Eczema during pregnancy is not limited to women with a history of eczema, and is the most common skin condition women can experience during pregnancy.
It is estimated that 20 to 40% of women who develop eczema during pregnancy have a history of the condition, and three quarters of these patients develop eczema symptoms during the first two trimesters. Women may also experience changes in skin pigmentation, acne, rashes, sensitive skin, or dry or oily skin during pregnancy.
There are a number of names for eczema during pregnancy, including:
- Atopic eruption of pregnancy (AEP)
- Prurigo of pregnancy
- Pruritic folliculitis of pregnancy
- Papular dermatitis of pregnancy.
What is Eczema?
Eczema is a common inflammatory skin condition. It is characterized by itchy, dry and visibly irritated skin. It often causes skin to become sore, cracked and red. It can be limited to small areas or be widespread across the body, and it is commonly found in the creases of the skin such as the inside of the elbows or the backs of the knees. Babies often develop eczema on the face.
Applying an cream emollient to dry flaky skin as in the treatment of psoriasis, eczema and other dry skin conditions. Image Credit: Ternavskaia Olga Alibec / Shutterstock
Causes of Eczema During Pregnancy
Eczema ‘flare ups’ are periods in which a patient’s eczema symptoms worsen. Although the exact cause for eczema is unknown, it is influenced by environmental and internal triggers. It is thought that changes in hormones during pregnancy may cause eczema.
Approximately 25% of pregnant women with a history of eczema experience improvement of their symptoms, but in more than 50% there is deterioration. Although data is limited, a slightly higher rate of eczema has been reported in the second trimester.
Although T cell immunity with a type 2 T-cell helper response is important in normal pregnancies, it is associated with atopy (the genetic tendency to develop allergic diseases including asthma and eczema), which may explain why eczema can worsen during pregnancy.
Both genetic and environmental factors can help determine whether a child will develop eczema, and there is good evidence to support this.
Recent genetic evidence has indicated that a proportion of atopic eczema is caused by non-functional forms of filaggrin (a gene which, when mutated, plays a significant role in eczema), which results in a primary skin barrier defect.
There are some studies that suggest there is higher eczema heritability from mothers rather than fathers, possibly due to maternal gene imprinting or transplacental fetal exposure to allergens, although this has not been confirmed. However, contradictory results have been reported in other studies.
Effects of Eczema on the Outcome of Pregnancy
There is little to no evidence suggesting that eczema has a direct effect on fertility, or that it causes birth defects, premature births or miscarriages. Eczema herpeticum, which is a rare and potentially serious viral infection that occurs when eczema comes into contact with the herpes virus, has not been linked to intrauterine infection. However, herpes simplex virus is linked to premature delivery, intrauterine growth restriction, and miscarriage.
Diagnosis of Eczema During Pregnancy
A simple visual examination of the skin is usually enough to diagnose eczema. Biopsies may also be taken.
Treatment of Eczema During Pregnancy
Ideally, strategies to control or minimize eczema should be put in place before conception, as eczema can worsen during pregnancy. However, this is not always possible. Some steps to minimize disease activity include avoiding allergens or irritants, including tight clothing and hot showers, harsh or medicated body cleansers, and using emollients (moisturizers).
There are a number of treatments that are safe to use during pregnancy:
- Mild, moderate or potent topical steroids
- Ultraviolet B (phototherapy).
Treatments that are considered relatively safe to use during pregnancy are:
- Low doses of very potent topical steroids
- Oral steroids in the third trimester
- Low doses of topical calcineurin inhibitors
Treatments to avoid during pregnancy are:
- Certain immune system suppressants
- Psoralen plus ultraviolet A (PUVA)
Around 2% of breastfeeding mothers develop eczema of the areola or nipple, and around 50% of these women will have atopic eczema. Low- to moderate-potency steroids along with emollients can be used to treat eczema in this area, although they should only be applied after feeding and completely washed off before feeding again.
PUVA and immune system suppressants should be avoided in breastfeeding mothers, and the recommended minimum systemic drug-free interval for both men and women before conception is three months for immune system suppressants.
Aside from these treatments, emollients are a very important part of eczema management, as they act as a protective barrier for the skin and minimize the water loss that exacerbates eczema symptoms.