Topical Treatments for Tinea Corporis:
- First Choice: Clotrimazole (Lotrimin)
- Alternatives: Miconazole, then ketoconazole.
- Limited Data but Likely Safe: Terbinafine, naftifine, ciclopirox
Topical Treatments for Candidiasis:
- Safe but Less Effective: Nystatin.
- Other Safe Options: Clotrimazole, miconazole, ketoconazole
- High doses in animals not linked to defects
- Alternative: Topical gentian violet (0.5%-1% solution)
Topical antifungal Treatments for Tinea Versicolor:
- Safe for Limited Application: Clotrimazole, miconazole
- For Widespread Areas: Zinc pyrithione soap, topical benzoyl peroxide soap
- Caution Advised: Selenium sulfide.
Systemic Antifungal Treatments:
- Should Be Avoided: Fluconazole , ketoconazole, itraconazole.
- Risks include craniosynostosis, congenital heart defects, skeletal anomalies
- Study found no increased risk with fluconazole in the first trimester, reassuring for prior use before pregnancy knowledge
Specific Considerations:
- Griseofulvin: Not recommended during pregnancy
- Terbinafine: Suggested as safe by a 2020 study.
- FDA categorizes it as pregnancy category B.
- No increased risk of spontaneous abortion or major malformations
- Oral or topical terbinafine is sometimes necessary for severe cases of onychomycosis despite regular topical therapy.
- Some authors prefer to postpone treatment until after delivery for conditions like dermatophytic onychomycosis, and chromomycosis.
Superficial Infections
- During Pregnancy: Topical treatments, including topical azoles, are safe throughout pregnancy
- Systemic Treatment (After Delivery): For conditions like dermatophytic onychomycosis, chromomycosis, and mycetoma, systemic treatment should be postponed until after delivery.
Treatment for Invasive Fungal Infections:
- Cornerstone Treatment: Amphotericin B and its lipid derivatives
- Alternative (After the First Trimester): Fluconazole, if no other agent is available, as suggested by some experts.
Recommendations:
- Topical Agents: Preferable over systemic treatments during pregnancy
- Systemic Agents: To be avoided unless necessary and after thorough risk assessment
References
- Common Antifungal Drugs in Pregnancy: Risks and Precautions(link)
- Antifungal drugs during pregnancy: an updated review(link)
- Oral Antifungal in Pregnancy Increases Miscarriage Risk(link)
- Skin Infections in Pregnant Women: Many Drugs Safe, but Not All(link)
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