Medication class	Drug name	Bioavailability	Use	Effectiveness and timing	Risk
Acne agents13,22	Azelaic acid, 15% to 20%	3% to 10%	Mild to moderate acne vulgaris	Acceptable for use in any trimester Apply twice per day at maximum strength	No demonstrated teratogenicity
	Benzoyl peroxide, 2.5% to 5%	Unknown
Analgesic13	Lidocaine, 4% to 5% patch, cream, or ointment	1% to 3%	Musculoskeletal pain and arthritis	Use only if the potential maternal benefit outweighs the potential risk to the fetus	Lidocaine crosses the placenta; acceptable for use after the first trimester19 Acceptable for use in the third trimester20
	Pramoxine, 1% foam, cream, or ointment	Unknown	Hemorrhoid pain and pruritus
Azole antifungals13,27	Clotrimazole, 1% solution, cream, or ointment Miconazole, 2% topical cream	Skin: < 0.5%	Dermatophyte infections: tinea corporis, tinea cruris, tinea pedis, Malassezia furfur Candida spp.	More effective than nystatin	Oral azole antifungals have teratogenic potential, making the lowest effective dose and duration and use after the first trimester reasonable27
Corticosteroid13,18	Hydrocortisone, 0.5% to 1% lotion, cream, or ointment	Varies with where applied and patient-specific factors	Atopic dermatitis Hemorrhoid pain and pruritus	Topical corticosteroids are first-line treatment for atopic dermatitis Low-potency, over-the-counter topical corticosteroids are acceptable for use throughout pregnancy No evidence of teratogenicity	Large cumulative doses of high-potency topical cortico-steroids show a probable association with low birth weight and hypothalamic-pituitary-adrenal axis suppression, rare hypertension, and hyperglcyemia26
Nonsteroidal anti-inflammatory drugs28,29	Diclofenac, 1% to 3% solution or gel	2% to 10%	Musculoskeletal pain and arthritis	Use only between 12 and 20 weeks’ gestation for conditions refractory to first-line therapies	Diclofenac crosses the placenta Possible embryotoxicity with first-trimester use Risk of fetal renal dysfunction and oligohydramnios with use after 20 weeks’ gestation Risk of premature closure of the ductus arteriosus with use after 30 weeks’ gestation
Retinoid22	Adapalene (Differin)	Minimal	Acne	Not recommended for use in any trimester	Insufficient data to support safe use Major congenital abnormalities associated with oral retinoids