An expert position paper on proposed treatments for atopic dermatitis (AD) in women who are pregnant and lactating and adults who are planning to conceive has been published by the European Task Force on Atopic Dermatitis (ETFAD). The paper is based on the most recent scientific literature for AD treatment during preconception, pregnancy, and lactation, and expresses the expert opinions and experiences of ETFAD members who treat AD. The following treatment recommendations have been published in Journal of the European Academy of Dermatology and Venereology.
Topical Treatments of AD During Pregnancy and Lactation
Use of topical corticosteroids (TCS) should be the first-line treatment of AD during pregnancy. The only exception is fluticasone propionate, which should not be used by pregnant women as it is the only TCS that is not metabolized by the placenta.
The ETFAD recommends that pregnant and lactating women use the lowest possible potency of TCS from class II or class III of the fourth generation drugs.
The use of topical calcineurin inhibitors during pregnancy is not recommended due to the lack of studies and experience. The only exception is tacrolimus ointment, for which there is a larger amount of existing data. ETFAD also recommends that crisaborole not be used during preconception, pregnancy, or during lactation due to lack of experience with this drug.
Topical Antiseptic Compounds
ETFAD recommends the use of antiseptics in AD during acute flares and when staphylococcal infections are present. All antiseptics, with the exception of triclosan, are recommended for use by pregnant women to prevent recurring infections but should not be used as a general measure.
Topical Antibiotic Drugs
The ETFAD recommends that topical fusidic acid be used to treat small areas of clinically infected AD in pregnant women. Mupirocin may be used to eradicate staphylococcal infections inside the nose if needed.
Broad-spectrum and narrow-band ultraviolet B therapy do not increase the risk for fetal harm in pregnant women. The ETFAD recommends the liberal use of narrow-band ultraviolet A1 and ultraviolet B therapy in pregnant women when feasible and advises against the use of psoralens.
Treatment of AD-Related Complications
The ETFAD recommends that pregnant women who are experiencing infectious complications of AD use ketoconazole and ciclopirox olamine as topical treatments and acyclovir as a systemic treatment. Oral cephalosporins or flucloxacillin should be used if no specific local guideline exists.
Systemic Anti-Inflammatory Treatment of AD in Pregnancy
Use of systemic corticosteroids (SCS) for AD during pregnancy may increase the risk for complications including gestational diabetes, preeclampsia, membrane rupture, and preterm delivery. However, SCS may be safe for pregnant women when both the mother and child are properly monitored. SCS treatment for AD during lactation is safe since less than 0.1% of the dose is secreted into breast milk.
The ETFAD states that SCS for AD in pregnancy should be limited and recommends that only prednisolone be used if SCS treatment is needed.