Topical Retinol and Retinal During Breastfeeding
Topical retinol and retinal are likely safe to use during breastfeeding because minimal amounts are absorbed systemically and transfer into breast milk is limited. 1
Safety Profile of Topical Retinoids
The American Academy of Dermatology indicates that topical retinol cream has minimal systemic absorption and limited breast milk transfer, making it appropriate for use during lactation. 1, 2 This stands in stark contrast to systemic retinoids like acitretin, which are absolutely contraindicated during breastfeeding due to significant blood levels that transfer into breast milk. 2
The safety of topical retinoids is further supported by their demonstrated safety profile in pediatric patients aged 9 and older, suggesting minimal systemic concerns even with direct application. 1
Practical Application Guidelines
To maximize safety when using topical retinol or retinal products while breastfeeding:
- Apply after breastfeeding sessions to maximize the time interval between application and infant contact 1, 2
- Wash hands thoroughly after application to prevent direct transfer of medication to infant skin through touch 1, 2
- Avoid application on the chest, neck, or any areas that may come into direct contact with the infant during breastfeeding—apply only to facial areas or other locations that will not touch the baby 1, 2
- Monitor the infant for any unusual skin reactions or irritation, though these are unlikely given the minimal transfer 1, 2
Important Distinction: Topical vs. Oral Vitamin A
While topical retinoids are safe, it's critical to understand that oral vitamin A supplementation during lactation has different considerations. The WHO does not recommend routine vitamin A supplementation in postpartum women for prevention of maternal and infant morbidity and mortality in developed countries. 3 There is no convincing evidence that maternal vitamin A supplementation during lactation reduces infant mortality or morbidity. 4, 3
The key difference is route of administration: topical application results in negligible systemic absorption, while oral supplementation directly affects breast milk retinol concentrations. 3 Vitamin A concentration in human milk reflects maternal intake more than infant requirements. 3, 1
Common Pitfalls to Avoid
- Do not confuse topical retinoids with systemic retinoids—systemic forms like acitretin require cessation of breastfeeding 2
- Do not apply topical retinoids to breast tissue or areas that contact the infant 1, 2
- Do not assume all vitamin A forms carry the same risk—beta-carotene (provitamin A) has negative feedback control and is safer than preformed vitamin A (retinol) if oral supplementation is considered 3, 1
- Avoid excessive oral vitamin A intake while using topical retinoids, as there is a narrow therapeutic window between deficiency and toxicity 3