A Practical Guide to Dermatological Drug Use in Pregnancy

C. Zip, MD, FRCPC

Disclosures

Skin Therapy Letter. 2006;11(4):1-4. 

In This Article

Acne and Rosacea

Topical therapy is preferred for the treatment of acne during pregnancy.[2] Topical erythromycin (category B), clindamycin (category B) and benzoyl peroxide (category C) are considered safe in pregnancy. Use of topical tretinoin (category C) is not advised due to case reports of congenital malformations in infants whose mothers used tretinoin during the first trimester of pregnancy.[3,4] Moreover, some of these malformations are consistent with those observed in retinoic acid embryopathy. However, the fetal risk, if any, from inadvertent exposure in early pregnancy appears to be very low.[5] Use of adapalene (category C) and tazarotene (category X) is also not recommended.

Topical metronidazole (category B) is minimally absorbed and considered safe in pregnancy. Topical azelaic acid (category B) is also minimally absorbed and likely safe in pregnancy.

Tetracyclines (category D) are associated with deciduous tooth staining when taken after the first trimester, decreased bony growth, and maternal liver toxicity. However, inadvertent exposure in the first few weeks of pregnancy is extremely unlikely to be harmful.[6] Erythromycin (category B) has long been considered safe in pregnancy. However, two recent Swedish studies have reported an increased risk of cardiovascular malformations with the use of oral erythromycin in early pregnancy.[7,8]

Oral isotretinoin (category X) is a well-known teratogen. However, it is safe for women to conceive 1 month after this medication is stopped.

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