Why Do I Get Acne During Pregnancy?
Acne is a chronic inflammatory condition of the pilo-sebaceous glands. Affecting more than 80% of adolescents, there are increasing more adults in theirs 20s, 30s and 40s suffering from acne. Acne during pregnancy can be a particularly frustrating time for many women as it can behave erratically. Generally, acne often subsides during the first trimester, but can flare up during the second and third trimester. This is due to an increased in circulating maternal androgens which have a direct effect on sebum (oil) production in the skin. Treatment of acne early helps to prevent worsening of the condition, and to prevent scarring acne in more severe cases.
Tips For Acne Treatment During Pregnancy
- Gentle cleansing both during morning and evening.
- Avoid squeezing and picking at your acne. This increases the chance of scarring.
- Use oil-free skin care products, and those that are non-comedogenic and non-acnegenic.
- Awareness that acne can be managed during pregnancy.
- Safe and effective topical and oral acne treatments available for mild, moderate and severe acne.
FDA Pregnancy Categories
The FDA Pregnancy Categories indicate the potential of a drug to cause birth defects if used during pregnancy. Generally, topical and/or oral medications in category A and B can be safely prescribed. Category C medications should only be given if the risks outweigh the benefits to the patient. Category D and X drugs are to be avoided during pregnancy.
Acne Treatment During Pregnancy
It is common for many women to shun acne treatment during pregnancy. This is most often due to the misinformation that all forms of acne treatment during pregnancy are harmful to the foetus. While it can be indeed challenging to treat acne during pregnancy because many of the standard acne treatment options are not recommended, there remain safe and effective options available.
Topical Acne Treatments
Topical acne treatments in cream and gel formulations are suitable for mild to moderate forms of acne vulgaris. Many of the topical treatments available to treat acne during pregnancy have an FDA Pregnancy Category of B and C. However, not all FDA Pregnancy Category C medications are recommended for use during pregnancy (e.g. retinoid based formulations) due to the theoretical risk of harm to the foetus.
Azelaic acid has a FDA Pregnancy Category B rating for the treatment of acne. It is clinically proven to kill bacteria, reduce inflammation, and actively eliminates blackheads and whiteheads. It has an added advantage of treating post-inflammatory hyper-pigmentation (PIH) that is prevalent in Asian skin type.
Benzoyl Peroxide has a FDA Pregnancy C rating, and is safe to use for acne treatment during pregnancy. Benzoyl peroxide is commonly found over the counter, and comes in various concentrations and formulations (e.g. gels, creams and foams). It is proven to reduce inflammation, kill off bacteria and reduce whiteheads and blackheads. Benzoyl peroxide has the added advantage of reducing bacterial resistance when combined with either a topical or oral antibiotic. The disadvantage is that it has a tendency to stain clothing and bedding.
Salicylic Acid based facial creams and washes are readily available over the counter. They have a FDA Pregnancy Category C, and are considered safe to use during pregnancy in small amounts. It works by exfoliating skin and reducing comedomes. We advise 2% salicylic acid formulations that are more gentle on the skin. Although well tolerated, it is less effective than Azelaic acid and benzoyl peroxide.
The only two topical antibiotics safe for acne treatment during pregnancy are Clindamycin and Erythromycin. They both have a FDA Pregnancy B rating. They are most effective for inflammatory acne, and act by killing off bacteria and reducing inflammation. Nowadays, antibiotic formulations are often combined with benzoyl peroxide. This makes sense as the addition of benzoyl peroxide has the benefical effect of reducing bacterial resistance.
The two most commonly used topical retinoid are Adapalene (e.g. Differin) and Tretinoin, and both have a FDA Pregnancy C rating. Tazarotene has a FDA Pregnancy X rating, which means that it is absolutely contraindicated during pregnancy. Although, topical retinoids are routinley prescribed for comedomal and inflammatory acne, they are not recommended during pregnancy and breastfeeding due to the risks of harm to the foetus and baby.
Oral Acne Treatments
Oral antibiotics for acne treatment during pregnancy is given for more severe cases of acne, or acne that is not responding to topical therapies. Generally, most oral antibiotics should only be started in the second or third trimester, because most the the foetal organs are still developing during the first trimester.
Oral antibiotics that are considered safe and have a FDA Pregnancy Category B rating are Erythromycin, Cephalexin, Amoxicillin and Azithromycin. These are safe choices during pregnancy, however, they should only be prescribed for a few weeks.
Antibiotics from the Tetracycline group (e.g. Doxycycline and Minocycline) have a FDA Pregnancy D rating, and thus not recommended to use during pregnancy. They have the potential to stain foetal teeth and bones, and cause bony growth retardation.
Steroids have an anti-inflammatory and immuno-suppressive action. They can play a role in severe acne not responding to oral antibiotics, and should only be used for a short duration of time after the first trimester. They fall under FDA Pregnancy C category, and is associated with cleft lips and/or palate, miscarriage and preterm births.
Oral Isotretinoin is absolutely contraindicated during pregnancy and breastfeeding. It falls under FDA Pregnancy Category X. Studies have documented malformation of the foetus face, brain, heart and nervous system.
- Zaenglein et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74:945-973.e933
- Chien Al et al. Treatment of Acne in Pregnancy. J of the Am Board of Fam Med. 2016;29:254-262