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Is any acne treatment safe to use during pregnancy?.Common Skin Conditions During Pregnancy | AAFP |
Benzac et grossesse
- Benzac et grossesse
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A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. Dermatologists care for people of all ages. So many things change during pregnancy, and your acne treatment may need to be one of them. What we know comes from animal studies and women who have used acne treatments while pregnant.
From this, researchers have learned the following about acne medications:. Antibiotics you apply to your skin : Applying clindamycin during pregnancy is thought to be safe. Antibiotics you take : Cefadroxil is an antibiotic that can help clear severe acne.
The antibiotics that are often used to treat acne, such as azithromycin and clarithromycin, also seem safe during pregnancy. A few women, however, have had a baby with a birth defect while taking one of these. Azelaic acid: This is thought to be safe to use during pregnancy. This is a newer acne treatment. For this reason, experts recommend that doctors be very cautious when they prescribe dapsone to women who are pregnant.
Pregnant women also may notice mild thickening of scalp hair. This is caused by a prolonged active anagen phase of hair growth. Postpartum, scalp hair enters a prolonged resting telogen phase of hair growth, causing increased shedding telogen effluvium , which may last for several months or more than one year after pregnancy.
Nails usually grow faster during pregnancy. Pregnant women may experience increased brittleness, transverse grooves, onycholysis, and subungual keratosis. Normal changes in estrogen production during pregnancy can cause dilation, instability, proliferation, and congestion of blood vessels. Most of these vascular changes regress postpartum. The condition is most common during the first and second trimesters.
Saphenous, vulvar, or hemorrhoidal varicosities occur in about 40 percent of pregnant women. All pregnant women experience some gingival hyperemia and edema, which may be associated with gingivitis and bleeding, especially in the third trimester. Observation is appropriate in most patients because these lesions typically regress post-partum. However, prompt consultation and possible excision may be indicated if bleeding occurs.
Preexisting skin conditions e. Atopic dermatitis and psoriasis may worsen or improve during pregnancy. Atopic changes may be related to prurigo of pregnancy and usually worsen, but may improve, during pregnancy. Fungal infections generally require a longer treatment course during pregnancy. These fibromas generally disappear post-partum. True dermatoses of pregnancy Table 1 1 , 17 — 23 include pruritic urticarial papules and plaques of pregnancy PUPPP , prurigo of pregnancy, intrahepatic cholestasis of pregnancy, pemphigoid gestationis, impetigo herpetiformis, and pruritic folliculitis of pregnancy.
PUPPP Figure 3 , is the most common pregnancy-specific dermatosis, occurring in one out of to pregnancies. A relationship between the condition and the maternal immune system and fetal cells has been proposed.
Histopathologic findings are nonspecific. Antihistamines and topical steroids may be used to treat pruritus, and systemic corticosteroids may be used for extreme pruritus. Prurigo of pregnancy Figure 4.
The cause of this condition is unclear, and there are no recognized adverse effects for the mother or fetus. An association with intrahepatic cholestasis of pregnancy or a history of atopy has been suggested. Intrahepatic cholestasis of pregnancy historically has been referred to as pruritus gravidarum because its classic presentation is severe pruritus in the third trimester. Intrahepatic cholestasis of pregnancy occurs in one out of to 1, pregnancies in the United States. Diagnosis is based on clinical history and presentation: pruritus with or without jaundice, no primary skin lesions, and laboratory markers of cholestasis.
The condition usually resolves postpartum. Cholestasis and jaundice in patients with severe or prolonged intrahepatic cholestasis of pregnancy may cause vitamin K deficiency and coagulopathy. The etiology of intrahepatic cholestasis of pregnancy remains controversial. A prospective cohort study demonstrated a correlation between bile acid levels and fetal complications, with a statistically significant increase in adverse fetal outcomes reported in patients with bile acid levels of Patients with mild pruritus may be treated with oral antihistamines.
Patients with more severe cases require ursodeoxycholic acid ursodiol [Actigall] to relieve pruritus and improve cholestasis while reducing adverse fetal outcomes. The impact of early delivery on perinatal complications is not completely clear. Pemphigoid gestationis Figure 5 , sometimes referred to as herpes gestationis, is an autoimmune skin disorder that occurs in one out of 50, mid- to late-term pregnancies.
The disease may take a variable course, although it generally improves in late pregnancy, with exacerbations in the immediate postpartum period. Flare-ups have been associated with oral contraceptive use and are common during subsequent pregnancies. Therefore, antenatal surveillance should be considered. Impetigo herpetiformis Figure 6 , a form of pustular psoriasis, is a rare skin disorder that appears in the second half of pregnancy.
Whether this disorder is specific to pregnancy or is simply exacerbated by it is controversial. Systemic signs and symptoms of impetigo herpetiformis include nausea, vomiting, diarrhea, fever, chills, and lymphadenopathy. Pruritus generally is absent. Medical complications e. Treatment of impetigo herpetiformis includes systemic corticosteroids and antibiotics to treat secondarily infected lesions.
Prednisone, 15 to 30 mg to as high as 50 to 60 mg per day followed by a slow taper, may be necessary. The extent of fetal risk is somewhat controversial; however, increased fetal morbidity has been reported, suggesting the need for increased antenatal surveillance. Pruritic folliculitis of pregnancy occurs in the second and third trimesters and presents as erythematous follicular papules and sterile pustules. Contrary to its name, pruritus is not a major feature. Spontaneous resolution occurs after delivery.
This condition likely is underreported because it often is misdiagnosed as bacterial folliculitis. The etiology of pruritic folliculitis of pregnancy is uncertain, and there are no reports of adverse fetal outcomes clearly related to the condition. Treatments include topical corticosteroids, topical benzoyl peroxide Benzac , and ultraviolet B light therapy. Figures 2 through 6 were printed with permission from the American Academy of Dermatology. This content is owned by the AAFP.
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