A Practical Guide to Dermatological Drug Use in Pregnancy

C. Zip, MD, FRCPC

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

Fungal Infections

The use of topical antifungals is considered safe in pregnancy because of negligible percutaneous absorption. Animal reproduction studies involving oral terbinafine (category B) have shown no abnormalities, but human pregnancy data are lacking.^[5] Oral fluconazole (category C) taken during the first trimester at a continuous daily dose of 400mg/day or more appears to be teratogenic and associated with a pattern of abnormalities involving the head and face, bones, and heart.^[26]

Smaller doses of fluconazole, as used for treatment of vaginal candidiasis, have been associated with minimal or no risk of fetal abnormalities. The available data pertaining to human use of itraconazole (category C) indicates no significant risk for major abnormalities. However, because of concern regarding the use of fluconazole, a structurally related triazole antifungal, avoidance of itraconazole is suggested in the first trimester.

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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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