Picking out pregnancy-safe skincare can seem complicated. I have an entire page on pregnancy beauty, dedicated to which skincare ingredients to avoid during pregnancy, breastfeeding, or IVF.
Today, is about azelaic acid, a naturally occurring acid, and frequently overlooked ingredient in skincare. Despite being safe during pregnancy and lactation, azelaic acid has yet to see a surge in popularity like that of vitamin C or retinoids.
Read on to know what makes this acid so special and if it is safe to use while pregnant or breastfeeding.
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What is azelaic acid?
AA is a naturally occurring acid in whole grain cereals, rye, and barley.
It is also found on the human skin and is produced by P.ovale, a fungus that usually resides on the skin.
It has multiple beneficial properties:
- Anti-inflammatory
- Anti-bacterial action against P.acnes that causes acne
- A mild exfoliative
- Inhibits free radical production
- It helps improve melasma and post-inflammatory hyperpigmentation disorders (e.g., after acne or trauma).
For topical use, it is available (with or without prescription, depending on the region) in 10%, 15%, and 20% in gel or cream form.
Despite its multiple beneficial actions, is azelaic acid pregnancy safe? What about its safety while breastfeeding?
Safety of azelaic acid in pregnancy & lactation
There is sufficient evidence in the literature and recommendations from major health bodies that AA is largely safe to use during pregnancy and while lactating.
- US FDA categorizes AA into pregnancy category B, i.e., animal reproduction studies have failed to demonstrate a risk to the fetus, and there are no adequate and well-controlled studies in pregnant women.
Other members of this category?
Prenatal vitamins and acetaminophen (also known as Tylenol or Paracetamol)
Furthermore, there are practically no medications in the FDA Category A drug, as there are no experimental studies on the pregnant human population.
*The lack of studies on the pregnant human population is not surprising, as it is unethical to experiment on pregnant women, and no pregnant woman will volunteer. The information we have about certain harmful topical medications in humans, e.g., topical retinoids, is case reports and not the result of deliberate experiments being conducted. So far, there have been no adverse events reported with AA. - Azelaic acid is not just well tolerated in pregnancy; it is also, as AAD (American Academy of Dermatology) states, safe to use during pregnancy.
- It has been studied how much of AA is absorbed into the bloodstream after topical application:
The study titled Percutaneous Absorption of AA in Humans found that 20% AA, when applied topically, resulted in just 3.6% of the topical dose being absorbed. - The NIH (National Institute of Health) states that only 4% of the topically applied AA gets absorbed into the bloodstream. Since it is normally found in food items and the human body (see above subtopic- What is AA?), this is a low risk to the nursing child, and thus, breastfeeding can be continued.
However, ensure the infant does not come in contact with it, and do not apply it in the breast or nipple area.
* On a side note, the NIH also recommends that ‘only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffin via licking.’
Uses of azelaic acid during pregnancy & lactation
Pregnancy leads to many changes in your skin- increased hormone levels can cause acne and hyperpigmentation called melasma.
It can also make your skin more sensitive to newly introduced or previously used skin-care products.
AA finds application in many pregnancy-related or unrelated skin conditions like acne, melasma, and rosacea.
- Mild to moderate acne
Its exfoliative and antibacterial action keeps your pores from clogging (a precursor to comedone formation that can lead to inflamed acne). Also, it inhibits Propionibacterium acnes, the bacteria responsible for acne.
It is also effective for the pesky dark marks left behind once the acne heals.
Azelaic acid, however, does not work in more severe nodulocystic acne cases, and other treatments might be needed –Pregnancy Safe Acne Treatments. - Melasma
Also known as the ‘mask of pregnancy’ or chloasma, these dark patches on the face that appear during pregnancy can be very stressful.
This happens as increased hormone levels in pregnancy can stimulate melanocytes to produce more melanin.
AA is one of the pregnancy-safe treatment options for melasma.
Pregnancy Safe Melasma Treatments.
Melasma in Pregnancy: Causes & Prevention.
Best Pregnancy & Nursing Safe Azelaic Acid Creams & Serums.
It inhibits the hyperactive melanocytes and reduces free radicals that can cause skin dullness.
Due to its exfoliative action, it also increases cell turnover to promote new and healthy skin. - Rosacea
AA in 15% gel form is a relatively new treatment for rosacea.
Its anti-inflammatory and free radical reduction effects are believed to be responsible for the benefits.
It reduces swelling and skin redness with minimal side effects.
Advisory: Never start medication on your own. As with the use of any other chemical or drug during pregnancy or lactation, it is essential that you take the advice of your treating physician so that your individual needs and health risks can be estimated and the right decision tailored for you can be made.
Takeaway
- AA is a naturally occurring acid in some grains and human skin.
- It is largely considered safe for topical use during pregnancy and lactation.
- It is effective for mild to moderate acne, the management of melasma or other hyperpigmentation disorders, and certain forms of rosacea.
- Always consult your physician before embarking on any medication regimen.
