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

Psoriasis

Topical corticosteroids (category C) have been widely used during pregnancy, although intrauterine growth retardation was reported in an infant whose mother applied 40mg/day of topical triamcinolone beginning at 12 weeks of gestation.[9] Calcipotriene (category C) is approximately 6% absorbed when the ointment form is applied to psoriatic plaques and is likely safe in pregnancy for the treatment of localized psoriasis.[10]

Broadband ultraviolet B phototherapy is considered the safest therapy for extensive psoriasis during pregnancy, although overheating during treatment should be avoided. PUVA is a potential teratogen because it is known to be mutagenic and to induce sister chromatid exchanges. However, adverse outcomes have not been reported in studies of women exposed to PUVA during pregnancy.[11,12]

Methotrexate and acitretin are both in pregnancy category X. Methotrexate can be used in women with childbearing potential who are using effective contraception. Pregnancy should be avoided for at least one ovulatory cycle after this medication is discontinued. Acitretin should not be prescribed for women of childbearing potential.

There are limited data on the safety of biologics used for the treatment of psoriasis during pregnancy. Animal reproduction studies of alefacept[13] (category B), a mouse analogue of efalizumab,[14] and etanercept (category B)[15] have shown no evidence of teratogenicity. No congenital malformations have been reported in the offspring of the few women who inadvertently became pregnant while taking alefacept or efalizumab (category C) in clinical trials. More data are available on the outcome of pregnancies exposed to etanercept given its utilization for the treatment of rheumatoid arthritis. Preliminary data from the Organization of Teratology Information Services (OTIS) study of pregnancy outcomes of women with rheumatoid arthritis exposed to anti-TNF therapy included information on 29 women exposed to etanercept. Spontaneous abortion, termination, and malformation rates were similar to those in the diseased and non-diseased control groups.[16]

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