Pregnancy Acne: Everything You Need to Know

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    Mary Lucas, RN
    Medically reviewed by Mary Lucas, RN Written by Our Editorial Team Last updated 8/30/2020

    When you’re pregnant, your body doesn’t feel like your own. Not only are you carrying another human, but parts of you seemingly unrelated to that task — like your complexion, hair and feet — are changing too. 

    Many women experience skin changes while pregnant. For a lucky some, it’s a “glow.” but for others, it’s acne lesions — acne lesions  everywhere. 

    Acne during pregnancy can be particularly troublesome. Not only is your body changing in different ways, your face is now marked with a condition commonly associated with pubescent teens. Add to that the difficulty in finding an appropriate treatment method during pregnancy, and this new symptom could push you over the edge. 

    But, don’t despair. There are ways to treat acne-prone skin in pregnant women, and a doctor’s help will guide  you to find the right ones for you. 

    What Causes Acne? 

    Acne is generally caused by a combination of four factors: oil (sebum) production, dead skin cells, inflammation, and the presence of bacteria. 

    Generally, oil produced in the sebaceous glands under the skin, travel up your hair follicles and moisturize your complexion. 

    However, when dead skin cells block your pores (the exit point for the sebum), pimples result. Add bacteria, and these pimples can turn into inflammatory lesions that ultimately lead to scarring.

    Multiply those lesions, and you have acne.

    Several things can trigger this process or put you more at risk for acne. Those things include: hormonal changes during puberty, taking (or stopping) birth control pills, some medications, excess oil on the skin — whether through cosmetics or even cooking oil, smoking, stress and hormonal changes during menstruation and pregnancy.

    According to research, as many as 85 percent of women experience worsening acne in the days leading up to their period. Likewise, researchers observed that many women were treated for acne when they were  entering menopause, during the perimenopause period.

    The Pregnancy-Acne Connection 

    Acne is one of the most common reasons pregnant women go to the dermatologist.

    It’s believed pregancy can trigger acne because of the increase in androgenic — what are typically known as “male” sex — hormones. These androgens are the very things to blame for increased acne occurrence during puberty, though changes to your immune system can also be to blame. 

    Most pregnant women who experience gestational acne have struggled with acne in the past, though that isn’t always the case.

    Acne during pregnancy is somtimes inflammatory acne. Inflammatory pimples are more likely to be red, painful and result in scarring. 

    Pustules (characterized by pus at the top and a red base), nodules (hard, large and painful pimples) and cysts (pus-filled, deep pimples) are all examples of inflammatory acne.

    How Common Is It? 

    Adult female acne is fairly common. We know women are affected by acne more often than men, and that acne is typically more severe. 

    Because many women report worsening acne around their menstrual cycle, the hormonal fluctuations women experience could be to blame for their increased risk of acne.

    While it isn’t clear how many pregnant women are affected by acne, one recent survey found that 40 percent of pregnant women who visited a dermatologist’s office did so because of acne.

    Acne Treatment Considerations During Pregnancy

    The main issue when dealing with acne during pregnancy is treating the acne without putting your or your baby’s health at risk. 

    While there are numerous treatment options for adult female acne, not all of them are safe for use when pregnant.

    The best way to know for certain whether a medication is safe for you to use while pregnant is to consult with a healthcare professional or dermatologist. 

    Some drugs are widely known to be unsafe for pregnant women and their unborn fetuses, while others have not been researched enough in pregnant women to know for certain. A healthcare professional can best help you weigh the potential risks versus rewards of taking a particular medication. However, we can provide a brief overview. 

    Not Safe During Pregnancy 

    Some drugs are known to be unsafe to take during pregnancy. These include drugs that have been well-researched and found to cause fetal abnormalities. They simply shouldn’t be taken, and include: 

    Tazarotene. Tazarotene is a topical retinoid, or a medication you apply directly to the skin that is derived from vitamin A. 

    It is sold under the brand names Avage®, Fabior® and Tazorac®, and is classified as a “category X” drug in regards to pregnancy safety, and even women who may become pregnant should be warned of the risks of birth defects.

    Isotretinoin. Like tazarotene, isotretinoin is a topical retinoid. It is sold under the brand names Absorica®, Amnesteem®, Claravis®, Myorisan® and Zenatane®. Very little of the medication is absorbed into the body, but it is known to increase the risks of birth defects.

    Spironolactone. Spironolactone, sold under the brand names Aldactone® and Carospir®, is an anti-androgen drug that works by suppressing the hormones that can cause acne. Some research indicates these same actions can cause feminization in male fetuses.

    May Be Unsafe or Needs More Research

    Scientific researchers don’t experiment on pregnant women, so sometimes the only evidence of a drug’s safety in women is based on how a drug reacts in animals, known reactions of related drugs, or incidences where women report taking medications and then having adverse events. In general, the following medications are not recommended for use in pregnant women, though the true risks may be unknown. In some cases, healthcare professionals may prescribe some of these drugs for short-term use.

    • Adapalene (Differin®)
    • Tretinoin (Retin-A®)
    • Salicylic acid
    • Dapsone (Aczone®)
    • Many oral antibiotics (tetracycline, minocycline, doxycycline, trimethoprim, amoxicillin, azithromycin and erythromycin, for example)

    Safe to Use in Pregnancy 

    Some acne treatments are known to be safe and effective during pregnancy. However, your doctor may recommend only short-term usage, to lessen any potential risks. 

    • Benzoyl peroxide 
    • Azelaic acid
    • Cefadroxil (oral antibiotic)
    • Zinc

    A doctor will be the best guide in determining a course of action to relieve your acne during pregnancy. Given your medical history and the latest research at their disposal, they’ll be able to help make safe recommendations for you and your unborn child.

    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.