Dermatologic Medications in Pregnancy

1. Background
   1. Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S.
      1. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm425317.htm
      2. Although FDA Pregnancy Categories are no longer FDA designated, they are included here
         1. As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking
2. Preparations: Pregnancy
   1. Topical Corticosteroids
      1. Low potency Topical Corticosteroids may be used in pregnancy
      2. Avoid high potency Topical Corticosteroids in pregnancy due to risk of low birth weight
   2. Topical NSAIDs (e.g. topical diclofenac or Pennsaid)
      1. Avoid in pregnancy
   3. Topical benzocaine
      1. Safe for limited use in pregnancy
   4. Topical retinoids (e.g. Tretinoin, Adapalene)
      1. Avoid retinoids in pregnancy (Teratogenic)
   5. Topical Calcineurin Inhibitors (Protopic, Elidel)
      1. Avoid in pregnancy (theoretical risk of prematurity and low birth weight)
3. Preparations: Lactation
   1. Topical Corticosteroids
      1. Avoid use on the nipple in Lactation (due to ingestion risk by infant)
   2. Topical NSAIDs (e.g. topical diclofenac or Pennsaid)
      1. Appear to be safe in Lactation
   3. Topical benzocaine
      1. Avoid use on the nipple in Lactation (due to ingestion risk by infant with associated Methemoglobinemia)
   4. Topical retinoids (e.g. Tretinoin, Adapalene)
      1. Tretinoin and Adapalene appear safe in Lactation, but limit the use of Tazarotene
   5. Topical Calcineurin Inhibitors (Protopic, Elidel)
      1. Appear to be safe in Lactation
4. References
   1. (2014) Presc Lett 21(10): 58
   2. Tyler (2013) J Am Acad Dermatol 68(4): 663-71 [PubMed]