Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-11T07:47:40.028Z Has data issue: false hasContentIssue false

Chapter 23 - Dermatologic Conditions in Pregnancy

Published online by Cambridge University Press:  26 January 2024

By
David J. Berman
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Grace Lim
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Grace Lim
Affiliation:
University of Pittsburgh
Get access

Summary

The unique hormonal environment of pregnancy causes several changes to skin, hair, and nails. These changes may alter the appearance or behavior of chronic skin conditions, necessitating management changes. Additionally, the anesthesiologist may encounter several pregnancy-specific dermatologic conditions, some of which have broad implications for anesthetic management. Dermatologic drug safety in pregnancy is also a significant concern, as many of the medications commonly used outside of pregnancy are considered teratogenic. A thorough understanding of common dermatologic disease states and their implications on anesthetic management is crucial for the practitioner of obstetric anesthesia.

Keywords

dermatosespregnancypemphigoid gestationiseruptioncholestasisdrug safetypustular psoriasisneuraxial anesthesia
Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 389 - 401
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Birnbach, DJ, Stein, DJ, Murray, O, et al. Povidone iodine and skin disinfection before initiation of epidural anesthesia. Anesthesiology 1998;88:668–672.Google Scholar
Messager, S, Goddard, PA, Dettmar, PW, et al. Comparison of two in vivo and two ex vivo tests to assess the antibacterial activity of several antiseptics. J Hosp Infect 2004;58:115–121.Google Scholar
McKay, RS, Schlicher, JE. Dermatoses. In Gambling, DR, Douglas, MJ, McKay, RS (Eds.), Obstetric Anesthesia and Uncommon Disorders (2nd edn.). Philadelphia, PA: W. B. Saunders, 2014:342.Google Scholar
Hillman, SC, Stokes-Lampard, H, Kilby, MD. Intrahepatic cholestasis of pregnancy. BMJ 2016;353:i1236.Google Scholar
Marschall, H-U, Wikström Shemer, E, Ludvigsson, JF, et al. Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: a population-based cohort study. Hepatology 2013;58:1385–1391.Google Scholar
Kowdley, KV. Lipids and lipid-activated vitamins in chronic cholestatic diseases. Clin Liver Dis 1998;2:373–389, x.Google Scholar
Yarnell, RW, D’Alton, ME. Epidural hematoma complicating cholestasis of pregnancy. Curr Opin Obstet Gynecol 1996;8:239–242.Google Scholar
Schumann, R, Hudcova, J. Cholestasis of pregnancy, pruritus and 5-hydroxytryptamine 3 receptor antagonists. Acta Obstet Gynecol Scand 2004;83:861–862.Google Scholar
Huilaja, L, Mäkikallio, K, Tasanen, K. Gestational pemphigoid. Orphanet J Rare Dis 2014;9: 136.Google Scholar
Roger, D, Vaillant, L, Fignon, A, et al. Specific pruritic diseases of pregnancy. A prospective study of 3192 pregnant women. Arch Dermatol 1994;130:734–739.Google Scholar
Kirtschig, G, Middleton, P, Bennett, C, et al. Interventions for bullous pemphigoid. Cochrane Database Syst Rev 2010;2010:CD002292.Google Scholar
Huilaja, L, Mäkikallio, K, Hannula-Jouppi, K, et al. Cyclosporine treatment in severe gestational pemphigoid. Acta Derm Venereol 2015;95:593–595.Google Scholar
Cianchini, G, Masini, C, Lupi, F, et al. Severe persistent pemphigoid gestationis: long-term remission with rituximab. Br J Dermatol 2007;157:388–389.Google Scholar
Marker, M, Derfler, K, Monshi, B, et al. Successful immunoapheresis of bullous autoimmune diseases: pemphigus vulgaris and pemphigoid gestationis. J Dtsch Dermatol Ges 2011;9:27–31.Google Scholar
Joly, P, Roujeau, J-C, Benichou, J, et al. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med 2002;346: 321–327.Google Scholar
Shornick, JK, Black, MM. Fetal risks in herpes gestationis. J Am Acad Dermatol 1992;26:63–68.Google Scholar
Nejim, T, Jenkins, CS, Uncles, DR, et al. Emergency caesarean delivery of a parturient with undiagnosed pemphigoid gestationis. Int J Obstet Anesth 2012;21: 288–290.Google Scholar
Taylor, D, Pappo, E, Aronson, IK. Polymorphic eruption of pregnancy. Clin Dermatol 2016;34:383–391.Google Scholar
Shornick, JK. Dermatoses of pregnancy. Semin Cutan Med Surg 1998;17:172–181.Google Scholar
Yancey, KB, Hall, RP, Lawley, TJ. Pruritic urticarial papules and plaques of pregnancy. Clinical experience in twenty-five patients. J Am Acad Dermatol 1984;10:473–480.Google Scholar
Regnier, S, Fermand, V, Levy, P, et al. A case-control study of polymorphic eruption of pregnancy. J Am Acad Dermatol 2008;58:63–67.Google Scholar
Aronson, IK, Bond, S, Fiedler, VC et al. Pruritic urticarial papules and plaques of pregnancy: clinical and immunopathologic observations in 57 patients. J Am Acad Dermatol 1998;39:933–939. https://doi.org/10.1016/s0190-9622(98)70265-8Google Scholar
Ambros-Rudolph, CM, Müllegger, RR, Vaughan-Jones, SA, et al. The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-center study on 505 pregnant patients. J Am Acad Dermatol 2006;54:395–404.Google Scholar
Roth, MM, Cristodor, P, Kroumpouzos, G. Prurigo, pruritic folliculitis, and atopic eruption of pregnancy: facts and controversies. Clin Dermatol 2016;34:392–400.Google Scholar
Vaughan Jones, SA, Hern, S, Nelson-Piercy, C, et al. A prospective study of 200 women with dermatoses of pregnancy correlating clinical findings with hormonal and immunopathological profiles. Br J Dermatol 1999;141:71–81.Google Scholar
Trivedi, MK, Vaughn, AR, Murase, JE. Pustular psoriasis of pregnancy: current perspectives. Int J Womens Health 2018;10:109–115.Google Scholar
Bellman, B, Berman, B. Skin diseases seriously affecting fetal outcome and matemal health. In Harahap, M, Wallach, RC (Eds.), Skin Changes and Diseases in Pregnancy. New York, NY: Marcel Dekker, Inc., 1996:129.Google Scholar
Oumeish, OY, Parish, JL. Impetigo herpetiformis. Clin Dermatol 2006;24:101–104.Google Scholar
Henson, TH, Tuli, M, Bushore, D, et al. Recurrent pustular rash in a pregnant woman. Arch Dermatol 2000;136:1055–1060.Google Scholar
Robinson, A, Van Voorhees, AS, Hsu, S, et al. Treatment of pustular psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2012;67:279–288.Google Scholar
Puig, L, Barco, D, Alomar, A. Treatment of psoriasis with anti-TNF drugs during pregnancy: case report and review of the literature. Dermatology 2010;220:71–76.Google Scholar
Lehrhoff, S, Pomeranz, MK. Specific dermatoses of pregnancy and their treatment. Dermatol Ther 2013;26:274–284.Google Scholar
Samieh-Tucker, A, Rupasinghe, M. Anaesthesia for caesarean section in a patient with acute generalised pustular psoriasis. Int J Obstet Anesth 2007;16:375–378. https://doi.org/10.1016/j.ijoa.2007.03.009Google Scholar
Jones, SV, Vaughan Jones, S, Ambros-Rudolph, C, et al. Skin disease in pregnancy. BMJ 2014;348:g3489–g3489. https://doi.org/10.1136/bmj.g3489Google Scholar
Lipson, AH, Collins, F, Webster, WS. Multiple congenital defects associated with maternal use of topical tretinoin. Lancet 1993;341:1352–1353.Google Scholar
Källén, BAJ, Otterblad Olausson, P. Maternal drug use in early pregnancy and infant cardiovascular defect. Reprod Toxicol 2003;17:255–261.Google Scholar
Källén, BAJ, Otterblad Olausson, P, Danielsson, BR. Is erythromycin therapy teratogenic in humans? Reprod Toxicol 2005;20:209–214.Google Scholar
Zeichner, JA. Narrowband, UV-B Phototherapy for the treatment of acne vulgaris during pregnancy. ArchDermatol 2011;147:537. https://doi.org/10.1001/archdermatol.2011.96Google Scholar
Weatherhead, S, Robson, SC, Reynolds, NJ. Management of psoriasis in pregnancy. BMJ 2007;334:1218–1220.Google Scholar
Huang, Y-H, Yee, Ng C, Chiou, M-J, et al. Fetal-neonatal and maternal outcomes in women with psoriasis vulgaris: a nationwide population-based registry linkage study in Taiwan. J Dermatol 2021;48:184–189.Google Scholar
Yang, Y-W, Chen, C-S, Chen, Y-H, et al. Psoriasis and pregnancy outcomes: a nationwide population-based study. J Am Acad Dermatol 2011;64:71–77.Google Scholar
Bozdag, K, Ozturk, S, Ermete, M. A case of recurrent impetigo herpetiformis treated with systemic corticosteroids and narrowband UVB. Cutan Ocul Toxicol 2012;31: 67–69.Google Scholar
Tauscher, AE, Fleischer, AB, Phelps, KC, et al. Psoriasis and pregnancy. J Cutan Med Surg 2002;6:561–570. https://doi.org/10.1177/120347540200600608Google Scholar
Clowse, MEB, Scheuerle, AE, Chambers, C, et al. Pregnancy outcomes after exposure to certolizumab pegol: updated results from a pharmacovigilance safety database. Arthritis Rheumatol 2018;70:1399–1407.Google Scholar
Mariette, X, Förger, F, Abraham, B, et al. Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, pharmacokinetic study. Ann Rheum Dis 2018;77:228–233.Google Scholar
Singh, G, Rao, DJ. Bacteriology of psoriatic plaques. Dermatologica 1978;157:21–27.Google Scholar
Jackson, M, Bird, J, Fearfield, L. Neuroaxial blockade and psoriasis. Int J Obstet Anesth 2008;17:80–81.Google Scholar
Drago, F, Broccolo, F, Zaccaria, E, et al. Pregnancy outcome in patients with pityriasis rosea. J Am Acad Dermatol 2008;58:S78–S83.Google Scholar
Werntz, M, Chun, C, Togioka, BM. Anesthetic considerations for neuraxial anesthesia in pregnant patients with pityriasis rosea with skin lesions covering the lumbar spine. A A Case Rep 2016;7:165–168.Google Scholar
Murase, JE, Heller, MM, Butler, DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol 2014;70:401.e1–14; quiz 415.Google Scholar
Acosta, KA, Haver, MC, Kelly, B. Etiology and therapeutic management of erythema nodosum during pregnancy: an update. Am J Clin Dermatol 2013;14:215–222.Google Scholar
Harger, JH, Ernest, JM, Thurnau, GR, et al. Frequency of congenital varicella syndrome in a prospective cohort of 347 pregnant women. Obstet Gynecol 2002;100:260–265. https://doi.org/10.1097/00006250-200208000-00010Google Scholar
Swamy, GK, Dotters-Katz, SK. Safety and varicella outcomes after varicella zoster immune globulin administration in pregnancy. Am J Obstet Gynecol 2019;221:655–656. https://doi.org/10.1016/j.ajog.2019.07.003Google Scholar
Nanthakumar, MP, Sood, A, Ahmed, M, et al. Varicella zoster in pregnancy. Eur J Obstet Gynecol Reprod Biol 2021;258:283–287.Google Scholar
Kumar, RK. Congenital varicella syndrome and neonatal chicken pox (varicella). J Pediatr Infect Dis 2020;2:23–24. https://doi.org/10.5005/jp-journals-10081-1224.Google Scholar
Samies, NL, James, SH, Kimberlin, DW. Neonatal herpes simplex virus disease: updates and continued challenges. Clin Perinatol 2021;48:263–274.Google Scholar
Hammad, WAB, Konje, JC. Herpes simplex virus infection in pregnancy – An update. Eur J Obstet Gynecol Reprod Biol 2021;259:38–45.Google Scholar
Bader, AM, Camann, WR, Datta, S. Anesthesia for cesarean delivery in patients with herpes simplex virus type-2 infections. Reg Anesth 1990;15:261–263.Google Scholar
Gieraerts, R, Navalgund, A, Vaes, L, et al. Increased incidence of itching and herpes simplex in patients given epidural morphine after cesarean section. Anesth Analg 1987;66:1321–1324.Google Scholar
Crone, LA, Conly, JM, Storgard, C, et al. Herpes labialis in parturients receiving epidural morphine following cesarean section. Anesthesiology 1990;73:208–213.Google Scholar
Boyle, RK. Herpes simplex labialis after epidural or parenteral morphine: a randomized prospective trial in an Australian obstetric population. Anaesth Intensive Care 1995;23:433–437.Google Scholar
Norris, MC, Weiss, J, Carney, M, et al. The incidence of herpes simplex virus labialis after cesarean delivery. Int J Obstet Anesth 1994;3:127–131.Google Scholar
Davies, PW, Vallejo, MC, Shannon, KT, et al. Oral herpes simplex reactivation after intrathecal morphine: a prospective randomized trial in an obstetric population. Anesth Analg 2005;100:1472–1476.Google Scholar
Bauchat, JR. Focused review: neuraxial morphine and oral herpes reactivation in the obstetric population. Anesth Analg 2010;111:1238–1241.Google Scholar
Mytton, OT, McGready, R, Lee, SJ, et al. Safety of benzyl benzoate lotion and permethrin in pregnancy: a retrospective matched cohort study. BJOG 2007;114:582–587. https://doi.org/10.1111/j.1471-0528.2007.01290.xGoogle Scholar
Kardos, M, Levine, D, Gürcan, HM, et al. Pemphigus vulgaris in pregnancy: analysis of current data on the management and outcomes. Obstet Gynecol Surv 2009;64:739–749.Google Scholar
Daneshpazhooh, M, Chams-Davatchi, C, Valikhani, M, et al. Pemphigus and pregnancy: a 23-year experience. Indian J Dermatol Venereol Leprol 2011;77:534.Google Scholar
Hern, S, Vaughan Jones, SA, Setterfield, J, et al. Pemphigus vulgaris in pregnancy with favourable foetal prognosis. Clin Exp Dermatol 1998;23:260–263.Google Scholar
Kalayciyan, A, Engin, B, Serdaroglu, S, et al. A retrospective analysis of patients with pemphigus vulgaris associated with pregnancy. Br J Dermatol 2002;147:396–397.Google Scholar
Okubo, S, Sato-Matsumura, KC, Abe, R, et al. The use of ELISA to detect desmoglein antibodies in a pregnant woman and fetus. Arch Dermatol 2003;139:1217. https://doi.org/10.1001/archderm.139.9.1217Google Scholar
Tavakolpour, S, Mirsafaei, HS, Delshad, S. Management of pemphigus disease in pregnancy. Am J Reprod Immunol 2017;77:e12601. https://doi.org/10.1111/aji.12601Google Scholar
Drenovska, K, Darlenski, R, Kazandjieva, J, et al. Pemphigus vulgaris and pregnancy. Skinmed 2010;8:144–149.Google Scholar
Al Arfaj, AS, Khalil, N. Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus 2010;19:1665–1673.Google Scholar
Gompels, MM, Lock, RJ, Abinun, M, et al. C1 inhibitor deficiency: consensus document. Clin Exp Immunol 2005;139:379–394.Google Scholar
Griffiths, RJ, O’Sullivan, G. C1-esterase inhibitor deficiency and elective caesarean section. Int J Obstet Anesth 2005;14:263–264.Google Scholar
Villeneuve, V, Kaufman, I, Weeks, S, et al. Anesthetic management of a labouring parturient with urticaria pigmentosa. Can J Anaesth 2006;53:380–384.Google Scholar
Castells, MC. Mastocytosis: classification, diagnosis, and clinical presentation. Asthma Proc Allergy 2004;25:33–36.Google Scholar
Watson, KD, Arendt, KW, Watson, WJ, et al. Systemic mastocytosis complicating pregnancy. Obstet Gynecol 2012;119:486–489.Google Scholar
Kawagoe, C, Ootaki, C, Kinishi, Y, et al. Management of labor and delivery by spinal and epidural analgesia in a woman with systemic mastocytosis: a case report. J Clin Case Rep 2021 (online). https://doi.org/10.22541/au.161372818.89527073/v1Google Scholar
Vaughan, ST, Jones, GN. Systemic mastocytosis presenting as profound cardiovascular collapse during anaesthesia. Anaesthesia 1998;53:804–807.Google Scholar
Auvray, L, Letourneau, B, Freysz, M. Mastocytosis: general anesthesia with remifentanil and sevoflurane. Ann Fr Anesth Reanim 2001;20:635–638.Google Scholar
Bieber, AK, Martires, KJ, Stein, JA, et al. Pigmentation and pregnancy: knowing what is normal. Obstet Gynecol 2017;129: 168–173.Google Scholar
Aktürk, AS, Bilen, N, Bayrämgürler, D, et al. Dermoscopy is a suitable method for the observation of the pregnancy-related changes in melanocytic nevi. J Eur Acad Dermatol Venereol 2007;21:1086–1090.Google Scholar
Silipo, V, De Simone, P, Mariani, G, et al. Malignant melanoma and pregnancy. Melanoma Res 2006;16:497–500.Google Scholar
Driscoll, MS, Grant-Kels, JM. Nevi and melanoma in pregnancy. Dermatol Clin 2006;24:199–204, vi.Google Scholar
Pagès, C, Robert, C, Thomas, L, et al. Management and outcome of metastatic melanoma during pregnancy. Br J Dermatol 2010;162:274–281.Google Scholar
Khosrotehrani, K, Nguyen Huu, S, Prignon, A, et al. Pregnancy promotes melanoma metastasis through enhanced lymphangiogenesis. Am J Pathol 2011;178:1870–1880.Google Scholar
Jeremić, J, Jeremić, K, Stefanović, A, et al. Pregnancy associated with melanoma and fetal anomalies: a case report and review of literature. Clin Exp Obstet Gynecol 2015;42:386–387.Google Scholar
Smith, FJD. The molecular genetics of keratin disorders. Am J Clin Dermatol 2003;4:347–364. https://doi.org/10.2165/00128071-200304050-00005Google Scholar
Pfendner, EG, Nakano, A, Pulkkinen, L, et al. Prenatal diagnosis for epidermolysis bullosa: a study of 144 consecutive pregnancies at risk. Prenat Diagn 2003;23:447–456.Google Scholar
Eady, RA. Epidermolysis bullosa: scientific advances and therapeutic challenges. J Dermatol 2001;28:638–640.Google Scholar
Bolt, LA, O’Sullivan, G, Rajasingham, D, et al. A review of the obstetric management of patients with epidermolysis bullosa. Obstet Med 2010;3:101–105.Google Scholar
Benavente, MA, Sanchez-Guijo, JJ. Combined anaesthesia in a young patient with dystrophic epidermolysis bullosa. Pediatr Anesth 2003;13:274. https://doi.org/10.1046/j.1460-9592.2003.01028_1.xGoogle Scholar
Herod, J, Denyer, J, Goldman, A, et al. Epidermolysis bullosa in children: pathophysiology, anaesthesia and pain management. Paediatr Anaesth 2002;12: 388–397.Google Scholar
Diwan, R, Vas, L, Shah, T, et al. Continuous axillary block for upper limb surgery in a patient with epidermolysis bullosa simplex. Pediatr Anesth 2001;11:603–606. https://doi.org/10.1046/j.1460-9592.2001.00714.xGoogle Scholar
Iohom, G, Lyons, B. Anaesthesia for children with epidermolysis bullosa: a review of 20 years’ experience. Eur J Anaesthesiol 2001;18:745–754.Google Scholar
Scherhag, A, Dick, W. Special aspects of anesthesia in patients with epidermolysis bullosa based on a case example. Anaesthesiol Reanim 1998;23:129–133.Google Scholar
Lin, AN, Lateef, F, Kelly, R, et al. Anesthetic management in epidermolysis bullosa: review of 129 anesthetic episodes in 32 patients. J Am Acad Dermatol 1994;30:412–416. https://doi.org/10.1016/s0190-9622(94)70048-6Google Scholar
Spielman, FJ, Mann, ES. Subarachnoid and epidural anaesthesia for patients with epidermolysis bullosa. Can Anaesth Soc J 1984;31:549–551.Google Scholar
Boughton, R, Crawford, MR, Vonwiller, JB. Epidermolysis bullosa – a review of 15 years’ experience, including experience with combined general and regional anaesthetic techniques. Anaesth Intensive Care 1988;16:260–264.Google Scholar
Ohara, T, Fujimoto, K, Okutsu, Y, et al. Intraoperative indirect monitoring of electrocardiogram. Masui 1999;48:1347–1353.Google Scholar
Baloch, MS, Fitzwilliams, B, Mellerio, J, et al. Anaesthetic management of two different modes of delivery in patients with dystrophic epidermolysis bullosa. Int J Obstet Anesth 2008;17:153–158.Google Scholar
Araújo, M, Brás, R, Frada, R, et al. Caesarean delivery in a pregnant woman with epidermolysis bullosa: anaesthetic challenges. Int J Obstet Anesth 2017;30:68–72.Google Scholar
Farthing, P, Bagan, J-V, Scully, C. Mucosal disease series. Number IV. Erythema multiforme. Oral Dis 2005;11:261–267.Google Scholar
Bastuji-Garin, S. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol 1993;129:92–96. https://doi.org/10.1001/archderm.129.1.92Google Scholar
Sehgal, VN, Srivastava, G. Toxic epidermal necrolysis (TEN) Lyell’s syndrome. J Dermatolog Treat 2005;16:278–286.Google Scholar
Roujeau, JC. Stevens-Johnson syndrome and toxic epidermal necrolysis are severity variants of the same disease which differs from erythema multiforme. J Dermatol 1997;24:726–729.Google Scholar
Ahiskalioglu, A, Yayik, AM, Erguney, OD, et al. Combined spinal-epidural anaesthesia for urgent caesarean section in a parturient with Stevens-Johnson syndrome. Int J Obstet Anesth 2017;30:78–79.Google Scholar
Tubbs, RS, Rutledge, SL, Kosentka, A, et al. Chiari I malformation and neurofibromatosis type 1. Pediatr Neurol 2004;30:278–280.Google Scholar
Butler, DC, Heller, MM, Murase, JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol 2014;70:417.e1–10; quiz 427.Google Scholar
Collaborative group on drug use in pregnancy (C. G. D. U. P.). Medication during pregnancy: an intercontinental cooperative study. Int J Gynecol Obstet 1992;39:185–196. https://doi.org/10.1016/0020-7292(92)90656-4Google Scholar
Chi, C-C, Kirtschig, G, Aberer, W, et al. Evidence-based (S3) guideline on topical corticosteroids in pregnancy. Br J Dermatol 2011;165:943–952.Google Scholar
Chi, C-C, Wang, S-H, Mayon-White, R, et al. Pregnancy outcomes after maternal exposure to topical corticosteroids: a UK population-based cohort study. JAMA Dermatol 2013;149:1274–1280.Google Scholar
Chi, C-C, Wang, S-H, Wojnarowska, F, et al. Safety of topical corticosteroids in pregnancy. Cochrane Database Syst Rev 2015;2015:CD007346.Google Scholar
McAleer, MA, Flohr, C, Irvine, AD. Management of difficult and severe eczema in childhood. BMJ 2012;345:e4770.Google Scholar
Zip, C. A practical guide to dermatological drug use in pregnancy. Skin Therapy Lett 2006;11:1–4.Google Scholar
Anderka, MT, Lin, AE, Abuelo, DN, et al. Reviewing the evidence for mycophenolate mofetil as a new teratogen: case report and review of the literature. Am J Med Genet A 2009;149A:1241–1248.Google Scholar
Bandoli, G, Palmsten, K, Forbess Smith, CJ, et al. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheum Dis Clin North Am 2017;43:489–502.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×