My Pregnancy Test Is Positive and My Eczema Is Bad!” So, What Do We Do Now?

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Mona Shahriari, MD, associate director of clinical trials at Central CT Dermatology and assistant clinical professor at Yale University, to discuss the challenges of treating pregnant and breastfeeding patients, particularly those with atopic dermatitis (AD). The conversation addresses a crucial yet often unclear topic for dermatologists: balancing safety and efficacy when managing AD in patients during pregnancy and lactation. Dr Shahriari emphasizes the importance of addressing uncontrolled inflammation, which can have potential consequences for both the mother and baby, such as premature birth and maternal sleep disruption. She shares insights into the physiological changes during pregnancy, including the shift from a Th1 to a Th2 immune state, and how this can impact conditions like AD and psoriasis. The discussion highlights the limited data available for systemic treatments in this population, as pregnant women are excluded from clinical trials. Despite this, therapies like dupilumab and cyclosporine are discussed for their safety profiles, with dupilumab often considered when patients need effective control with minimal risk. Dr Shahriari also addresses strategies to involve partners in treatment decisions, ensuring patients feel supported and informed. Drs Del Rosso and Shahriari emphasize the importance of open communication with patients, managing risk tolerance, and understanding the nuances of systemic treatment in pregnancy and lactation. Dr Shahriari shares real-world cases, including the use of dupilumab in a pregnant patient with severe AD and counseling a patient with psoriasis who unintentionally administered a biologic injection during the first trimester. Tune in to the full episode for practical guidance on navigating these complex cases and balancing patient care with available evidence. This episode is a must-listen for dermatologists managing pregnant or breastfeeding patients with inflammatory skin conditions.