Eczema and Pregnancy: What You Need to Know

Ah, the joys of pregnancy! While some women sail right through it, others endure morning sickness, varicose veins and hemorrhoids, to name just a few common afflictions of that blessed state. And a history of eczema flare-ups may add one more source of distress into the mix.

The worsening of eczema during pregnancy has to do with the influence of female sex hormones — specifically estrogen — on a woman’s immune system, said Dr. Jenny Murase, a dermatologist on the faculty of the University of California-San Francisco.

“During pregnancy, a shift takes place in a woman’s body from Th1-dominant to Th2-dominant immunity,” Murase explained. “Th1 cells specialize in defending our bodies against foreign invaders such as bacteria, viruses and anything recognized as ‘non-self’ that try to penetrate our cells. Half of the fetus’s genetic material comes from the mother and half from the father. So the Th1-dominant response, left to its own devices, will mount an attack against the half that’s from the father and cause the fetus to abort.

“To protect the growing fetus,” Murase continued, “a pregnant woman’s body temporarily shifts to Th2-dominant immunity. Th2 cells are all about fighting off allergens and toxins that circulate outside our cells.”

“To protect the growing fetus,” Murase continued, “a pregnant woman’s body temporarily shifts to Th2-dominant immunity. Th2 cells are all about fighting off allergens and toxins that circulate outside our cells.”

The upshot is that Th2-dominant immunity keeps the fetus safe but makes the mother more sensitive to allergens — in other words, to triggers that aggravate asthma, food allergies and eczema.

In her research, Murase has found that the high levels of estrogen seen in pregnancy are responsible for the shift from Th1- to Th2-dominant immunity. Estrogen, then, is at least partly to blame when the happiest of events turns a woman’s skin inflamed and itchy and her nights sleepless and miserable.

Pregnancy affects eczema differently in women

Carol Kim, a 28-year-old Asian American from Puyallup, Washington, has had atopic eczema all her life. As a child, she’d scratch in the creases inside her elbows and behind her knees. “Usually, a small application of steroid cream would keep it under control,” she said. “In fact, my eczema was only a minor problem until I got pregnant with my first child about two years ago.”

Kim was “ecstatic” about the pregnancy. But soon, this skin condition reared its ugly head, and it erupted full force after her son was born. “A couple of months into breastfeeding, I woke up covered with eczema from top to bottom. The skin all over my face and body was flaking, oozing, itchy and painful. I had cuts at each corner of my mouth and on my earlobes and eyes. My eyes were so swollen that they wouldn’t close.

“At its worst,” she added, “I couldn’t sleep, get out of bed, go out in public and, worst of all, I couldn’t be the mother I wanted to be with my newborn baby.”

Kim made several visits to an urgent care facility, where she received corticosteroid shots. These provided relief, but when their effects wore off, her eczema returned with a vengeance. Soon after a new treatment option was approved, she went on the new biologic and experienced “five glorious months of normal skin.” But Kim couldn’t tolerate the side effects she experienced, so she had to stop taking it.

Thankfully, her eczema isn’t as severe now as it was right after giving birth. She still struggles with her “full face of eczema” and outbreaks here and there on her body. Topical steroids help her stay afloat while she considers other options, such as immunosuppressants and methotrexate. And she hasn’t given up hope that one day, she’ll find her way back to something resembling normal skin.

Meg Waterston* hasn’t given up either. The 24-year-old from London gave birth to a baby boy a little more than a year ago. But unlike Kim, whose skin erupted after childbirth, eczema hit hard during Waterston’s second trimester for the first time in her life. “Sometimes, my skin itched so bad that I’d scratch until I bled. I also developed a staph infection and a bad case of hives. At a certain point, I decided to go on oral steroids,” she said.

That’s when anxiety started to take over. Waterston was told by her doctors that her son might be born addicted to steroids, in which case he’d need steroid injections right after birth and for some time thereafter. Torn between her urgent need for relief and her baby’s risk for addiction, she took steroids during her third trimester and hoped for the best.

To Waterston’s relief, her newborn son didn’t need injections after all. And his skin is “perfect,” she said. “As for my own skin, I’m under the care of a really good dermatologist now. I’m taking oral steroids once a week or once every two weeks, and that seems to be keeping my eczema under control.”*

*Not her real name.

Safe treatments for pregnant women with eczema

Dr. Peter Lio, a member of the faculty of Northwestern University’s Feinberg School of Medicine, who has a clinical practice in Chicago, estimates that about 50 percent of pregnant women with a history of eczema experience worsening symptoms during pregnancy. Any pregnant person with eczema or a history of hay fever or other allergies is at an increased risk of an atopic eruption of pregnancy.

He often prescribes phototherapy for his pregnant patients with eczema, insisting that they also take folic acid, an important nutrient that can easily become depleted by light treatment.

According to Murase, topical steroids are safe to use during pregnancy, especially at low-to-medium potency levels. “There’s a slightly higher incidence of low birth weight with steroid use, but only if a woman were to apply more than 300 grams of it over the course of her entire pregnancy,” she said. “That’s more than most patients would ever need.”

To stay on the safe side, Murase suggests diluting a topical steroid with moisturizer to achieve a ratio of four parts moisturizer to one part steroid. “I advise my patients to avoid using it on areas that will expand during pregnancy, such as the belly and breast. That’s because topical steroids can worsen the appearance of stretch marks.”

Both Lio and Murase stressed the importance of keeping eczema under control during pregnancy. A sleep-deprived mother offers a less-than-favorable environment for her unborn child, and the negative effects of postpartum stress on the developing fetus have been well documented, Murase said.

Before starting a treatment option, whether a supplement, steroid or skin care product, discuss your options with your healthcare providers. Especially if there are skin changes during pregnancy, you live near eczema irritants or have a history of itchiness or dry skin from eczema, you want a dermatologist in your corner during and after pregnancy.

Having a healthy pregnancy is within reach, even when eczema is on the warpath. During pregnancy and after childbirth, a woman needs to be well-nourished, well-rested and as free from stress as possible. Excellent self-care, the doctors agreed, is the greatest gift a woman can give herself and her newborn.