Dermatological medication and local therapeutics

4.12.1

Topical applications and cosmetics

Topical applications during breastfeeding are, in principle, acceptable as long as they are applied to a limited area of the skin and for a limited period of time. This applies to all topical treatments, as well as antiseptics and disinfectants (for iodine see Chapter 4.11 ), repellents, anti-infectives (topical antibiotics, antimycotics and virostatics), corticosteroids and topical anti-inflammatory drugs, astringents, antipruritics and keratolytics.

For substances not mentioned in this chapter, the Recommendations in Chapter 2.17 can serve as an orientation.

If treatment involves a large area of the skin over a long period of time, the absorption and the effects of the individual substances must be considered, and it is advised to use systemic applications of the drug as a guide (i.e. iodine and acetylsalicylic acid). If the skin of the breast needs to be treated with topicals, it should be cleaned before the baby is fed.

Cosmetics and hair preparations, including coloring and permanent waves, may be used if they improve the mother’s well-being. However, absorption and transmission of its compounds through mother’s milk cannot be ruled out (i.e. moschus derivatives and lead; Chapter 4.18 ), and particular attention needs to be paid to the ingredients of, for example, hair dyes which may contain toxic substances like lead. Even though an allergic potential of compounds of the topicals (cosmetics) used by the mother resulting in sensitization of the breastfed baby is theoretically possible, this seems a very rare and hard situation to prove.

Furthermore, avoidance of potential allergens seems not to prevent the development of atopic eczema. Studies on maternal dietary restrictions during pregnancy and lactation have led researchers to believe that antigen avoidance does not play a significant role in the prevention of atopic disease or food allergies ( ).

4.12.2

Essential oils

In principle, there is no reason to object to the use of essential oils. However, direct contact of the breastfed baby with the area of the treated skin should be avoided. If solutions or emulsions containing essential oils are applied to the breast, the relevant site of the skin should be thoroughly cleaned before breastfeeding (see also Chapter 2.19 ).

4.12.3

Retinoids and topicals for psoriasis, dermatitis and acne

About 1% of the maternal weight-related dose of acitretin , which is metabolized to etretinate , is passed to the fully breastfed infant. This was reported for a patient who received 40 mg p.o. daily ( ). There are no reports available on toxic symptoms in the child.

There is no experience available on isotretinoin and on external use of adapalene , alitretinoin gel , tazarotene and tretinoin or on calcipotriol , dithranol – which is sometimes combined with salicylic acid, urea, coal tar and azelaic acid preparations. However, with regard to retinoids such as tretinoin and its isomer isotretinoin , no appreciable exposure of the breastfed baby is expected following topical administration ( ).

There is no experience on the topical use of lithium for seborrhoic dermatitis during breastfeeding. However, percutaneous intake is limited ( ); therefore, an appreciable passage into the milk seems unlikely.

Tacrolimus and pimecrolimus are used for topical treatment of atopic dermatitis ( Chapter 4.10 ).

There are also no systematic studies on the use of schist oil extracts such as ammonium bituminosulfonate and sodium bituminosulfonate ; there is no hint for toxic symptoms in the breastfed baby after maternal use either.