How to use eczema meds safely while trying to conceive?

Question

Hello doctor,

I have had atopic dermatitis since I was a youngster, but my symptoms have recently gotten worse and are most noticeable on my neck, breasts, and inner thighs. I am 32 and trying to conceive, and I am worried about the safety of steroid creams or immunosuppressive meds when attempting to conceive or do IVF.

Are these treatments safe at this point?
I have also found that my flare-ups seem to get worse right before my period. Are there hormonal influences on this pattern?
Also, the acute itching has been impacting my sleep and personal life and has begun to affect me emotionally. Can stress really make eczema worse?
I have heard some people get better dermatitis when pregnant and some get worse eczema. What produces these differences?
I would also need some advice on appropriate moisturizers or treatment choices to use while pregnant and breastfeeding. Finally, might eczema itself or the medications used to treat it affect the baby?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have read your query and understand your concern.

I know how painful and irritating atopic dermatitis can be, especially when the itching is severe and starts to affect your day-to-day life, sleep, and emotional well-being. I can understand it is quite normal that you would be worried, as you have been living with this issue for a long time, and now you are planning a pregnancy.

You said you are currently on steroid medicines and immunosuppressants. These medicines can help to reduce severe flare-ups, but some therapies may not be suitable when pregnant or attempting to conceive. That is why I highly recommend speaking with your dermatologist and gynecologist before continuing or changing any medication. They can help direct you to the safest treatment alternatives for you and your future baby.

Hormonal fluctuations can certainly play a part in increasing eczema symptoms, and many women will feel flare-ups around their periods. It is a cycle of itching and flare-ups that can be worsened by stress and emotional pressure. Besides treatment, taking care of your emotional health and decreasing stress as much as possible can also help relieve symptoms.

Try to keep your skin well moisturized, as dryness often makes eczema worse. Stay away from the sun, heat, strong soaps, and irritants. There are gentle, pregnancy-safe moisturizers available; however, the decision should be made based on your skin condition and medical history.

To better understand the severity of the condition and rule out associated issues, some investigations may be helpful, including:

Serum IgE levels.
Complete Blood Count (CBC).
ESR and CRP.
Liver Function Test (LFT).
Kidney Function Test (KFT).

At present, the probable diagnosis is atopic dermatitis, an immune-mediated skin condition. Continue using the medications prescribed by your dermatologist, but please avoid starting or stopping steroids or immunosuppressants on your own while planning pregnancy.

I would also recommend a follow-up consultation within a week, or earlier if your symptoms worsen. If needed, taking a second opinion from both a dermatologist and a gynecologist may help you feel more reassured and confident about the treatment plan moving forward.

Look after yourself, drink enough fluids, use moisturizer regularly, and try to reduce stress as much as possible. With appropriate counseling and therapy, your symptoms can be safely managed during this stage of life.

I hope these suggestions are helpful.

Take care, and feel free to reach out if you need further guidance.

Thank you.