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  1. Sophie Weatherhead, Wellcome clinical training fellow1,
  2. Stephen C Robson, professor of fetal medicine2,
  3. Nick J Reynolds, professor of dermatology1
  1. 1Dermatological Sciences, Institute of Cellular Medicine, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne
  2. 2Uterine Cell Signalling Group, Institute of Cellular Medicine
  1. Correspondence to: N J Reynolds N.J.Reynolds{at}ncl.ac.uk

    Many women with eczema experience flares during pregnancy, and management must take account of the possible effects of some treatments on the fetus

    Introduction

    Atopic eczema has a reported lifetime prevalence of 8-17% in adults aged under 60.1 It is more common in women, affecting 16% in the United Kingdom, and in adults has its highest prevalence between the ages of 16 and 24.2 The incidence of eczema seems to be generally increasing, particularly in children.3 4 Moderate to severe eczema can be particularly difficult to manage, and second line treatments are often needed to control it.5

    As the scenario suggests, treatment options become limited when a patient decides to try to conceive, and disease control is often suboptimal. This article discusses management of eczema and the important implications in pregnancy.

    SCENARIO

    A 26 year old woman with lifelong moderate to severe atopic eczema had been unable to achieve good disease control with topical drugs. She received narrow band ultraviolet B phototherapy in 2001 but relapsed within a short time. As part of a randomised controlled trial she received 12 weeks of azathioprine,6 on which she greatly improved. She subsequently failed to respond to topical tacrolimus but received two further courses of azathioprine, both with an excellent response.

    Six months after stopping azathioprine she became pregnant, and her eczema quickly flared. This was managed with potent topical steroids, although her disease remained troublesome throughout the pregnancy. After the birth of her child, her eczema was managed with methotrexate with a good response.

    Methods

    We searched national health information sources, the Cochrane database and PubMed up to March 2007. Key search words used included “atopic dermatitis”, “eczema”, “pregnancy”, “maternal”, and “breastfeeding”. We used our personal archive of references and sought advice from the National Teratology Information Service, Drug Information …

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