New baby, new bumps: Acne and pregnancy 2

Oral drugs known to cause birth defects
I recommend avoiding all oral medicines to treat acne when you’re
pregnant. However, an oral penicillin derivative, such as amoxi-
cillin (if you’re not allergic to it), may be taken safely if your acne is
really bad. If you’re allergic to penicillin or it’s not working, your
dermatologist may prescribe another oral antibiotic that can be
used in pregnancy.
Many oral drugs can harm your unborn baby. In these cases,
clear evidence exists that your child may have serious birth
defects if you use them. The following medications must be
avoided if you’re pregnant or if you’re contemplating becoming
pregnant:
 Tetracycline: Tetracycline and its derivatives, minocycline
and doxycycline, may cause some inhibition of bone growth
and discoloration of teeth in a fetus. Tetracycline and its side
effects are covered in Chapter 10.
 Hormones: The anti-androgens such as spironolactone that
are sometimes used to treat acne, can, by blocking testos-
terone, interfere with the normal development of a male fetus
and cause feminization. (See Chapter 11.)
 Oral isotretinoin (Accutane): Oral isotretinoin (eye-so-tret-ih-
no-in) available as Accutane, Roaccutane, Amnesteem,
Claravis, and Sotret, is a powerful drug that’s used to treat
severe nodular acne in carefully selected patients. This drug
can cause severe fetal abnormalities. I discuss Accutane and
its generics in Chapter 13.
There are many restrictions currently in place regarding
oral isotretinoin, and with understandable cause. Oral
isotretinoin can cause serious birth defects to infants born
to women exposed to them. They should never — not under
any circumstances — be taken during pregnancy! Even if a
woman becomes pregnant within one month after stopping
the drug, problems can still occur.
There also is an increased risk of miscarriage, premature
births, and infant death associated with taking oral isotretinoin
during pregnancy.
A recently published Swedish study showed an increased occur-
rence of certain heart defects in children born to mothers who had
taken oral erythromycin in early pregnancy (first trimester). But it
can’t be certain that factors other than erythromycin didn’t con-
tribute to the increase in malformations. In the same study, the risk
after treatment with penicillin demonstrated no increase in these
malformations.
You’re never too old
Some women pass through menopause without outgrowing their
acne. Yes — acne during and after menopause! Just when you felt
certain that the years of pimples have faded from your skin and
your memory, they’re back! No, you’re not going through a second
adolescence, it’s those pesky hormones again! Although hormon-
ally influenced acne typically begins around age 20 to 25, acne can
persist in women over the age of 40 and continue into the peri-
menopausal and menopausal periods.
Along with all the other changes that you go through during this
time, acne just seems to add insult to injury. Post-menopausal
acne isn’t a common occurrence, but when estrogen levels begin
to taper off and testosterone becomes the dominant hormone,
acne — usually mild — can appear.