Treatment of different age groups
PregnancyDuring pregnancy, topical treatment modalities comprise
- menthol, camphor
- mild to moderately potent corticosteroids (in severe cases, potent corticosteroids may be applied under dermatological surveillance)
- antibiotics and antiseptics such as gentamycin, neomycin, clindamycin and fusidin acid
- antifungals - miconazole and ciclopirox may be used during pregnancy
Topical therapies with very potent corticosteroids and capsaicin are contraindicated. As there are no definitve data concerning the use of topical immunomodulators in pregnancy they should be considered as contraindicated due to their immunosuppressive potential. Salicylic acid should be avoided during late pregnancy and metronidazole is not indicated to be used during the 1st trimester of pregnancy.
For systemic treatment, antibiotics such as penicillin, ampicillin, erythromycin and cephalosporins may be used. The systemic steroid of choice during pregnancy is prednisolone (alternatively prednison). Chlorpheniramine is a first generation antihistamine that may be used during pregnancy. Cyclosporine application is possible during pregnancy but should only be considered in severe cases where the potential benefits of therapy outweigh the risk.
Contraindicated systemic treatments are antibiotics such as tetracycline, clindamycine, aminoglycosides and metronidazol, antifungals such as griseofulvin, strong corticosteroids such as betamethasone and dexamethasone and retinoids. The use of second generation antihistamines is not indicated during the 1st trimester of pregnancy. UV-therapy is generally not clearly contraindicated but as an immunosuppressive therapeutical regimen it should only be performed in severe cases, in advanced pregnancy and after careful education of the patient.