Managing Skin Diseases that Flare During Pregnancy and in the Postpartum period: Part 2- Management & Safety Considerations.

Abstract

Pregnant and lactating patients and their clinicians must navigate a fragmented therapeutic landscape when managing dermatoses that flare during pregnancy. Although a growing number of topical, systemic and procedural modalities, including newer biologics, small-molecule immunomodulators and narrow-band UVB, have demonstrated efficacy, safety and dosing data remain dispersed across disparate specialty literatures and registry reports. Reliance solely on US Food and Drug Administration (FDA) pregnancy categories and anecdotal experience fosters wide practice variation and therapeutic gaps. Effective therapies are often withheld, subtherapeutic regimens are prescribed and breastfeeding guidance is inconsistent. Furthermore, the exclusion of pregnant and lactating women from randomized trials leaves critical pharmacokinetic and teratogenicity questions unanswered. In part I of our CME we reviewed pregnancy and lactation induced immunologic, hormonal, vascular and barrier changes that exacerbate common dermatoses. In part II of this CME we present a consolidated, evidence-based framework regarding atopic dermatitis, psoriasis, acne vulgaris, rosacea, melasma, alopecia (due to telogen effluvium or androgenetic, hormonally and/or nutritionally related), and hidradenitis suppurativa that integrates up-to-date safety profiles, trimester-specific dosing adjustments, lactation pharmacology and clinical algorithms, all of which are essential to optimize maternal disease control while minimizing fetal and neonatal risk.