Treatment of Atopic Dermatitis in the Pregnant Patient

This presentation covers the treatment of atopic dermatitis in pregnant patients, emphasizing that atopic dermatitis often experiences flares during pregnancy due to hormonal changes. Topical treatments like emollients and low-potency steroids are generally safe for pregnant women. However, more potent topical steroids should be used cautiously due to potential systemic absorption. Topical calcineurin inhibitors are deemed low risk, while topical PDE4 inhibitors may also be safe but lack extensive human data. Phototherapy, particularly narrowband UVB, is considered acceptable, though monitoring folate levels is recommended to prevent neural tube defects. Systemic treatments, particularly steroids, are discouraged for long-term use in pregnancy due to associated risks; they may be utilized in short bursts for flare management. Biologics like dupilumab and tralokinumab show promising safety profiles based on ongoing studies but should still be approached with caution. Mycophenolate mofetil and methotrexate are strictly contraindicated as they are linked to congenital malformations. Overall, a conservative approach is advocated, with a clear classification indicating when treatments are safe (green), need caution (orange), or should not be used (red). The discussion underlines the complexity of managing atopic dermatitis in pregnancy and the need for careful consideration of each treatment's safety profile.