How is eczema treatment different when I am pregnant as compared to other times?

During pregnancy, some people can experience flare or worsening of their eczema. The hormonal changes can lead to a number of itchy skin rashes such as:

• prurigo in pregnancy
• atopic eruption of pregnancy
• intrahepatic cholestasis of pregnancy
• polymorphic eruption of pregnancy.

So it's important to be sure of the diagnosis.

During pregnancy, it is safe to use gentle soap-free cleansers and moisturizers. You should use them regularly as we do in eczema treatment.

You can also use topical steroids. But it is best to avoid using very potent steroids for too long and to large areas. I would recommend opting for milder potency topical steroids.

Oral antihistamines can be taken during pregnancy. They are generally safe. But your doctor will choose those that have a better safety profile in pregnant women.

In general, we do try to minimize taking oral medications during pregnancy. You can discuss this further with your doctor or dermatologist.

The principles of treatment of eczema during pregnancy is similar to the
treatment of other diseases during pregnancy, which is to minimise the use
of medications which can have an effect on the growing baby.

As such, in my practice, I assess the severity of my patient’s eczema.

For very mild cases of eczema, simple measures like using non soap-based shower creams, regular moisturising will be helpful and it will definitely not
have any effect on the baby.

For more moderate to severe cases, other than the above regular moisturising, I will give a course of topical steroids to treat the flare of eczema. Topical steroids are applied on the skin, work locally on eczema and are generally safe during pregnancy.

The principles of treatment of eczema during pregnancy, is similar to the
treatment of other diseases during pregnancy, which is to minimise the use
of medications which can have an effect on the growing baby.

As such, in my practice, I assess the severity of my patient’s eczema.

For very mild cases of eczema, simple measures like using non soap-based
shower creams, regular moisturising will be helpful and it will definitely
not have any effect on the baby. A mild potency steroid such as
Hydrocortisone 0.01% or Betamethasone 0.025% can also be used to treat the
flare.

For more moderate to severe cases, other than the above regular
moisturising, stronger courses of topical steroids like betamethasone 0.1%
can be used. Topical steroids are applied on the skin, work locally on the
eczema and are generally safe during pregnancy. Once the flare is
controlled, wean off the topical steroids and just continue regular
moisturising

As eczema can get quite itchy, and scratching it can worsen the flare of
eczema, I usually also give my patients some anti-histamines to reduce the
itchy sensation. I like to give a day-time non drowsy antihistamine like
cetirizine which enables my patient to continue with their daily activities
and a night-time drowsy antihistamine like Chlorphenamine which allows them
to have a better night sleep. Most antihistamines are safe for pregnancy.