State law and teratogenic medications
Patient access to teratogenic medication may be impacted by state abortion access laws. The Academy has resources for members who prescribe teratogenic medications.
Patient access to reproductive resources
Do you have questions about changes to state laws since the Supreme Court decision overturning Roe v Wade? Do your patients need reproductive health resources?
Use the Center for Reproductive Rights’s state tracker for information on how state laws have changed.
Access the American College of Obstetricians and Gynecologists’s guide for patients seeking abortion care.
* The Academy is able to share these resources on an informational basis only. This does not represent an endorsement by the Academy.
JAAD publications on reproductive access
This article discusses how the overturn of Roe v. Wade may impact access to isotretinoin.
Letter in Reply to The Supreme Court abortion ban impact on dermatology.
Medications of concern during pregnancy
The medications below are either contraindicated during pregnancy or may have some negative effect on the fetus. Additionally, some of the listed medications need special monitoring during pregnancy. Some medications are mainly used in the treatment of advanced melanoma, BCC, or cSCC.
You can also download and keep a PDF version of the guidance below. Please see our disclaimer beneath the tables.
Table 1: Systemic Medications
| Medication | Notes |
|---|---|
Abrocitinib |
There is a registry for pregnant patients taking abrocitinib. Currently, there are insufficient data to establish a drug-associated risk for major birth defects, miscarriage, or other adverse maternal or fetal outcomes. |
Acitretin |
Acitretin must not be used by patients who are pregnant or who intend to become pregnant during therapy or at any time for at least 3 years following discontinuation of therapy. Acitretin also must not be used by females who may not use reliable contraception while undergoing treatment and for at least three years following discontinuation of treatment. Acitretin is a metabolite of etretinate, and major human fetal abnormalities have been reported with the administration of acitretin and etretinate. Potentially, any fetus exposed can be affected. |
Apremilast |
No studies on pregnancy, but there is a registry for pregnant women taking the medication. Dermatologists are encouraged to discuss pregnancy planning and prevention with patients of childbearing potential during treatment with apremilast. |
Baricitinib |
Based on animal data, it may cause fetal harm. However, there are insufficient human data to inform a drug-associated risk for major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Consider the risk and benefits of chronic use during pregnancy. |
Bleomycin |
Can cause fetal harm when administered to pregnant patients. |
Cetuximab |
Can cause fetal harm. Advise patients about the risk to the fetus and suggest using effective contraception. |
Dabrafenib (BRAF Inhibitor) |
Can cause fetal harm when administered to pregnant patients. |
| Dupilumab | There is a registry for pregnant patients using dupilumab. In women with poorly or moderately controlled asthma, evidence demonstrates that there is an increased risk of preeclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate. The level of asthma control should be closely monitored in pregnant women and treatment adjusted as necessary to maintain optimal control. |
| Flucanazole | Use in pregnancy should be avoided except in patients with severe or potentially life-threatening fungal infections in whom fluconazole may be used if the anticipated benefit outweighs the possible risk to the fetus. |
| Ipilimumab (Anti-CTLA- 4) | Can cause fetal harm. Patients should be advised about the potential risk to the fetus. Patients should consider effective contraception. |
| Isotretinoin (Retinoids) | Teratogenic. |
| Lapatinib | Can cause fetal harm. Advise patients about the risk to the fetus and suggest using effective contraception. |
| Methotrexate | Teratogenic. |
| Minocycline | Animal studies have revealed evidence of embryo and fetotoxicity. There are no controlled data in human pregnancy. However, there have been reports of congenital defects associated with the tetracycline class of antibiotics. Minocycline topical should only be given during pregnancy when benefit outweighs risk. |
| Mycophenolate mofetil | Use during pregnancy is associated with increased risks of first-trimester pregnancy loss and congenital malformations. Avoid if safer treatment options are available. Females of reproductive potential must be counseled regarding pregnancy prevention and planning. |
| Pembrolizumab (Anti- PD-1) | Can cause fetal harm. Patients should be advised about the potential risk to the fetus. Patients should consider effective contraception. |
| Sonidegib (Hedgehog Inhibitor Pathway) | Embryo-fetal toxicity (Black Box Warning). |
| Tetracycline | Animal studies have revealed evidence of embryotoxicity and teratogenicity, including toxic effects on skeletal formation. There are no controlled data in human pregnancy, however, congenital defects and maternal hepatotoxicity have been reported. When used during tooth development (second half of pregnancy) tetracyclines may cause permanent yellow-gray- brown discoloration of the teeth and enamel hypoplasia. The use of tetracycline during pregnancy is generally not recommended, especially during the last half of pregnancy. |
| Tofacitinib | There is a registry for pregnant patients taking tofacitinib. |
| Tralokinumab | There is a risk of transplacental transfer due to human IgG antibodies’ ability to cross the placental barrier. |
| Trametinib (MEK Inhibitor) | Can cause fetal harm when administered to pregnant patients. |
| Upadacitinib | It may cause fetal harm based on animal studies. Advise female patients of reproductive potential of the potential risk to a fetus and to use effective contraception. |
| Ustekinumab | There is limited data on the use of ustekinumab and humans. |
| Vemurafenib (Targeted therapy) | Placental transfer of vemurafenib has been reported. There are no data on the use of vemurafenib in pregnant patients. |
| Vismodegib (Hedgehog pathway inhibitor) | Embryo-fetal toxicity (Black Box Warning). |
| Vitamin A (retinol) | Risk of teratogenicity w/ doses >25,000 units/day based on human data. |
Table 2: Topical Medications
| Medication | Notes |
|---|---|
5-Fluorouracil |
Teratogenic. |
Adapalene |
Only use in pregnant patients if the potential benefit outweighs the potential risk to the fetus. |
Corticosteroids |
Safe during pregnancy in low cumulative doses. Super potent topical corticosteroids should be avoided in the nipple area in people who are nursing. |
Diclofenac |
The use of NSAID’s can cause premature closure of the fetal ductus arteriosus and fetal renal dysfunction leading to oligohydramnios and, in some cases, neonatal renal impairment. Because of the risks, limit the dose and duration of NSAID’s use between about 20 and 30 weeks of gestation, and avoid NSAID’s use at about 30 weeks of gestation and later in pregnancy. |
| Imiquimod | Only use in pregnant patients if the potential benefit outweighs the potential risk to the fetus. |
| Tazarotene | Teratogenic and is contraindicated in pregnancy. Females of child-bearing potential should have a negative pregnancy test within two weeks prior to initiating treatment and use an effective method of contraception during treatment. |
| Tretinoin | Weigh risk/benefit during pregnancy; risk of teratogenicity and holoprosencephaly low based on limited human data and minimal systemic absorption; risk of teratogenicity and fetal death based on human data w/ systemic retinoids. |
Table 3: Phototherapy
| Category | Notes |
|---|---|
Phototherapy |
Decreases folate, which is vital for pregnancy; however, this can be managed with appropriate supplements and monitoring. |
* The Academy is sharing the information above for educational purposes only. The information provided is based in part on a review of third-party sources and guidelines. The Academy does not warrant the accuracy or comprehensiveness of these external sources or the information provided above. The information is not intended to create a standard of care. Physicians must make independent judgments about appropriate treatments and therapies based on the circumstances presented by individual patients.
Additional Academy resources
Learn more about the Academy‘s advocacy around the iPLEDGE program and patient access.
See an Academy FAQ on the lidocaine shortages, including resources for dermatologists.
Access Academy advocacy priorities, including drug access, reimbursement policy, and more.
