Safety of dermatologic medications in pregnancy and lactation

Part I. Pregnancy
      Dermatologists are frequently faced with questions about the safety of commonly prescribed topical and systemic medications during pregnancy and lactation from women of childbearing age who are pregnant, considering pregnancy, or breastfeeding. Safety data, particularly regarding medications that are unique to dermatology, can be difficult to locate and are not consolidated in a single reference guide for clinicians. Parts I and II of this continuing medical education article provide a capsule summary of key points for the most commonly prescribed dermatologic medications to facilitate patient medication risk counseling in pregnancy. A summary table details safety classification data for 3 primary international classification systems: the US Food and Drug Administration, the Swedish Catalogue of Approved Drugs, and the Australian Drug Evaluation Committee. In addition, this table includes an alternative pregnancy classification system developed by a consortium of active members of teratology societies in the US and Europe detailed in Drugs during Pregnancy and Lactation: Treatment Options and Risk Assessment and a safety classification system developed for breastfeeding mothers detailed in Medications and Mother's Milk.

      Key words

      Abbreviations used:

      ADEC (Australian Drug Evaluation Committee), BBUVB (broadband ultraviolet B light), FDA (Food and Drug Administration), HCQ (hydroxychloroquine), IVIG (intravenous immunoglobulin), MMF (mycophenolate mofetil), NBUVB (narrowband ultraviolet B light), NTD (neural tube defect), PUVA (psoralen plus ultraviolet A light phototherapy), TNF (tumor necrosis factor)
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      Linked Article

      • The use of tumor necrosis factor inhibitors in pregnancy: What is the evidence?
        Journal of the American Academy of DermatologyVol. 71Issue 4
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          To the Editor: We commend Murase et al1 on their excellent review of the use of medications for dermatologic conditions in pregnant and lactating women, which we believe will be of significant value for all dermatologists. We are concerned, however, about the lack of evidence supporting the statement in the CME article that there is an increased rate of spontaneous abortion if etanercept is used during the first trimester. This was based solely on a small study of 140 pregnant patients with rheumatoid arthritis from the British Society for Rheumatology Biologics Register.
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        Journal of the American Academy of DermatologyVol. 70Issue 3