Topical, Systemic Atopic Dermatitis Treatment Use Decreases During Pregnancy

While cyclosporine is recommended in guidelines as first line systemic therapy during pregnancy, most pregnant women are treated with systemic steroids.

A substantial proportion of pregnant women with atopic dermatitis (AD) discontinue use of topical and systemic medications once they become aware of their pregnancy, according to study findings published in Journal of the American Academy of Dermatology.

Researchers conducted an observational cohort study using longitudinal claims data of women with commercial health insurance in the United States from 2017 to 2021. Pregnant women with a live birth and AD diagnosis 180 days before pregnancy were included in the study. Cohort entry date was established by the last menstrual period (LMP) computed by delivery date minus estimated gestational age at birth identified by week-specific gestational codes from International Statistical Classification of Diseases, Tenth Revision (ICD-10). Follow-up began 4 weeks after LMP and lasted until inpatient live birth, disenrollment, or death, whichever occurred first.

The primary endpoints were the number of dermatologist visits and medications used to treat AD (ie, topical agents, systemic glucocorticoids, dupilumab, phototherapy, cyclosporine, and azathioprine).

Women who were enrolled fewer than 180 days before pregnancy, had any pregnancy-related claim, organ transplant, IBD or Crohn disease, psoriasis, lupus, or never received an AD diagnosis were excluded from the study.

After the initial decrease, use continued to decrease gradually throughout the pregnancy trimesters.

Among the 3563 participants (mean age 31 range [15-50] years; mean gestational age at delivery, 38.5 weeks) diagnosed with AD during the 180 days prior to awareness of pregnancy, 58.4% received topical agents, 17.6% received systemic glucocorticoids, 2.0% received dupilumab, 0.6% received phototherapy, and 0.1% received cyclosporine.

During pregnancy, medication usage ranged from 29 to 294 days from the LMP. Topical agent use was reduced but stable between first (6.6%), second (8.2%), and third trimesters (6.6%). Use decreased each trimester with systemic glucocorticoids (first, 1.5%; second, 1.4%; third, 1.1%) and phototherapy (first, 0.3%; second, 0.2%; third, 0.1%). Dupilumab decreased then leveled (first, 0.7%; second, 0.3%; third, 0.3%). Cyclosporine was completely discontinued with pregnancy awareness.

The mean number of dermatologist visits in the 180 days before pregnancy was 2.63±4.78. The median number of dermatologist visits was 1, and the interquartile range (IQR, 0-3). During the first, second, and third trimesters, the mean number of dermatologist visits increased slightly with each trimester (2.71±4.91; 2.81±5.09; 2.92±5.27, respectively) and the median number and IQR of dermatologist visits were unchanged.  

Study limitations include possible data input error in electronic health records, and the unaccounted number of women without commercial insurance.

“In this nationwide study of pregnant women with AD, a substantial proportion of women discontinued the use of topical and systemic medications, once they became aware of their pregnancy,” the study authors conclude. “After the initial decrease, use continued to decrease gradually throughout the pregnancy trimesters.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Schoder K, Zhu Y, Schneeweiss S, et al. Use of systemic immunomodulating medications in pregnant women with atopic dermatitis: a nationwide US study. J Am Acad Dermatol. Published online March 9, 2023. doi:10.1016/j.jaad.2023.02.047