From the Guidelines
Acne during pregnancy can be safely managed with topical benzoyl peroxide (2.5-5%) and topical azelaic acid (15-20%) as first-line treatments, as they are considered safe during all trimesters. For mild to moderate acne, start with topical benzoyl peroxide, applying a thin layer to affected areas once or twice daily 1. Topical azelaic acid is another safe option, applied twice daily. For cleansing, use a gentle, non-medicated cleanser twice daily and avoid harsh scrubbing.
Key Considerations
- Avoid using topical retinoids (like tretinoin, adapalene), oral isotretinoin, tetracycline antibiotics (doxycycline, minocycline), and spironolactone during pregnancy as these can harm the developing fetus 1.
- If acne is severe or not responding to topical treatments, consult with an obstetrician or dermatologist who may consider prescribing topical clindamycin or erythromycin, or in some cases, oral erythromycin 1.
- Hormonal fluctuations during pregnancy often cause acne flares, particularly in the first trimester, but symptoms typically improve in later trimesters.
- Maintaining a healthy diet, staying hydrated, and avoiding oil-based cosmetics can also help manage pregnancy acne.
Treatment Options
- Topical benzoyl peroxide (2.5-5%): safe during all trimesters, apply a thin layer to affected areas once or twice daily 1.
- Topical azelaic acid (15-20%): safe during all trimesters, apply twice daily 1.
- Topical clindamycin or erythromycin: may be considered for severe acne or acne not responding to topical treatments, under the guidance of an obstetrician or dermatologist 1.
- Oral erythromycin: may be considered in some cases, under the guidance of an obstetrician or dermatologist 1.
From the FDA Drug Label
INDICATIONS AND USAGE: Erythromycin Topical Solution is indicated for the topical treatment of acne vulgaris. INDICATIONS AND USAGE Clindamycin Phosphate Topical Solution, Clindamycin Phosphate Gel, and Clindamycin Phosphate Lotion are indicated in the treatment of acne vulgaris.
The treatment of acne in pregnant women can be done with topical antibiotics such as erythromycin 2 and clindamycin 3.
- Erythromycin is indicated for the topical treatment of acne vulgaris.
- Clindamycin is also indicated for the treatment of acne vulgaris.
From the Research
Treatment Options for Acne in Pregnant Women
- Topical medications are recommended as first-line treatment for acne vulgaris in pregnant and lactating women, including antibiotics (erythromycin, clindamycin, metronidazole, and dapsone), benzoyl peroxide, azelaic acid, and salicylic acid 4
- Oral agents and/or light-based therapy may be considered as second-line treatment, with oral macrolides (erythromycin and azithromycin), cephalexin, or zinc compounds being options 4
- Hormonal therapy, antibiotics consisting of tetracyclines, co-trimoxazole, and fluoroquinolones, and both oral and topical retinoids should be avoided due to potential risks 4
Safety of Specific Treatments
- Topical azelaic acid or benzoyl peroxide can be recommended as baseline therapy for acne in pregnancy 5
- A combination of topical erythromycin or clindamycin with benzoyl peroxide is recommended for inflammatory acne 5
- Oral erythromycin or cephalexin is generally considered safe for moderate to severe inflammatory acne when used for a few weeks 5
- Benzoyl peroxide is safe for use in pregnant and lactating females because it is degraded to benzoic acid 6
Considerations for Treatment
- The risk-to-benefit ratio, efficacy, acceptability, and costs are considerations when choosing a treatment for acne in pregnancy 5
- Topical and oral antibiotics should not be used as monotherapy, but combined with topical benzoyl peroxide to decrease bacterial resistance 5, 7
- Alternative treatments such as light therapy and cosmetic procedures may be evaluated, but limited data exist regarding their safety and efficacy 8