Eczema flare during pregnancy

By trimester

Weeks 1–13

1st trimester

Flaring is less commonly reported this early, though the immune shifts of pregnancy can begin affecting the skin from the start. If a flare does appear now, standard low-to-moderate potency topical corticosteroid use, matched to the affected area, is still a reasonable first-line option.

Weeks 14–27

2nd trimester

This is one of the two trimesters research most often links to worsening eczema, alongside the third. A pregnancy-related shift toward the type of immune response involved in eczema is one proposed reason. Steroid cream strength is generally matched to location: milder formulations for the face and skin folds, stronger ones for the trunk, limbs, or scalp.

Weeks 28–birth

3rd trimester

Flaring frequently continues or peaks here, and this is also the trimester most linked to pemphigoid gestationis, a separate, rarer condition that can look like eczema at first but involves blistering and carries pregnancy-specific risks. Watch for blisters or a rash starting around the navel, and mention any new or changing rash to your provider rather than assuming it is simply eczema.

What does the evidence show for eczema flare?

• Individual studies of eczema during pregnancy have found worsening in widely varying shares of pregnant people, 52%, 61%, and 17% across different cohorts, while about 20% of women in one study reported improvement instead, reflecting genuinely unpredictable individual variation rather than one uniform pattern. 1
• Pregnancy shifts the immune system toward the type of inflammatory response associated with eczema, and changes in estrogen and progesterone are thought to stimulate that same pathway. Physical and psychological stress during pregnancy may also play a contributing role. 1
• Recommended topical corticosteroid potency is matched to body location: mild-to-moderate potency, such as 1% hydrocortisone ointment, for the face and neck; moderate potency for skin-fold areas; and potent formulations for the trunk, limbs, or scalp. Beyond topical steroids, other options for more difficult cases include topical calcineurin inhibitors, narrowband UVB light, and, for severe disease, systemic options such as ciclosporin or dupilumab. 1
• There have been reports of atopic dermatitis symptoms worsening or flaring specifically during the second or third trimester. Guidance emphasizes discussing the benefits of managing the condition against the risks of leaving it unmanaged with your healthcare provider rather than stopping medication on your own. 2
• Topical corticosteroids are often a first-line option during pregnancy for skin conditions. Studies of topical corticosteroid exposure have not found a higher chance of birth defects, and typical use is not expected to raise the chance of miscarriage or other pregnancy complications. 3
• Pemphigoid gestationis, a separate and much rarer skin condition, can be mistaken for an eczema flare early on but typically starts as intense itching around the navel that spreads and progresses to tense blisters in more than 65% of cases. Unlike an ordinary flare, it is associated with preterm birth, fetal growth restriction related to placental dysfunction, and transient newborn skin lesions, and it usually needs specific testing rather than a visual assessment alone to confirm. 4

When should I call my provider about eczema flare?

New blistering, especially starting around the navel and spreading to the abdomen or limbs, can signal pemphigoid gestationis rather than an ordinary eczema flare, and needs prompt evaluation given its association with preterm birth and fetal growth restriction. Spreading redness, warmth, pain, or pus-like drainage from broken or scratched skin can indicate a secondary skin infection rather than the flare itself and also needs prompt attention. Any new rash you are not confident is your usual eczema, particularly one that is intensely itchy, blistering, or spreading in a new pattern, is worth bringing to your provider rather than managing at home with your usual routine. Whatever the pattern, any symptom that feels beyond your usual range is a reason to call: obstetric teams expect these questions and would rather hear early than late.