Can I plan a pregnancy safely while on eczema treatment?

Question

Hello doctor,

I have been struggling with eczema for years, and I am using topical steroids plus Dupilumab. I want to start a family, but I am unsure if it is okay to stay on biologics while pregnant.

My concerns are:

If I stop, what if it flares badly?
Are there safer treatments to switch to?
Also, could severe eczema or itching cause stress that might affect the baby?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Your concern is about Dupilumab. It is a monoclonal antibody that is safer, but in the long term, if you use this medication, it should be stopped in pregnancy. The benefit of the potential risk of eczema is to control it with the moisturizer and topical short-course, steroid, and narrowband UVB phototherapy is considered safer in pregnancy as compared to Dupilumab. The probable cause may be immune-mediated skin inflammation.

So, I would like to advise you to undergo certain tests, such as

Blood profile for baseline, pregnancy.
Serum test.
Vitamin D.
Iron status to rule out the skin infection if worse.

We need to rule out:

Chronic contact dermatitis.Prurigo of pregnancy.Atopic dermatitis.

Probable diagnosis would be atopic dermatitis or chronic eczema.

I would suggest the following:

Continue with the Dupilumab.

Visit your dermatologist regarding safety with this medication, or discontinue the medication. Switch to a topical low- to moderate-potency steroid or phototherapy.

Avoid systemic steroids unless short-term for severe flares.

Review with your dermatologist after four to six weeks during pregnancy or a flare of the disease. Avoid triggers, maintain skin hydration, and manage stress.

I hope this helps.

Thank you.