In this video blog, Jenny Murase, MD, summarizes her Fulfilling Great Expectations: Safe Medical Management of Skin Disease in Pregnancy lecture , given on November 10, 2024, at the 5th Annual Elevate-Derm West Conference at the Westin Kierland Resort in Scottsdale, AZ.

In this video

Dr. Murase starts with acne, noting how many women of childbearing age are affected. She explains that benzoyl peroxide is over the counter "for a reason" — it's a food additive quickly converted to benzoic acid in the skin — and that topical retinoids like adapalene deliver a level of vitamin A comparable to or less than a prenatal vitamin, making these topicals safe on limited body surface areas. When topicals aren't enough, she reaches for cephadroxil (the cephalosporin with the lowest reported birth-defect rate per the Briggs reference) for acne vulgaris, and amoxicillin for a rosacea pattern.

She emphasizes the provider's responsibility to counsel proactively, citing that 50% of pregnancies occur without consulting a provider and dermatology patients discuss it beforehand only 20% of the time — so anything prescribed to women of childbearing age, including JAK inhibitors for atopic dermatitis, needs that conversation up front. On biologics, she explains that antibody transfer across the placenta is minimal in the first trimester and increases exponentially right before delivery (infliximab reaches ~160% of maternal levels), meaning first-trimester embryogenesis concerns are largely irrelevant — and she cautions against prematurely pulling biologics and leaving women to suffer flared disease. She also points to her recently published 10-year JAAD CME update on dermatologic medications in pregnancy and lactation as a counseling resource.

  • Benzoyl peroxide and topical retinoids like adapalene are over the counter "for a reason" and are safe on limited body surface areas in pregnancy, since retinoid vitamin A exposure is comparable to a prenatal vitamin.
  • For oral antibiotics, cephadroxil has the lowest reported birth-defect rate among cephalosporins for acne vulgaris; amoxicillin is preferred for a rosacea pattern and has an excellent pregnancy safety profile.
  • The onus is on the provider to counsel proactively — 50% of pregnancies aren't discussed with a provider, and dermatology patients raise it beforehand only 20% of the time.
  • With biologics, exposure that matters occurs in the third trimester, when antibody transfer increases exponentially (infliximab reaches ~160% of maternal levels); first-trimester embryogenesis concerns are largely irrelevant.
  • Don't prematurely pull biologics — flared skin disease, infection, chronic itch, and lost sleep create stress that can itself impact the pregnancy.