I'm frequently asked by patients what medications are safe during pregnancy. This is among the toughest questions I get asked for a simple reason: human studies have usually not been done. In fact, it's unlikely human studies will ever be done on many of the products because clinical trials are not often done during pregnancy. Here are a few important considerations. Any pregnant woman considering using these medications should certainly review these medications with the physician caring for her pregnancy.
1) Anti-dandruff shampoos
What I often recommend to my own patients. We don't have much information on the safety of anti-dandruff shampoos in pregnancy. The data would suggest that periodic use of zinc pyrithione and ciclospirox have reasonable safety and these are frequently my top choices for many of my own patients. If dandruff (or seborrheic dermatitis) is troublesome, I generally advise use once every 2 weeks and to be left on the scalp for 60 seconds before rinsing off. Small amounts of betamethasone valerate scalp lotion can be used once weekly if itching persists.
What I usually don't recommend to my patients. Ketoconazole shampoos don't have much in the way of data. Patients interested in using should check with their OB or the physician caring for the pregnancy. There is no good data to really suggest a problem with periodic use of topical shampoos containing ketoconazole. It's not the top choice for my practice as they have the potential to affect testosterone synthesis. Oral ketoconaole is certainly not advised. It increased the risk of cardiovascular, skeletal, craniofacial and neurological problems in many studies. I don't recommend coal tar shampoos during pregnancy. Animal studies show that high doses are associated with perinatal mortality, cleft palate, small lungs and other developmental issues. I avoid them in my practice.
2) Topical steroids
What I usually recommend to my own patients. I don't recommend topical steroids unless they are needed. Troublesome itching can occur in pregnancy. Periodic use of a low to medium strength topical steroid is often fine and there is no evidence for harm. For patients with troublesome scalp itching, or burning, periodic dabs of betmethasone validate scalp lotion once weekly or twice weekly has no evidence of being harmful.
What I usually don't recommend. I don't recommend frequent use of potent topical steroids unless this has been reviewed in detail by a physician who will carefully monitor the patient. Potent topical steroids can give growth restriction, particularly when used in the third trimester.
Minoxidil should not be used during pregnancy. There are no exceptions. Although it's clear that oral minoxidil is associated with several developmental abnormalities, isolated case reports have suggested issues with topical use, including cardiovascular, GI, and kidney. One should not use minoxidil during pregnancy.
4) Oral Medications
Most oral medications having any role in hair growth should not be used. Oral immunosuppressants such as methotrexate are clear contraindications and must be avoided. Methotrexate increases the risk of miscarriage and various congenital abnormalities. For serious life threatening autoimmune diseases, hydroxychloroquine and cyclosporine can be considered on a case by case basis. Spironolactone, used for androgenetic alopecia, must never be used. It can increase the risk of genital developmental issues (hypospadias) and feminization of a male fetus. Topical spironolactone must also be avoided.
Nearly 1 in 5 women use a medication during pregnancy that is potentially harmful. Any time a medication is to be used topically or ingested, one must review the safety of that medication with a medical professional. This includes over the counter, herbal and prescription medications.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299