Atopic Eczema — SCE Dermatology MCQ

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ModerateDermatopharmacologyAtopic EczemaSCE Dermatology

A 28-year-old pregnant woman (16 weeks gestation) with moderate atopic eczema flare has not responded to emollients and moderate potency topical corticosteroids. Which systemic treatment is considered safest in pregnancy?

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Correct answer: C — Azathioprine

Azathioprine is considered the safest systemic immunosuppressant for use in pregnancy for atopic eczema, based on extensive safety data from transplant and IBD populations. Methotrexate and Mycophenolate mofetil are absolutely contraindicated (teratogenic). Oral retinoids are highly teratogenic with required contraception for 3 years after cessation. Ciclosporin can be used in pregnancy but has more safety concerns (renal impairment, hypertension). BAD and NICE guidelines recommend Azathioprine when systemic therapy is necessary in pregnancy.

Reference: BAD 2018 Guidelines on prescribing systemic drugs in dermatology during pregnancy