From the Guidelines
For a female trying to get pregnant with cystic acne, the most recommended treatment options prioritize safety for conception, focusing on topical treatments such as benzoyl peroxide, azelaic acid, and gentle skincare routines. Given the potential risks associated with oral medications during pregnancy, it's crucial to weigh the benefits and risks of each treatment option. The most recent and highest quality study, 1, provides guidelines for the management of acne vulgaris, emphasizing the importance of multimodal therapy and the use of topical retinoids, benzoyl peroxide, and azelaic acid. Key considerations include:
- Topical treatments: benzoyl peroxide (2.5-5%) once or twice daily, azelaic acid (15-20%) twice daily, and glycolic acid or salicylic acid cleansers.
- Gentle skincare with non-comedogenic products is essential.
- Oral options are limited but may include low-dose oral antibiotics like erythromycin (250-500mg twice daily) for short courses under medical supervision.
- Physical treatments such as gentle extraction by a dermatologist, cortisone injections for individual cysts, and blue light therapy are safe alternatives.
- Diet modifications, including reducing dairy and high-glycemic foods, and increasing anti-inflammatory foods, can help.
- Stress management through meditation, yoga, or adequate sleep can also improve symptoms. It's critical to avoid hormonal treatments like spironolactone and isotretinoin due to their potential for causing birth defects, as noted in studies such as 1 and 1. Always consult with both a dermatologist and obstetrician before starting any treatment while trying to conceive, as individual circumstances may require personalized approaches, as suggested by 1.
From the Research
Treatment Options for Cystic Acne in Females Trying to Get Pregnant
- Topical azelaic acid or benzoyl peroxide can be recommended as baseline therapy for cystic acne in females trying to get pregnant 2
- A combination of topical erythromycin or clindamycin with benzoyl peroxide is recommended for inflammatory acne 2
- Oral erythromycin or cephalexin is generally considered safe for moderate to severe inflammatory acne when used for a few weeks 2
- A short course of oral prednisolone may be useful for treating fulminant nodular cystic acne after the first trimester 2, 3
Safety Considerations
- Oral retinoids are teratogenic and absolutely contraindicated for women who are pregnant or considering pregnancy 2, 4, 5
- Topical and oral antibiotics should not be used as monotherapy, but combined with topical benzoyl peroxide to decrease bacterial resistance 2
- The risk-to-benefit ratio, efficacy, acceptability, and costs are considerations when choosing a treatment for acne in pregnancy 2, 4, 5, 6