Conference Coverage

Prioritize topical treatments in pregnant women


 

EXPERT ANALYSIS FROM AAD 18

SAN DIEGO – Pregnant patients with a skin problem often pose unique challenges for dermatologists because of the risks associated with certain dermatologic medications. “Some doctors don’t treat them at all, or they undertreat because they’re afraid of prescribing anything,” said dermatologist Kelly H. Tyler, MD.

Dr. Kelly H. Tyler

Dr. Kelly H. Tyler

Human trials are lacking, and most evidence is from animal studies, said Dr. Tyler of the division of dermatology at Ohio State University, Columbus, who spoke during a presentation at the annual meeting of the American Academy of Dermatology.

But the Food and Drug Administration’s new system of prescription drug labeling for pregnant women offers improved insight for dermatologists, and a variety of alternatives are available to commonly used dermatologic drugs that pose risks, said Dr. Tyler, who has a unique perspective on this issue: She used to practice as an ob.gyn.

In her presentation, she provided the following tips when caring for pregnant patients.

Check the prescription drug labeling for pregnant and lactating women

Prior to 2015, the FDA used a letter ratings to denote the risk of medications during pregnancy. The ratings – A, B, C, D, and X – go from “A” showing no fetal risk in controlled studies to “X” in which a drug is contraindicated because “there is no reason to risk use of drug in pregnancy.”

This rating system is problematic, Dr. Tyler said, since it’s imprecise. She noted that about two-thirds of medications have a risk rating of C, which means “Risk cannot be ruled out; human studies may or may not show risk; potential benefits may justify potential risk.” But, she asked, “How are you supposed to know what to do with that kind of information?”

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