From the Guidelines
When pregnant, the safest acne treatment options include topical azelaic acid and benzoyl peroxide, as they are considered pregnancy category B medications with minimal expected systemic absorption. According to the most recent guidelines 1, these agents are not expected to cause fetal harm. Start with gentle cleansing twice daily using a mild, fragrance-free cleanser. Apply benzoyl peroxide to affected areas once daily, gradually increasing to twice daily if tolerated. Azelaic acid (15-20%) can be applied twice daily as an alternative.
Some key points to consider when treating acne during pregnancy:
- Avoid retinoids (like tretinoin), as they can harm fetal development 1
- Limit the use of salicylic acid, as it can be used in pregnancy if the area of exposure and duration of therapy is limited, but use for large areas or prolonged duration is not recommended 1
- Topical antibiotics like clindamycin and erythromycin are considered safe, but their use should be limited to minimize the development of antibiotic resistance 1
- Glycolic acid products can help exfoliate and reduce breakouts, but their safety during pregnancy is not well established 1
It's essential to consult with your obstetrician before starting any treatment to ensure it's appropriate for your specific situation, especially if you have severe or distressing acne. Hormonal changes during pregnancy often cause acne, particularly in the first trimester, but these typically resolve after delivery. The most recent guidelines 1 also suggest avoiding certain systemic antibiotics during pregnancy, such as oral metronidazole, co-trimoxazole, and doxycycline, due to potential risks to the fetus.
From the FDA Drug Label
Isotretinoin is contraindicated in patients who are pregnant The FDA drug label does not answer the question.
From the Research
Acne Treatment During Pregnancy
When it comes to treating acne during pregnancy, it's essential to consider the safety of the medications used. According to 2, topical medications are recommended as the first-line treatment for acne vulgaris in pregnant and lactating women. These include:
- Antibiotics such as erythromycin, clindamycin, metronidazole, and dapsone
- Benzoyl peroxide
- Azelaic acid
- Salicylic acid
Oral Agents and Light-Based Therapy
Oral agents and/or light-based therapy may be considered as second-line treatment for acne during pregnancy. The oral agents that can be used include:
- Oral macrolides such as erythromycin and azithromycin
- Cephalexin
- Zinc compounds
- Blue-violet or red light phototherapy can be used as monotherapy or in addition to topical and/or oral therapies
Medications to Avoid
Certain medications should be avoided during pregnancy, including:
- Hormonal therapy
- Antibiotics such as tetracyclines, co-trimoxazole, and fluoroquinolones
- Oral and topical retinoids
It's essential to consult a healthcare provider before starting any acne treatment during pregnancy to determine the best course of treatment. While other studies such as 3, 4, 5, and 6 provide information on acne treatment in general, they do not specifically address pregnancy and lactation. Therefore, the recommendations from 2 should be followed for acne treatment during pregnancy.