Eczema During Pregnancy: Causes, Symptoms & Safe Treatment

Eczema during pregnancy is not just a skin irritation. It is the most common skin condition seen in pregnant women, representing up to 50% of all skin conditions that arise during gestation, according to a 2024 clinical review published in Clinical Medicine (Guy's and St Thomas' NHS Foundation Trust, King's College London). For some women, pregnancy causes their first-ever eczema flare. For others, a condition they already manage suddenly becomes harder to control. Understanding why this happens — and what is actually safe to do about it — matters for both mother and baby.

Why Does Pregnancy Cause or Worsen Eczema?

The answer lies in the immune system. To carry a pregnancy to term, the body makes a deliberate shift in its immune response — suppressing the type of immunity that might cause the body to reject the developing fetus, and boosting a different arm of the immune system called the Th2 pathway.

The problem is that eczema is itself a Th2-driven condition. As research published in the Journal of Allergy and Clinical Immunology explains, rising levels of estrogen and progesterone during pregnancy reinforce this Th2 immune shift — the same biological mechanism that drives atopic dermatitis. In effect, the immune adjustment that protects the fetus also amplifies the immune imbalance behind eczema.

Hormonal changes contribute directly too. According to a 2024 review in Clinical Medicine, oestrogen and progesterone stimulate what is called "type 2 inflammation" — the inflammatory pattern characteristic of eczema and allergic disease. Physical and psychological stress during pregnancy adds another layer.

The result is unpredictable. A 2024 NIH-indexed review found that studies have reported eczema worsening in between 52% and 61% of pregnant individuals. Improvement occurs in around 20%. Some women develop eczema for the first time while pregnant, often by the end of the second trimester, with no prior history of the condition.

What Is Atopic Eruption of Pregnancy?

When eczema — whether pre-existing or entirely new — appears or worsens during pregnancy, it is grouped under the clinical term atopic eruption of pregnancy (AEP). According to a peer-reviewed overview published via NIH's National Library of Medicine, AEP is now recognized as the most common dermatosis (skin condition) of pregnancy, covering flare-ups of known atopic dermatitis as well as new-onset cases.

AEP typically appears in the first or second trimester, which distinguishes it from most other pregnancy skin conditions that tend to show up later. Skin lesions usually appear in the classic eczema locations: the face, neck, flexures (insides of elbows, backs of knees), and hands.

Importantly, AEP does not pose a direct risk to the developing baby. Most cases resolve after delivery, though some women with pre-existing eczema find the condition continues postpartum — sometimes intensified by the stresses of newborn care, sleep disruption, and skin contact with soaps and wet wipes.

What Does Eczema During Pregnancy Feel Like?

The symptoms mirror those of eczema outside pregnancy: dry, intensely itchy skin, red or inflamed patches (or darker, greyish patches in women with darker skin tones), and a tendency to flare and settle unpredictably.

Itching tends to worsen at night, disrupting sleep — already a challenge during pregnancy. Scratching can break the skin and open the door to bacterial infections, the most common of which involves Staphylococcus aureus. A skin infection during pregnancy warrants prompt medical review.

Some women notice eczema spreading to areas not previously affected, or appearing on the face and neck for the first time. The physical discomfort compounds the emotional weight of pregnancy, and the psychological burden of eczema — including anxiety about treatment safety — is real and worth acknowledging with a healthcare provider.

Safe Treatment Options During Pregnancy

Treatment decisions during pregnancy require extra care. The goal is controlling eczema effectively while ensuring nothing harms the developing fetus. A board-certified dermatologist familiar with pregnancy skin conditions is the right partner for that decision.

Moisturizers and Emollients — The Foundation

Emollients are the safest and most important treatment at any stage of pregnancy. According to a PubMed-indexed review on atopic dermatitis in pregnancy, emollients form the basis of all eczema therapy in gestation. They restore the skin barrier, reduce moisture loss, and can dramatically reduce the frequency and severity of flares without any risk to the baby.

The AAD recommends fragrance-free creams and ointments applied at least twice daily, immediately after bathing. Look for ingredients such as ceramides, glycerin, and shea butter. Avoid fragranced, alcohol-based, or "botanical" products — these may trigger further irritation.

Topical Corticosteroids

Low- to mid-potency topical corticosteroids — such as hydrocortisone — are widely used during pregnancy and are considered generally safe when applied as directed under medical supervision. The AAD confirms they are among the most widely utilized treatments for pregnant women with eczema. Very high-potency steroids applied over large areas for prolonged periods require more caution and should only be used on specialist advice.

Phototherapy

Narrow-band UVB light therapy is an option for pregnant women with moderate-to-severe eczema that does not respond adequately to topical treatments. It does not involve UV-A or psoralen (which are avoided in pregnancy), and there is no significant evidence of risk to the fetus. It requires repeated clinic visits, typically two to three times per week, and is managed by a dermatologist.

Treatments to Discuss with a Doctor

Topical calcineurin inhibitors (such as tacrolimus and pimecrolimus) may be used in some cases, though their safety data during pregnancy is more limited than topical corticosteroids. The decision should be made with a specialist.

Certain systemic medications used for eczema outside pregnancy — including baricitinib, upadacitinib, and methotrexate — are contraindicated during pregnancy due to known or potential risks to the developing fetus, according to Healthgrades/Medical News Today citing peer-reviewed sources. The biologic dupilumab has been used in severe cases under specialist supervision, but its routine use in pregnancy is not yet established.

The key message: do not adjust, add, or stop any prescription eczema medication during pregnancy without speaking to a dermatologist or obstetrician first.

Managing Triggers During Pregnancy

The same trigger management that helps eczema generally applies during pregnancy — and matters even more, given that treatment options are narrower.

Skin care routine:

Short, lukewarm baths rather than long, hot ones
Fragrance-free, dye-free soap used sparingly
Moisturizer applied immediately after bathing, within a few minutes

Environment and clothing:

Fragrance-free laundry detergent
Cotton or bamboo fabrics close to the skin — avoid wool and synthetic materials
A humidifier in dry indoor environments, especially in winter

Stress: Pregnancy itself is a significant stressor, and emotional stress is a documented eczema trigger. Adequate rest, gentle physical activity, and support from a healthcare provider or mental health professional can make a meaningful difference.

Keeping a symptom diary — noting what changed on bad skin days — often reveals specific triggers that can be reduced or eliminated.

Does Eczema During Pregnancy Affect the Baby?

Eczema itself does not directly harm the fetus. The condition is not contagious and does not cross the placenta. However, severely uncontrolled eczema can affect the mother's sleep, wellbeing, and stress levels, which in turn may have indirect effects on pregnancy outcomes. This is a strong reason to seek treatment rather than simply endure symptoms.

There is one additional consideration: children born to a parent with atopic dermatitis have a higher genetic risk of developing eczema themselves. This does not mean the baby will definitely develop eczema, but a pediatrician or dermatologist can advise on early skin care steps, such as regular moisturizing from the first days of life, that may help support healthy skin development.

FAQ

Is eczema during pregnancy harmful to the baby?
Eczema during pregnancy is not directly harmful to the fetus. The condition does not cross the placenta or affect fetal development. Severe uncontrolled eczema can disrupt the mother's sleep and increase stress, which warrants treatment. Always consult a doctor to find the safest approach for your situation.

Why did I get eczema for the first time during pregnancy?
Pregnancy shifts the immune system toward a Th2-dominant response to prevent rejection of the fetus. Because eczema is also a Th2-driven condition, this immune change can trigger eczema in women who have never had it before. This is classified as atopic eruption of pregnancy and usually resolves after delivery.

What eczema creams are safe to use when pregnant?
Fragrance-free emollients and moisturizers are safe and strongly recommended throughout pregnancy. Low- to mid-potency topical corticosteroids are generally considered safe under medical supervision. Always check with a dermatologist or obstetrician before using any topical medication during pregnancy.

Will my eczema go away after giving birth?
For women who develop eczema for the first time during pregnancy (atopic eruption of pregnancy), symptoms typically resolve after delivery. Women with pre-existing eczema may find symptoms improve postpartum — or temporarily worsen due to newborn care demands, sleep loss, and frequent handwashing. Continuing your skin care routine after birth is important.

When should I see a doctor for eczema during pregnancy?
See a doctor if eczema is affecting your sleep or daily life, if symptoms are not improving with moisturizers and basic trigger avoidance, or if your skin shows signs of infection such as oozing, crusting, increased warmth, or fever. Moderate-to-severe eczema in pregnancy warrants early dermatology input.

Practical Takeaway

Eczema during pregnancy is common, real, and treatable. Start with a twice-daily fragrance-free moisturizer applied right after bathing, avoid known triggers, and speak to a dermatologist about any prescription treatments you currently use or may need. Do not simply tolerate severe symptoms — safe options exist at every stage of pregnancy, and managing eczema well protects both your comfort and your wellbeing throughout.