Clinician's Photo Guide to Recognizing and Treating Skin Diseases in Women: Part 2. Pregnancy-Related Dermatoses

, University of Singapore in Singapore, National Skin Centre in Singapore

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Risks of Treatment: Dermatologic Disease and Pregnancy

The greatest risks of administering drugs during pregnancy--particularly systemic drugs--are the potential adverse effects on the fetus and outcome of pregnancy. Similar risks exist when drugs are given to mothers who are breast-feeding their children.

Fortunately, many dermatologic disorders allow deferral of treatment or alternate methods of treatment during pregnancy.[5] To make the most appropriate treatment decision, a dermatologist who is treating pregnant and lactating women must be familiar with the potential adverse effects of various pharmacologic agents on the fetus and breast-fed baby. Physicians should frequently refer to drug information resources before writing prescriptions for pregnant and lactating women. An article by Reed[5] integrates data from multiple sources to provide a valuable resource for the physician in dermatologic practice. Using this information, the practicing physician may assist a mother in the decision-making process regarding risks and benefits to herself and her child.

The US Food and Drug Administration has assigned pregnancy categories to drugs. This risk-evaluation system is based on animal studies and available human trials, balancing risk to the fetus against the potential benefit of the drug to the patient. Categories with associated risk are as follows: Category A = controlled studies show no risk; Category B = no evidence of risk in humans; Category C = risk cannot be ruled out; Category D = positive evidence of risk; Category X = contraindicated in pregnancy; Category Other = category not specified.

Retinoids and antineoplastic agents. Among the drugs used in dermatology, isotretinoin used to treat acne vulgaris and antineoplastic agents such as methotrexate are 2 drug types that present a high risk during pregnancy. These agents are classified under pregnancy Category X. Tretinoin is designated as a Category C drug.

Antipruritic agents. Antipruritic medications, such as trimeprazine and doxepin, should be avoided during pregnancy and lactation. Hydroxyzine is classified as moderate risk in the first trimester of pregnancy and is associated with a risk of congenital abnormality. Hydroxyzine is also not recommended during lactation.

Antibiotics. Most antibiotics--including tetracycline and ciprofloxacin--pose potential risks during pregnancy and lactation, and should therefore be avoided. When antibiotics are essential, penicillins are considered comparatively safe during pregnancy.

Analgesics. Analgesics, including acetaminophen, are associated with minimal risk to the fetus or infant. Some nonsteroidal anti-inflammatory agents (such as indomethacin) are, however, associated with problems in infants and are not recommended for use in pregnant women.

Topical agents. Topical corticosteroids during pregnancy are considered to present a low risk to the fetus. The FDA classifies these drugs as having a Category C risk, whereby the risk cannot be ruled out because no human studies have been done. Potential benefit to the woman may justify potential risk to the fetus.

Other topical agents, such as povidone-iodine and podophyllin, may place a fetus at risk. These agents are not recommended for use during pregnancy.

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