Topical Antiviral and Antifungal Medications in Pregnancy: A Review of Safety Profiles

Abstract

Medications should be employed with caution in women of childbearing age who are pregnant or considering pregnancy. Compared to oral or parenteral agents, topical medications have limited systemic absorption and are deemed safer. However, their safety profile must be assessed cautiously due to the limited available data. In this article, we aggregate human and animal studies to provide recommendations on utilizing topical antiviral and antifungal medications in pregnancy. For antiviral medications, acyclovir and trichloroacetic acid are safe to use in pregnancy. Docosanol, imiquimod, and penciclovir are likely safe, but should be utilized as second-line agents. Podofilox and podophyllin resin should be avoided. For antifungal medications, clotrimazole, miconazole and nystatin are considered first line agents. Butenafine, ciclopirox, naftifine, oxiconazole, and terbinafine may be utilized after the above agents. Econazole should be avoided during the first trimester and used sparingly during 2^nd and 3^rd trimester. Ketoconazole and selenium sulfide are likely safe, but should be employed in limited areas for brief periods.

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