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Pregnancy and Lactation Considerations with Therapy


The panel speaks to how to treat acne for people who are pregnant and/or lactating.

Casey Butrus, PharmD: As we mentioned, acne can persist into adulthood and it’s very common in adults as well as adolescents. As we’re [treating] the older population, especially specific special populations, how do you [treat] women who [are pregnant or breastfeeding,] since I know some medications [they] may want to avoid are oral contraceptives or isotretinoin?

Hilary Baldwin, MD: I think all adult female acne patients, regardless of their age and current station in life, present unique challenges for treatment. And we started with the psychological aspect. I completely agree. My adult [patients], especially the ones who have acne for the very first time over the age of 25, thought they escaped all of that and they didn’t, and here it hits them. And as you mentioned, they may be the only people they know with a face full of acne and people say really rude things and [make] unhelpful comments like, you should drink more water and get more sleep and things that have no facts behind them, like maybe you need to wash your face more often. Just crazy things.

Arash Mostaghimi, MD, MPH: Those are all blaming the patient.

Hilary Baldwin, MD: Yes, exactly.

Arash Mostaghimi, MD: You can sleep more and wash your face, but as you said, those have no bearing on the illness.

Hilary Baldwin, MD: The psychological impact on the adult [patient] is huge. And then if you take stages of life like menopause and [breastfeeding] and pregnancy, which are all hormonal events, which are all independently associated with psychological overlay, for many of our patients, you have another perfect storm. You have maybe a woman with postpartum depression and a face full of acne just compounding the issue…. When I was in training, we were basically told for pregnancy, wait until delivery and then treat the patient. [Breastfeeding] is an option; it’s a personal choice. She’s made her choice; wait until she finishes [breastfeeding] before you treat her. And I think we consider those concepts to be archaic nowadays. And we recognize that there are many safe and effective medications for pregnancy and [breastfeeding] and you can’t just wait it out. That’s a ridiculous comment, especially for [patients with] moderate to severe disease.

Casey Butrus, PharmD: I agree with just having more conversations about the adult population, too, trying to reduce the stigma and make it less taboo to talk about in this population. I think that’s one of the first steps to reducing the amount of burden that we’ve seen for this population specifically.

Transcript edited for clarity.

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