How to Tell the Difference Between Nummular Eczema and Ringworm
It’s often difficult to distinguish between nummular eczema and ringworm, so it’s always best to be evaluated by a dermatologist, say experts.
Published On: May 1, 2023
Last Updated On: Jun 28, 2023
Pregnancy can be a roller coaster of excitement, nausea and raging hormones. What happens when you add eczema to the ride?
Many women experience eczema for the first time while pregnant, and those who already have eczema sometimes find their condition flares up during this time.
We asked Dr. Jeff Yu, a board-certified dermatologist at Massachusetts General Hospital, to help answer some vital questions about eczema during pregnancy.
Eczema can impact anyone during pregnancy. In fact, it is the most common prenatal skin condition.1
A majority of women with eczema in pregnancy have never had it before.1 Approximately 60%–80% of prenatal eczema patients have no prior history of the condition.1
“Often pregnancy can cause flaring atopic dermatitis, called atopic eruption of pregnancy,” said Dr. Yu. “It’s unpredictable, as it doesn’t happen in all patients.”
Eczema in pregnancy may occur because of changes in hormones and the immune system. During pregnancy, your body’s immunity shifts to help keep the fetus safe. But this shift in immunity can make the mother more sensitive to allergens.2
And if you have eczema, hay fever or other allergies before your pregnancy, it can put you at higher risk of developing eczema during pregnancy.
Research has found that over 50% of women with eczema found their symptoms worsen while pregnant.1 However, 25% experienced improved eczema symptoms.1
Increased flaring can happen at any time while pregnant or postpartum, though it occurs slightly more often in the second trimester.1
Mild and moderate cases of eczema generally do not hurt an unborn infant. However, “untreated, severe atopic dermatitis can negatively affect the fetus,” said Dr. Yu.
Another condition to look out for during pregnancy is eczema herpeticum, an infection caused by the same virus as oral herpes. Having eczema herpeticum in pregnancy can cause complications and in some cases lead to fetal loss.3 Talk to your doctor if you have concerns about eczema herpeticum.
Here is a breakdown of various treatment options and their safety while pregnant:
Over-the-counter moisturizers – “Over-the-counter moisturizers are generally safe to continue during pregnancy,” said Dr. Yu. “However, most prescription medications for atopic dermatitis have not been adequately tested during pregnancy to determine their safety.”
Topical corticosteroids – According to Dr. Yu, there was a large research review that found topical corticosteroid use to be safe in pregnancy.4 However, these medications have a Pregnancy Category C rating. This means more research needs to be done to conclusively determine safety. Topical corticosteroids can worsen the appearance of stretch marks on the belly or breasts.
Mild topical steroids – Many dermatologists, including Dr. Yu, cautiously prescribe mild topical steroids to pregnant patients. “My usual practice is to restrict topical steroids to a low- to medium-potency, over a limited body surface area, and to make sure to get the okay from the patient’s OB-GYN before prescribing,” said Dr. Yu.
Novel topical agents – “Even less is known about the safety of novel topical agents, such as tacrolimus and pimecrolimus,” said Dr. Yu. These fall into a category of medications called topical calcineurin inhibitors and also have a Pregnancy Category C rating. A 2007 research review stated they are relatively safe to use during pregnancy in small quantities.1
Phototherapy – Other dermatologists sometimes prescribe phototherapy. Ultraviolet B light therapy is considered to be safe during pregnancy, but Psoralens plus ultraviolet A (PUVA) light therapy is regarded as unsafe.1
Biologics – “Systemic agents are generally not recommended for use during pregnancy unless absolutely necessary,” said Dr. Yu. “The general belief is that severe, uncontrolled atopic dermatitis is more detrimental to the fetus than dupilumab. However, a thorough discussion of risks and benefits should be done with a dermatologist and OB-GYN.”
JAK inhibitors – Some eczema treatments are completely off-limits. “JAK inhibitors (upadacitinib and abrocitinib) are not safe during pregnancy,” explained Dr. Yu. Methotrexate should also be avoided in pregnancy.1
Genetics do play a role in eczema, but determining the size of that role is difficult.
Having at least one parent with eczema is a risk factor for developing eczema. If both parents have eczema, a child has a 50% chance of developing it too.
But it’s not all about genes. The environment also determines whether or not eczema-prone genes will be expressed. Research has found that people living in urban environments are more likely to have eczema than those in rural environments, likely due to air pollution.5
Climate and food allergies can also contribute to eczema, as well as chemicals in clothing and other household items.5
Scientists are still trying to answer this question. So far, there aren’t any definitive answers.
Some studies have found that moisturizing infants’ skin at least once per day may help prevent or improve eczema symptoms. More research is needed to examine the basis of these results and determine which ingredients work best.
Research has also been done on whether or not changes in diet or extended breastfeeding can prevent eczema in children. So far, there is no conclusive evidence that changes in maternal or infant diet, or extended breastfeeding, make a difference.
Other researchers have explored a relationship between eczema and gut health. Supplementing with Lactobacillus or Acidophilus strains of probiotics in pregnancy and postpartum may help to reduce atopic dermatitis in infants, but more research needs to be done in this area too.
Eczema can make pregnancy even more of an adventure than it already is. If you’re struggling, don’t hesitate to speak with your healthcare professionals. And find an eczema expert if you don’t already have one in your corner.
References:
It’s often difficult to distinguish between nummular eczema and ringworm, so it’s always best to be evaluated by a dermatologist, say experts.
Karin Stoddart, 20, a college student from Seattle, finally has her eczema under control after battling with two insurance companies to stay on her doctor-prescribed medication.
Learn which plants won’t irritate your eczema — and can also help purify the air in your home.
Christina Crowley, from Berkeley, California, shares how she became a NEA board member — recently NEA’s Board Chair in 2023 — as well as a donor and Itching for a Cure fundraiser.
Evidence-based articles, expert-sourced lifestyle tips and stories from your community.