Safety First: Navigating Dermatologic Therapies in Pregnancy

Dr Melissa Mauskar demystified dermatologic care in pregnancy with equal parts evidence, candor, and real-life experience. Her key message: Thoughtful risk-benefit counseling is essential, and often empowering, for patients managing chronic skin conditions during pregnancy and lactation.

“Patients are afraid; I think a lot of dermatologists are afraid to keep their patient on a medicine,” Dr Mauskar said, referencing how even when conditions like hidradenitis suppurativa or pustular psoriasis are well-controlled, they are often destabilized by abrupt medication discontinuation. “You have to think about how that disease is impacting them,” she emphasized, noting the ripple effect on both mother and baby when severe flares occur.

Dr Mauskar provided an overview of the outdated A/B/C/D/X rated pregnancy drug categories and the current labeling, which includes more detailed risk summaries. Still, she acknowledged, “I think that a lot of people still use that old labeling even though it’s 10 years ago that we made this change.”

A major theme of the session was counseling before, during, and after pregnancy. For acne, she stressed topical-first approaches: “Azelaic acid and benzoyl peroxide are my go-to options,” she said, highlighting their safety profiles in pregnancy and lactation. But she also addressed what to do when topicals fail. “Some patients do need oral antibiotics,” Dr Mauskar explained, adding that safe systemic options include amoxicillin or low-dose prednisone when flares are severe.

And what about retinoids or spironolactone during lactation? “You can use topical retinoids, spironolactone, and short-term tetracyclines for acne in your lactating patients,” Dr Mauskar reassured the audience.

The session also spotlighted more complex cases, like generalized pustular psoriasis of pregnancy. “It can be life-threatening,” Dr Mauskar warned, noting that options include cyclosporine, prednisone, and, for severe cases, spesolimab, the only US Food and Drug Administration-approved IL-36R antagonist for generalized pustular psoriasis.

Closing with a call for collaboration, Dr Mauskar urged attendees to coordinate closely with obstetricians and other specialists. “Preconception counseling and involving both patients and their OBs is key,” she said.

Reference

Mauskar M. Safety of drugs in pregnancy​​. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.