QuestionDear Dr. Rappaport,
Again I haev a question that I would like to ask you after having received already several good advises from your part on other topics.
My wife is pregnant with a second child and will enter in her 8th week (as counted from her last menstrual period which started on Jan.4). about 8 days ago, some rashes appeared on here skin, first isolated and then more and more. Several tests have been done (chickenpox and other childhood illnesses (I don't know the english words for them...) and we were told that viral infections that can cause harm to the foetus can likely be excluded (Thanks God!). However, the rashes now cover basically all the body and she saw a dermatologist who prescribed a topical corticosteoid called "Betnovate" as a cream/ointment.
I red on the internet, that those may have higher risks of cleft lip and cleft palate, although this seems to be controversial and maybe also possible teratogenic effects. I seem to remember, that lip and palate formation happen sometime around week 9-10 of pregnancy (?), so does this mean that the risk of using corticosteroids right now is presenting the highest risk? The question is, that if she doesn't use it now, will the risk be lower in 3-4 weeks?
The rashes seem to become more and more severe and itch so much that she has a hard time sleeping. The cream seems to help significantly (she used the first time this evenening). So is there something else she could use to help while waiting to use the coticosteroid cream?
Or would you believe that the risk of using topical corticosteroids is still advised? (I would believe that through the skin the risk must be reduced compared to inhalatio or pills?). Also, is "Betnovate" of specificallly high risk and is there another cream that is less "dangerous"? Always keeping in mind that she uses it sort of like a sunscreen because of rashes cover her whole body by now...
Sorry for those many questions and thank you in advance, once more, for your advise.
With kind regards,
Andreas.
AnswerWe have used cortocosteroid creams during pregnancy for many years. Although there is a 1% chance of cleft lip or cleft palate with the use of steroids during pregnancy, the surgical repair of these defects has improved so greatly that we do not avoid the use of steroids. Even in cases of severe asthma, where systemic steroids may have to be used, we still use massive doses of steroids at times. In the treatment of preterm labor, we routinely administer steroids in order to speed up the maturation of the fetal lung (standard of care). You can use the cream at this time without fear. If itching is severe, Benadryl can also be taken to relive the itching.
