A Practical Guide to Dermatological Drug Use in Pregnancy

C. Zip, MD, FRCPC

Skin Therapy Letter. 2006;11(4):1-4.

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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Cite this: A Practical Guide to Dermatological Drug Use in Pregnancy - Medscape - May 01, 2006.

Table 1. FDA Pregnancy Categories for Drugs
A	No fetal risk in controlled studies
B	No risk to human fetus despite possible animal risk or no risks in animal studies but human studies lacking
C	Human risk cannot be ruled out. Animal studies may or may not show risk
D	Evidence of risk to human fetus
X	Contraindicated in pregnancy

Table 2. Safe treatments for Dermatological Disorders During Pregnancy
Disease	Medication Name
Acne	Topical clindamycin, erythromycin, benzoyl peroxide
Rosacea	Metronidazole, azelaic acid
Psoriasis	Topical corticosteroids, calcipotriol, broad band UVB
Dermatitis	Topical corticosteroids, chlorpheniramine or diphenhydramine
Genital human papillomavirus infection	Liquid nitrogen, trichloroacetic acid
Herpes simplex virus infection	Acyclovir
Fungal infections	Topical antifungals
Bacterial infections	Penicillins, cephalosporins after first trimester, azithromycin

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