How to safely manage atopic dermatitis in nursing mothers?

Question

Hello doctor,

My 28-year-old daughter has severe atopic dermatitis that has worsened significantly since she had her baby eight months ago. The eczema now covers most of her arms, face, and neck, and she scratches until she bleeds during the night. We suspect it may be related to hormonal changes from breastfeeding, but none of the creams are working anymore. She tried tacrolimus ointment, but it burned her skin and made the redness worse. Her IgE levels came back at 450, which the dermatologist said is very high.

The flare-ups occur every few weeks and last for days, during which she can barely function or take care of the baby. Topical steroids helped previously, but now they cause skin thinning, and we are concerned about the long-term effects. She had to stop breastfeeding because one of the medications could affect the baby. The itching is so severe that she cannot sleep, and it is affecting her mental health. Are there any safe treatments for nursing mothers, or should she consider stopping breastfeeding completely to access more effective medications?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am so sorry your daughter is going through this. Postpartum flares can be brutal. Yes, hormonal shifts and stress-absolutely worsen eczema.

While breastfeeding often helps some, her severe case may require stepping up treatment safely:

Specialist urgent: Request a review by a dermatologist and allergist due to her high IgE level (450). Dupilumab (Dupixent) is an injectable biologic approved for breastfeeding with excellent results for severe eczema-like hers. It often works when creams fail.
Soothing now: Try wet wrap therapy over thick moisturizers (like plain petroleum jelly) to heal broken skin and reduce night scratching. Use fragrance-free colloidal oatmeal baths for itch relief. Cool packs and cotton gloves are used at night to protect her skin.
Mental health: Sleep loss and stress feed the cycle. Ask her doctor about safe antidepressants (e.g., Sertraline) that also reduce itching.
Breastfeeding choice: Many strong meds (like JAK inhibitors) do require weaning. Dupilumab is likely safest if continued. If she chooses to stop, that’s okay; her health matters, too.
Action: Request Dupilumab access now and wet wrap guidance today. She should not suffer needlessly.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.