Atopic Dermatitis and Pregnancy: Managing Eczema During Pregnancy
Atopic dermatitis (AD), commonly referred to as eczema, is a chronic skin condition characterized by inflamed, itchy, and dry skin. For women with atopic dermatitis, pregnancy can bring both challenges and changes in how the condition manifests. Most pregnant women experience a worsening of symptoms, while others may find that their eczema improves. In this article, we will explore how pregnancy affects atopic dermatitis, what treatments are safe during pregnancy, and how to manage the condition to ensure the health and well-being of both mother and baby.
How Pregnancy Affects Atopic Dermatitis
Pregnancy brings significant changes in a woman's body, including hormonal fluctuations and alterations in the immune system. These changes can affect atopic dermatitis in various ways:
Hormonal Changes: Pregnancy hormones, particularly estrogen and progesterone, can have a direct impact on the skin. For some women, these hormonal shifts may improve eczema symptoms by increasing skin moisture and reducing inflammation. However, for others, the same hormonal changes can exacerbate skin dryness and trigger flare-ups.
Immune System Modulation: During pregnancy, the immune system shifts to protect the growing fetus, leading to changes in inflammatory responses. Atopic dermatitis is an immune-mediated condition, and these changes can either worsen or alleviate symptoms. Some women may experience new onset eczema during pregnancy, even if they had never suffered from the condition before.
Increased Sensitivity: Pregnancy can also increase the skin’s sensitivity, making women more prone to irritation from allergens, fragrances, or other irritants. This can result in more frequent or severe eczema flare-ups during pregnancy.
Postpartum Changes: After childbirth, hormone levels and immune responses gradually return to pre-pregnancy levels. Some women may notice an improvement in their eczema after delivery, while others may experience a temporary flare-up due to stress, fatigue, or hormonal shifts associated with breastfeeding.
One Study showed that most women reported worsening of their symptoms by the twentieth week of pregnancy.
Safe Treatments for Atopic Dermatitis During Pregnancy
Managing atopic dermatitis during pregnancy requires extra care, as certain medications and treatments may not be safe for the developing baby. However, there are still several effective and safe options available:
Moisturizing: Keeping the skin well-hydrated is crucial for managing atopic dermatitis, especially during pregnancy when skin may become drier. Use fragrance-free, hypoallergenic moisturizers that contain ceramides, glycerin, or petroleum jelly to maintain the skin barrier and reduce itching.
Topical Corticosteroids: Mild to moderate topical corticosteroids can be safely used during pregnancy under the guidance of a healthcare provider. These creams help reduce inflammation and control flare-ups. It is generally advised to use the lowest effective dose for the shortest duration necessary to minimize any potential risks. Studies have shown some association between high potent topical corticosteroids and lower birthweight.
Topical Calcineurin Inhibitors (TCIs): TCIs, such as tacrolimus and pimecrolimus, are non-steroidal creams that can help control inflammation without the long-term side effects associated with steroids. Although studies suggest that TCIs are relatively safe during pregnancy, they should only be used under medical supervision and when other treatments are not effective.
Antihistamines: Oral antihistamines, particularly those that cause drowsiness like diphenhydramine, can help alleviate itching and improve sleep. However, it’s important to check with a healthcare provider before using any antihistamines, as some may not be recommended during pregnancy.
Phototherapy: Narrowband ultraviolet B (NB-UVB) light therapy is considered a safe and effective treatment for managing moderate to severe eczema during pregnancy. This therapy helps reduce inflammation and itching without the use of medications that could pose risks to the fetus.
Avoiding Triggers: Identifying and avoiding triggers, such as harsh soaps, fragrances, or certain fabrics, can help prevent flare-ups. Use gentle, fragrance-free cleansers and laundry detergents, and opt for soft, breathable fabrics like cotton.
Treatments to Avoid During Pregnancy
While many treatments are safe for atopic dermatitis during pregnancy, there are some medications that should be avoided due to potential risks to the baby:
Oral Corticosteroids: Systemic corticosteroids, such as prednisone, are generally not recommended during pregnancy due to the risk of complications, including preterm birth and low birth weight. If necessary, they should only be used for short periods under strict medical supervision.
Immunosuppressants: Medications like cyclosporine and methotrexate are typically avoided during pregnancy due to their potential to cause birth defects and other complications.
Biologics: While biologics, such as dupilumab, have been used to treat severe atopic dermatitis, their safety during pregnancy is not well-established. Use of biologics during pregnancy should be discussed with a healthcare provider on a case-by-case basis.
Managing Stress and Sleep
Pregnancy can be a stressful time, and stress is a known trigger for atopic dermatitis flare-ups. Finding ways to manage stress is essential for both the mother’s and baby’s health. Some strategies include:
Relaxation Techniques: Practices like mindfulness, deep breathing exercises, and prenatal yoga can help reduce stress and promote relaxation.
Sleep Hygiene: Itching and discomfort from atopic dermatitis can interfere with sleep, which is crucial during pregnancy. Using cool, moist compresses and taking soothing baths with colloidal oatmeal can help ease itching before bedtime. Additionally, keeping the bedroom cool and wearing loose, breathable clothing can help improve sleep quality.
Atopic Dermatitis and Pregnancy Outcomes
For most women with atopic dermatitis, the condition does not pose a significant risk to pregnancy outcomes. However, in cases of severe or poorly controlled eczema, there may be an increased risk of complications such as preterm birth or low birth weight. Maintaining regular prenatal checkups and working closely with a healthcare provider to manage symptoms is key to ensuring a healthy pregnancy.
Conclusion
Atopic dermatitis during pregnancy can present unique challenges due to the body’s changing hormones and immune responses. However, with the right management strategies, most women can effectively control their symptoms and enjoy a healthy pregnancy. Moisturizing regularly, using safe medications under medical supervision, and avoiding known triggers are essential steps in managing eczema during this time. At Mellinos, we offer resources and support for expectant mothers dealing with atopic dermatitis, ensuring that both mother and baby remain healthy and comfortable throughout pregnancy.
References
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Vestergaard, C., & Henningsen, L. (2010). Safe treatment of atopic dermatitis during pregnancy. British Journal of Dermatology, 162(3), 517-523.
Eichenfield, L. F., Tom, W. L., Chamlin, S. L., & Feldman, S. R. (2014). Guidelines of care for the management of atopic dermatitis. Journal of the American Academy of Dermatology, 71(1), 116-132.
Chi, C. C., & Kirtschig, G. (2013). Safety of topical corticosteroids in pregnancy. Cochrane Database of Systematic Reviews, 10(1), CD007346.
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Chi CC, Wang SH, Wojnarowska F, Kirtschig G, Davies E, Bennett C. Safety of topical corticosteroids in pregnancy. Cochrane Database doi:10.1002/14651858.CD007346.pub3 Syst Rev. Oct 26 2015;(10):Cd007346