Handling Eczema During and After Pregnancy

Many people who have a history of eczema notice that the skin condition tends to worsen during pregnancy, likely thanks to changing hormones and other shifts that occur in the body while growing a baby. If you've had eczema in the past, pregnancy might be a time when your eczema reappears.

Others experience eczema for the first time while pregnant. The itchy, inflamed skin patches may linger (or show up for the first time) after your baby is born, too.

Wondering why eczema often pops up with pregnancy and during the postpartum stage, and how to keep your symptoms in check? Here is a guide for managing your eczema after delivery and beyond, including which treatments and medications are safe while breastfeeding.

What Is Eczema?

Eczema, also called dermatitis or atopic dermatitis (AD), is a common, non-contagious skin condition characterized by rough, itchy, inflamed, overly dry skin that afflicts millions of people each year. While incurable, it can disappear for periods of time or altogether. Most often, eczema affects children, the majority of whom grow out of it by age 10. According to the American Academy of Dermatology, eczema affects approximately 25% of children, 60% of whom develop it in the first year of life.

The exact causes are unknown, but the condition is thought to be linked to an overactive immune response and is more common in individuals who experience other immune issues, asthma, heightened stress levels, dry skin, and/or other environmental factors.

For some, it is a minor inconvenience or irritation, while for others it causes acute discomfort, particularly intense itchiness. And the symptoms can lead to others. For example, excessive scratching can cause small cuts on the skin, which can make affected areas prone to infection. All that itching can also cause affected skin to thicken and/or discolor (darkening or lightening), which is another reason it's important to get symptoms under control.

When eczema symptoms are brought on by contact with something (such as latex, makeup, or metal jewelry) that an individual is allergic to, this is called contact dermatitis. This type of eczema can be resolved by removing the allergen.

Prenatal Eczema

There are actually a variety of skin conditions that can worsen or crop up for the first time during pregnancy, including acne, dark spots, stretch marks, and changes in pigmentation. Rashes are also common, including pruritic urticarial papules and plaques of pregnancy (PUPPS), an itchy rash that only appears in pregnant people, most often in first pregnancies. But of all the skin conditions that can occur during pregnancy, eczema is the most common.

Eczema accounts for anywhere from one-third to around one-half of all skin conditions that people experience during pregnancy. One of the most surprising facts about the prevalence of eczema in pregnancy is that most of those cases are new. In fact, 60% to 80% of those who experience eczema during pregnancy have never had it before.

It's thought that eczema tends to flare up during pregnancy because of the immune cells involved. During pregnancy, a person's immune system shifts to favor specific types of immune cells, which may trigger the conditions that let eczema develop. Doctors have also theorized that there might be a skin barrier change or a shift in the skin protein process that occurs during pregnancy that can give way to eczema.

There is also significant research (and anecdotal evidence) that suggests that stress can play a role in the development of eczema, and pregnancy and the postpartum period can be extremely taxing (as well as joyous). There are many normal stressors that come along with pregnancy and new parenthood, such as lack of sleep and the hard work of caring for an infant.

Characteristics

No doubt eczema is an uncomfortable condition, especially during pregnancy and the postpartum period. If you have never had eczema before, a sudden itchy rash may be confusing and alarming.

When It Occurs

The most common time for eczema to show up during pregnancy is within the first two trimesters. Because eczema is brought on by environmental and internal triggers, it can be hard to predict and can show up at any time during pregnancy or just after giving birth. How long the condition persists also varies.

Where It Occurs

Eczema can show up anywhere on the body but most often flares up on the extremities (particularly on the arms or hands), neck, and face. Although it's very rare (it happens to less than 2% of breastfeeding parents), eczema can develop on the areola or nipples.

This can occur as either a typical case of eczema (that seems to show up out of nowhere but may be the result of internal and external forces) or be triggered by a sensitivity to something the nursing baby has eaten that comes into contact with the parent's nipple and areola while breastfeeding.

In cases of eczema on the nipples or areola, it's often recommended that the parent apply an emollient and topical steroid to the affected area in between feedings. The medicine and emollient need to be washed off thoroughly before the baby nurses again or the parent pumps to prevent contamination of the breast milk. At this time, experts recommend that breastfeeding parents avoid using cyclosporin and methotrexate to treat eczema during the postpartum period.

Another treatment that is generally not recommended for nursing people is topical calcineurin inhibitors, although it's unclear just how much of the medicine passes into the milk of a nursing parent. More research is needed to conclude whether it's dangerous or safe to use while breastfeeding.

Risk of Eczema in Your Baby

Many who develop eczema during pregnancy worry whether that means their baby is more likely to develop eczema. The answer is that it may be more likely but it's certainly not guaranteed that your baby will have it in their lifetime.

In many cases, eczema is a hereditary condition, especially if it accompanies other immune-related medical conditions like allergies, asthma, or other autoimmune disorders. If you have a history of eczema as well as other family members who also have eczema, your baby may be more likely to also develop eczema. Often children who develop eczema grow out of it by adulthood.

Reducing Triggers

While some of the suspected causes of eczema are not under your control (such as malfunctions of your immune response), many environmental factors are suspected to be at play as well. These include typical allergy triggers, such as food allergies, dander, chemicals in body products or detergents, and down fillings in bedding and clothing—basically anything that might cause the skin to become reactive or overly dry.

Stress (physical and emotional), lack of sleep, and dry air may also contribute to eczema outbreak frequency, severity, and longevity. Do what you can to limit exposure to any of these factors that may be triggering to you.

Treatments

Eczema is managed through several different strategies during pregnancy. The focus, of course, is on making sure that none of the treatments are dangerous to the developing fetus or parent during the course of the pregnancy. Treatments are aimed at being strong enough to manage the condition while safe enough to protect the fetus from harm.

The following treatments are generally considered safe for people to use to manage eczema during pregnancy:

• Emollients
• Topical steroids (that go on the skin)
• Ultraviolet B light (although people who are pregnant should take extra caution with sun exposure because they can experience skin sensitivity)

Other therapies are used on a case-by-case basis, depending on the severity of eczema, the doctor's assessment, and your comfort level. These treatments might include oral steroids or stronger steroid creams for the skin, as well as antibiotics that can help clear up eczema in some cases. Pregnant people and breastfeeding parents should avoid taking methotrexate or using PUVA therapy, however, as those two therapies do pose some potential harm to the developing fetus.

Coping

While eczema symptoms most often show up in early to mid-pregnancy, the condition can often stick around in the postpartum period. Consistent treatment may play a role in how quickly the condition resolves. For some people, occasional eczema flare-ups may become a new normal. Postpartum treatment options are similar to those advised for pregnant people, particularly for breastfeeding parents.

Typically, a person experiencing mild or moderate cases of eczema during the postpartum period can use the same treatments as recommended in early pregnancy. For example, tepid baths (not too warm and not too cold) followed by emollients and topical steroids are frequently recommended. Many people who suffer from eczema find that hypervigilant, consistent, copious use of emollients can help to get on top of symptoms, reducing the severity.

Ultraviolet B (UVB) is also safe to use during breastfeeding, but it's generally not the first line of treatment for eczema. It might also help to keep bathing to a minimum as the process can be drying (always apply emollients right after bathing) and avoid harsh soaps or other drying or chemical-based products.

A Word From Verywell

Pregnancy tends to bring on eczema flare-ups in people who have had it in the past and also leads to many new-onset cases as well. For some, eczema clears up on its own after pregnancy, but for others, eczema can linger even after the baby is born.

Don't despair if your eczema continues postpartum; there are many effective ways to treat your eczema and boost your comfort. While eczema can't necessarily be "cured," its severity can be managed and usually lessened. Consistent treatment (especially crucial when symptoms are waning) of trouble areas is the best way to knock out eczema symptoms—and tends, for most people, to provide significant relief.