Managing Dermatoses in Pregnancy: Evidence-Based Therapeutic Insights

Atopic Eruption of Pregnancy (AEP) is the most frequent pregnancy-specific dermatosis, typically affecting women with a personal or family history of atopy. It manifests during the first or second trimester with eczematous or pruritic lesions, often on the face, palms, or soles. Management starts with topical therapies such as urea or menthol-based agents to relieve itching and safe antihistamines like chlorpheniramine or loratadine. Topical corticosteroids, including medium to high-potency options (avoiding fluticasone), may be used cautiously. For moderate to severe cases, short-term oral corticosteroids (e.g., prednisone 0.5 mg/kg/day for 2–3 weeks) are effective. Ultraviolet therapies (UVB, UVA-1) may also offer symptom control. Systemic agents like cyclosporine A and azathioprine can be considered if the maternal benefit outweighs fetal risk, while drugs such as methotrexate and JAK inhibitors remain contraindicated.

Polymorphic Eruption of Pregnancy (PEP), also referred to as pruritic urticarial papules and plaques of pregnancy, is the second most common gestational dermatosis. Typically arising in the third trimester of first pregnancies or in multiple gestations, PEP presents with intensely pruritic papules and plaques originating on abdominal striae. These lesions may extend to the limbs but usually spare the face, palms, and mucosa. Treatment involves oral antihistamines and mid-potency topical corticosteroids like triamcinolone 0.1%. In more symptomatic cases, systemic corticosteroids (prednisolone 0.5 mg/kg/day) can be administered with a short tapering course.

Pemphigoid Gestationis (PG) is a rare autoimmune blistering disorder, often presenting in the latter half of pregnancy with urticarial plaques that evolve into tense bullae, typically starting around the umbilicus. It is associated with HLA-DR3/DR4 and may flare postpartum. Topical corticosteroids such as fluocinonide or clobetasol 0.05% and oral antihistamines like loratadine form the first-line therapy. In cases of extensive involvement, systemic corticosteroids are necessary. For severe or refractory cases, additional options may include azathioprine, dapsone, intravenous immunoglobulin, or rituximab. Fetal monitoring is advised due to risks like preterm delivery or neonatal blistering.

Source: Garg, R., Agarwal, P., Singh, S. K., Gupta, P., Sahoo, L. N., Kundalia, A., & Sharma, S. (2025). Dermatoses during Pregnancy. Journal of South Asian Federation of Obstetrics and Gynaecology, 17(2), 259–263. https://doi.org/10.5005/jp-journals-10006-2658