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 pregnancy-safe acne treatment.
With pregnancy, many hormonal changes occur in your body, one of them being increased sebum production, which can lead to acne.
Pregnancy acne is like any other acne; there are no special medications that are used only during pregnancy, but finding a pregnancy-safe acne treatment can help manage breakouts effectively.
However, many drugs that can be used normally are contraindicated in pregnancy as they can cause serious developmental deformity in the developing fetus. Hence, your favorite anti-acne medication may no longer be safe to use.
Pregnancy acne, in most cases, can be treated with self-care and over-the-counter medications.
My aim with all my pregnant patients is to minimize the exposure of chemicals to the baby growing inside them and, at the same time, help the mother treat her acne; hence, my conservative approach in such cases.
First, start with basic self-care practices to help you reach your goal of blemish-free skin.
You must inculcate skincare habits to improve your acne. These practices not just act as a ‘booster’ for any anti-acne medication you may be on, but many times, just following these basic practices might be the only treatment your acne needs.
Second, when suitable and appropriate, choose a topical product in place of oral medicine. E.g., Topical clindamycin antibiotic gel over any oral antibiotic.
Third, start with products that do not stay on your skin for too long. E.g., salicylic acid face cleanser over a salicylic lotion.
Fourth, choose a lower concentration of an active ingredient. E.g., 2.5% strength of Benzoyl Peroxide instead of 5%.
Fifth, have patience. I cannot stress this enough. Any anti-acne treatment takes at least 4 to 6 weeks to show effect. Switching between products too soon will not allow any of them to influence your acne.
However, every case is different, and the treatment needs to be individualized.
Hence, seeking an initial consultation with a medical professional is prudent.
✕ Do not use these if planning pregnancy or pregnant.
This group includes medications that are FDA Category X, which means that studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities.
These medications are absolutely contraindicated when pregnant and for at least a month before you plan to get pregnant.
✕ Isotretinoin
Brand name: Absorica, Amnesteem, Claravis, Isotroin, Myorisan, Zenatane, etc.
✕ Spironolactone
Brand name: Aldactone, Aldostix, Laslactone, Spirotic, Torlactone, etc.
✕ Tazarotene
Brand name: Avage, Fabior, Tazorac, Tazret, Zorac, etc.
If your baby has been exposed to any of these medicines, let your doctor know.
Using other treatments in pregnancy
Due to inherent ethical issues, no studies have been conducted on the pregnant human population. Thus, recommendations are based on animal studies or the observation of results of unintended exposure of the medicines to pregnant women.
Azelaic acid, Benzoyl peroxide, low-dose Salicylic acid, and low-dose AHAs are more commonly used.
Your doctor will be the best guide to customizing a treatment for you.
Azelaic acid
Animal studies have shown no toxic effects on the fetus, and it is generally thought to be safe. It is anti-inflammatory, has mild exfoliative action, and also shows activity against P.acnes, the bacteria that cause acne.
One advantage this has over many others is that it is also effective in pigmentation that occurs with acne scarring or pregnancy.
Benzoyl peroxide
This is available in both leave-on and cleanser forms. It is rapidly eliminated from the kidney, due to which systemic toxicity is not expected and theoretically has only a small risk, if any, of affecting the fetus. It is anti-microbial, anti-inflammatory, and mildly exfoliative.
Salicylic acid
Oral salicylic acid (aspirin) has resulted in birth deformities in humans and experimental rats. Topical use in low doses (up to 2%) to a restricted area, like just the face, and for a short duration, is generally considered safe. Refrain from using high concentration ( like in facial peels) or on a large area (the back for back acne).
For detailed information on using salicylic acid in pregnancy, clickhere.
For a list of pregnancy and lactation-safe salicylic acid cleansers, click here.
Alpha hydroxy acids
AHAs are exfoliants that dissolve dead cells on the skin surface, which does not allow comedones (blackheads and whiteheads) to develop. Low concentrations of glycolic acid (up to 7%) and lactic acid (up to 5%) are generally considered safe. These are available in multiple formulations- cleansers, lotions, serums, medical peels, etc. However, these make the skin sensitive to sun damage, and appropriate sun protection measures should be used.
Topical Dapsone
FDA-approved for acne treatment in 2005, it is a relatively new entrant with anti-microbial and anti-inflammatory properties. Due to the limited information available, it is generally used only when the benefits outweigh the risks.
Topical antibiotics
Erythromycin and Clindamycin are the most commonly used antibiotics. They reduce the amount of acne-causing bacteria and reduce inflammatory acne, and are safe for short-term use.
Topical retinoids
Adapalene and tretinoin are topical retinoids that are commonly used for acne in the non-pregnant population. These belong to the same group as Isotretinoin and Tazarotene, which have shown a positive association with fetal malformation when used in pregnancy. Opinion remains divided on whether adapalene, tretinoin, or other types of retinoids like retinyl esters, retinyl, etc., also show the same side effects. Still, as a family, retinoids are best avoided as the risk-benefit ratio in pregnancy remains questionable.
Oral antibiotics
These inhibit the bacteria that cause acne and are used in inflammatory acne.
Cefadroxil is an antibiotic that can help clear severe acne. It has not shown any birth defects in animal testing. The antibiotics that are often used to treat acne, such as azithromycin and clarithromycin, also seem safe during pregnancy.
However, antibiotics should be reserved only for specific cases after weighing the risk-benefit ratio and only for a short duration.
Oral steroids
This has to be used cautiously and under medical supervision, as both human and animal studies have shown miscarriages and fetal deformities. It is generally reserved for cases of severe fulminant acne and after the first 3 months of pregnancy.
Takeaway
- Pregnancy leads to increased sebum production and can cause acne in some women.
- The treatment recommendations made are those observed after animal studies or unintended exposure to pregnant women.
- Isotretinoin, Spironolactone, and Tazarotene are associated with fetal malformations, and under no circumstances should they be used in pregnant women or those trying to get pregnant.
- Azelaic acid, Salicylic acid, Benzoyl peroxide, and AHAs are commonly used in pregnancy.
- Certain medications, like oral antibiotics and steroid,s should be used only when the risks outweigh the benefits.
- It is prudent to have at least an initial consultation with a professional.
