Eczema, or atopic dermatitis, is a chronic inflammatory skin condition characterized by dry, intensely itchy skin. Pregnancy can trigger the first appearance of this condition or cause a flare-up of pre-existing disease. This is attributed to the profound hormonal shifts and immunological adjustments that occur within the maternal body to support the developing fetus. These internal changes can manifest as a persistent, uncomfortable rash.
Is Eczema Common During Pregnancy?
Eczema is the most frequently observed skin condition during gestation, accounting for most pregnancy-related dermatoses. It presents either as a new onset condition, often termed atopic eruption of pregnancy, or as a worsening of pre-existing eczema. Approximately 60% to 80% of pregnant individuals who develop eczema have no prior history of the condition.
The maternal immune system shifts toward a T-helper 2 (Th2) dominant state. This rebalancing, influenced by rising estrogen and progesterone levels, protects the fetus but promotes the inflammation associated with atopic diseases. This shift, combined with changes to skin barrier function, creates an environment favorable for eczema flares, often occurring in the first or second trimester.
Identifying Eczema Versus Other Rashes
Differentiating eczema from other pregnancy-specific rashes is important because misdiagnosis can lead to inappropriate management. Eczema typically presents as intensely itchy, red patches with dryness and scaling. The rash commonly appears in classic flexural areas, such as the inner elbows and behind the knees, as well as on the neck, face, and chest. Onset usually occurs early, in the first or second trimester.
This presentation contrasts with Polymorphic Eruption of Pregnancy (PUPPP), a non-eczema rash beginning most often in the third trimester. PUPPP lesions are hive-like, raised papules and plaques that start on the abdomen, frequently within stretch marks, and characteristically spare the navel. A rarer but more serious condition is Pemphigoid Gestationis, an autoimmune blistering disease. This rash typically starts later in the second or third trimester, often around the navel, and rapidly progresses to form large, tense blisters.
Any pregnant individual experiencing a new rash must consult a dermatologist or obstetrician for an accurate assessment. A professional evaluation helps distinguish eczema from other conditions that may require different therapeutic approaches or carry specific fetal risks.
Safe Management and Relief Strategies
Managing eczema during pregnancy requires a careful approach that prioritizes the safety of both the mother and the fetus. The foundation of relief involves meticulous non-pharmacological skincare aimed at restoring the impaired skin barrier.
This begins with bathing in lukewarm water for short periods, as hot water can strip the skin of its natural oils. Immediately after gently patting the skin dry, a thick, cream-based or ointment-based emollient should be applied to seal in moisture, ideally within three minutes. Avoiding known irritants, such as harsh, fragranced soaps and detergents, minimizes flare triggers. For severely inflamed areas, wet wrap therapy, which involves applying damp dressings over topical treatments, can intensely hydrate the skin and reduce itching.
For more persistent inflammation, low-to-moderate potency topical corticosteroids are considered the first-line medical treatment and are safe for use during pregnancy. These medications reduce inflammation directly at the rash site, but their use must be guided by a healthcare provider. When intense itching interferes with sleep, certain oral antihistamines, such as loratadine or cetirizine, may be prescribed. Older-generation antihistamines that cause drowsiness can be helpful for nighttime relief.
For widespread or severe cases not controlled by topical therapy, Narrowband Ultraviolet B (UVB) phototherapy is a non-systemic treatment option. Consulting with a dermatologist and obstetrician ensures that any treatment plan, whether involving over-the-counter emollients or prescription medications, is optimized for safety and effectiveness throughout the pregnancy.
Postpartum Resolution
For individuals who developed eczema for the first time during pregnancy, the prognosis for resolution is favorable. The condition begins to improve or completely clears shortly after childbirth, typically within a few weeks to months. This improvement is linked to the rapid stabilization of sex hormone levels and the maternal immune system returning to its non-pregnant state.
If the condition was a flare-up of pre-existing eczema, the rash may not vanish entirely but will likely revert to its baseline severity. In some instances, it may temporarily worsen postpartum as the immune system completes its rebalancing process. However, for most cases of pregnancy-induced eczema, the resolution is complete, even if the condition returns in a subsequent pregnancy.