How to Safely Treat Acne, Psoriasis, and Eczema During Pregnancy

A balance of medication safety and effective disease control is often necessary when clinicians treat common dermatologic conditions in pregnant patients, and this topic was highlighted during the 2026 SDPA Summer Dermatology Conference by Jenny Murase, MD, professor of dermatology at the University of California, San Francisco (UCSF).^1,2

Murase spoke with HCPLive about several major themes from her session, titled ‘Fulfilling Great Expectations: Safe Medical Management of Skin Disease in Pregnancy,’ providing practical guidance on managing psoriasis, acne, atopic dermatitis, and pregnancy-specific dermatoses. Murase discussed preferred approaches for several common inflammatory skin diseases during pregnancy, the ways in which physiologic immune shifts can impact disease activity, and reasons why clinicians should avoid discontinuing effective therapies unnecessarily when available safety data support continued use.

The following Q&A interview with Murase highlights her responses to inquiries by the HCPLive editorial team during the SDPA conference:

HCPLive: Acne, psoriasis, and other conditions may persist or flare during pregnancy. Which treatment approaches do you find most useful in managing those particular patients?

Murase: For acne, I tend to prescribe amoxicillin if it's more like an acne rosacea patient, and then cefadroxil or cefalexin if it's an acne vulgaris patient. Those have more data to support the safety than the macrolide antibiotics, for which there have been reports of both pyloric stenosis and atrial septal defect potential for increase with the macrolides. The macrolides are still okay to use, like azithromycin, but it's a second-line agent compared to the penicillin class. Now, you know I think you always have to look at the baseline of what the pregnancy itself does to the condition.

For something like psoriasis, for example, that actually tends to improve in pregnancy when you get that shift of immunity to have a decrease in Th17 and a decrease in Th1, and you increase Th2. But eczema can worsen. So you get this sort of yin-yang effect where there's this shifting immune system. Sometimes during pregnancy, the pregnancy itself is going to treat it, and they don't necessarily need to even be on a biologic. Whereas other times, for example, for atopic dermatitis patients, it might be even more necessary to use the therapeutics.

I did just publish on dupilumab specifically. I contacted my colleagues, and we got 85 cases worldwide to further reinforce that the therapeutic is not showing any safety signals that have been out for close to a decade now. I think it's important for providers not to be making the recommendation to remove a therapy unnecessarily when it's really treating the patient and getting them to a point that they can live in their own skin and not have the stress of a bad exemptuous eruption or skin infection or itch that's keeping them up at all hours of the night, when the therapeutic itself is really documented over now close to a decade to show that safety in pregnancy.

HCPLive: Pregnant patients can present with a variety of rashes and eczematous eruptions. What are some key clinical clues that can help clinicians to distinguish pregnancy-specific dermatoses from other causes?

Murase: Pregnant women can get everything that non-pregnant women get. So, scabies, allergic contact, and irritant contact will all occur. For the pregnancy dermatoses specifically, we're looking particularly at atopic eruption of pregnancy, which is AEP, as well as polymorphous eruption of pregnancy, which is PEP. Those are far and away the two most common, and luckily, they don't have any implications for the fetus. The AEP, the atopic eruption, usually has some kind of history of atopy, maybe asthma, eczema in childhood, or maybe they have eczema even to adulthood, and those patients are going to start kind of earlier in the first trimester, and it'll be sort of in sites of friction, like the hands or the nipples, especially extremities.

Whereas the PEP, the polymorphic eruption, which used to be called PUP, urticarial papules and plaques of pregnancy. They're not just urticarial; they can be erythematous. They can even have small vesicles. They can be targetoids sometimes. So that's why it turned into polymorphous, lots of shapes, polymorphous eruption of pregnancy. So that condition tends to be related to the skin stretching. That's why it happens more the first time a baby is conceived. So primogravida, the first child, is more common in twins and triplets. Multi-gravida pregnancies tend to occur late in the third trimester because the skin is being stretched on the buttocks, thighs, and abdomen, and luckily, both of those are benign conditions. The things that we don't want to miss, you know, I say when in doubt, you know, do these two things.

For intrahepatic cholecystases of pregnancy, where the bile acids can actually compromise the placenta itself, you want to do a bile acid level. Usually, the patients will just have secondary change, meaning that they've scratched themselves, but there's no primary excoriation process. Also, certainly, pemphigoid gestationalis, which is a blistering disease, because the placenta and the skin are both epidermal in origin. Antibodies are created that attack both the skin and the placenta, causing placental insufficiency if it's not caught. You detect that either through doing an ELISA blood test for BP180 or you can you can you can do a DIF, a direct immunofluorescence biopsy, and if you do those two things, you're kind of covering your bases.

There's also something called pustular psoriasis of pregnancy, which is kind of like the third pregnancy dermatosis. It's not always included in the pregnancy dermatosis category, and they usually don't have a personal history of psoriasis for that condition specifically. There are pustules, with the special consideration that you need to check a calcium level because hypocalcemia has been associated with seizures and tetany. That would be something I also consider. Definitely something to consider is doing that calcium level.

Disclosures: Murase has previously reported serving on the speakers board for AbbVie, Galderma, LEO Pharma, Lilly, Pfizer, Regeneron, Sanofi, and UCB; on advisory boards for Arcutis, Blueprints Medicine, Bristol Myers Squibb, Galderma, LEO Pharma, Lilly, Pfizer, Regeneron, Sanofi, and UCB; and providing dermatologic consulting services for AbbVie, Apogee Therapeutics, Attovia, Galderma, Lilly, Regeneron, Sanofi, UCB, and UpToDate.

References

1. Murase J. Skin at Different Stages Track: Fulfilling Great Expectations: Safe Medical Management of Skin Disease in Pregnancy. Session presented at SDPA Summer 2026; June 10–14.

2. Murase J. Tips for Safe Management of Skin Disease During Pregnancy, With Jenny Murase, MD. HCPLive. July 9, 2026. Accessed July 10, 2026. https://www.hcplive.com/view/tips-safe-management-skin-disease-pregnancy-jenny-murase-md.