Infect Dis Obstet Gynecol. 1996; 4(4): 239–242. doi: 10.1155/S1064744996000452.
2.Eczema Herpeticum in Pregnancy and Neonatal Herpes Infection,DiCarlo, Angela; Amon, Erol MD; Gardner, Morey MD; Barr, Susan MD; Ott, Kelly MD, Obstetrics & Gynecology: August 2008 - Volume 112 - Issue 2, Part 2 - pp 455-457, doi: 10.1097/AOG.0b013e318169ce19, Case Reports.
|3.Weatherhead S, Robson SC, Reynolds NJ. Eczema in pregnancy. BMJ. 2007 7;335(7611):152-154-An excellent review on this topic.|
|4.Oxford text book of medicine,third edition,Voulme 2 pp1805.|