What You Need to Know

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2 years ago

Your body goes through a multitude of changes when you’re pregnant. Symptoms of atopic dermatitis (eczema) might be one of them.

“Eczema is the most common skin disorder of pregnancy,” says Daniel P. Friedmann, MD, a dermatologist with Westlake Dermatology and the clinical research director of the Westlake Dermatology Clinical Research Center in Austin, Texas.

Unfortunately, just because you haven’t experienced atopic dermatitis before doesn’t mean you’re in the clear. It’s entirely possible for eczema to appear for the first time while you’re pregnant, Dr. Friedmann says. Only 20 to 40 percent of pregnant people with atopic dermatitis are estimated to have a preexisting history of eczema; the rest develop symptoms for the first time during pregnancy, most commonly during the first and second trimesters.

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The Link Between Pregnancy and Atopic Dermatitis

Atopic dermatitis flares are the result of different internal or environmental triggers, and it appears pregnancy is one of them.

This is especially true if you’ve dealt with atopic dermatitis before. “Women with a history of eczema prior to pregnancy have a significant risk of an eczema flare during pregnancy,” Friedmann says.

For pregnant women who already have a history of atopic dermatitis, it tends to worsen slightly during the second trimester (Friedmann suspects because of the immunological changes that occur as the fetus grows), though it can occur in the first or third trimesters as well, or postpartum.

So, why does pregnancy seem to worsen atopic dermatitis symptoms? Blame those shifting hormones. “Eczema symptoms during pregnancy are largely related to the impact of female sex hormones on the immune system,” says Natalie C. Yin, MD, a dermatologist with Providence Dermatology in Hillsboro, Oregon.

During pregnancy, the immune system shifts in order to protect the fetus, which can produce an inflammatory response and make atopic dermatitis worse, Dr. Yin says.

It can also worsen asthma and food allergies, she adds.

Ruling Out Other Skin Conditions When You’re Pregnant

Complicating the picture is that pregnant women are prone to developing other rashes that might look similar to atopic dermatitis.

For example, pruritic urticarial papules and plaques of pregnancy (PUPPP) is another common pregnancy-related rash. The itchy, red patches tend to first appear toward the end of pregnancy around stretch marks, though they can spread to the arms, legs, and buttocks.

Meanwhile, atopic dermatitis during pregnancy usually appears on the face, chest, neck, or underneath the breasts.

If you develop a new rash while you’re pregnant, it’s important to seek medical attention from your ob-gyn or dermatologist, Yin says. This is in order to rule out potentially harmful rashes that can resemble atopic dermatitis, including pityriasis rosea.

Tips for Treating Atopic Dermatitis When You’re Pregnant

If you’ve dealt with atopic dermatitis before, you may have treated it with topical ointments, oral medications, over-the-counter skin-care products, or other prescriptions. And while they may have been safe to use before, that may no longer be the case for certain treatments during pregnancy.

Pregnant women should avoid some atopic dermatitis treatment options, such as methotrexate and some forms of phototherapy.

During pregnancy, it’s best to approach potent topical steroids, oral steroids, topical calcineurin inhibitors, and oral immunosuppressive agents with extreme caution, along with biologics, says Yin. If you’re taking one of these drugs, be sure to work closely with your doctor.

That said, over-the-counter moisturizers and mild topical steroids of low to medium potency are generally safe to use during pregnancy.

“There is a risk of low birth weight with topical steroid use, but this typically occurs with application of over 300 grams during the entire pregnancy, which is rarely necessary,” Yin says.

Always consult your doctor first to get the okay on any medication you’re taking. “I always recommend patients run products by their board-certified dermatologist or ob-gyn in order to confirm that they are safe to use while pregnant,” Friedmann says.

Even if you currently take medication for atopic dermatitis and are not pregnant yet, but plan to become pregnant in the near future, share your plans with your doctor.

Lifestyle Changes That Can Help Tame Atopic Dermatitis Symptoms

Also keep in mind that many of the atopic dermatitis treatments involving lifestyle tweaks can be safely incorporated regardless of whether you’re pregnant. “The treatment of eczema during pregnancy begins with warm (not hot) showers and the use of moisturizers and synthetic soaps (no true soaps) in order to limit overdrying of the skin,” Friedmann says.

Other helpful tips include:

Take warm baths or showers for less than 10 minutes each day.
Apply moisturizer within three minutes of showering or bathing.
Moisturize at least twice a day.
Take diluted bleach baths.
Use a humidifier.
Manage stress.

The Takeaway

Pregnancy can cause atopic dermatitis to flare up, and can trigger the condition for the first time in some people. If you’re seeing a dermatologist for pregnancy-related atopic dermatitis, be sure to keep your ob-gyn in the loop, especially about any medication you’re taking.

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