During pregnancy, acne is unpredictable. For some lucky women,
the result is a welcome surprise — clear skin, the “glow of preg-
nancy” that you were told about. If this is your case, enjoy it! But
don’t get overconfident. When existing acne virtually disappears
during pregnancy, it often recurs afterward — sorry!
However, existing acne can also get worse. Pregnancy is a time of
tremendous hormonal upheaval. Your levels of estrogen and prog-
esterone are rising, and your skin becomes more sensitive to the
changes in the circulating hormones in your body. In fact, some
women may experience acne for the first time when they become
pregnant, even if they never had acne during their teens.
Acne is a perfectly normal occurrence during pregnancy (more
common than most women realize), whether you have previously
had acne or not. There’s no way to prevent it from developing
during pregnancy, but be patient and, with time, your skin will
probably clear up and return to its natural, pre-pregnancy state.
Lesions during pregnancy are generally inflammatory in their
appearance and typically take the form of papules, pustules, and
sometimes nodules. (Check out Chapter 3 for information on differ-
ent types of acne lesions.)
Acne tends to be worse during the first trimester (the first three
months) of pregnancy when the levels of these hormones are
increasing. Your progesterone is more androgenic (male hormone-
like) than estrogen and causes the secretions of your skin glands
to increase, which can lead to more acne. There are also times
when your sebaceous glands go into high gear during the first,
second, and third trimesters, causing even more frequent and seri-
ous breakouts.
When breastfeeding, some of the hormones that trigger your acne
during pregnancy may still be at work, and you may wish to contin-
ues treating those pesky pimples. But be aware, as I mention in the
sections that follow, that certain medications taken by mouth or
applied to your skin may wind up in your breast milk.
Safe acne drugs when you’re pregnant
The best course is to “say no” to any unnecessary drugs if you’re
pregnant or breastfeeding. Your baby is your first concern and you
want to minimize any potentially harmful agents that might reach
her. That said, the best way to treat acne during pregnancy is with
a topical acne-fighting preparation. (Check out Chapters 9, 10, and
11 for details on the agents I mention in this section as well as
other medications that fight acne.)
If you’re planning to get pregnant, discuss your acne treatments
with your dermatologist or healthcare provider. Some of the
medications that are safely used to treat acne when you aren’t
pregnant may be potentially harmful to a developing fetus.
Topical treatments that your doctor may prescribe during preg-
nancy (and I discuss in Chapter 9) include:
Erythromycin: There are many topical prescription products
that contain this antibiotic.
Benzamycin Gel: Benzamycin Gel combines erythromycin
and benzoyl peroxide.
Azelaic acid: This is a natural chemical produced by a yeast.
It is the active ingredient in the prescription products Azelex
and Finevin.
The U.S. Food and Drug Administration (FDA) classifies Azelaic
acid as a pregnancy category B drug. This designation means that
animal reproduction studies have failed to demonstrate a risk to
the fetus; however, there are no adequate and well-controlled
studies in pregnant humans.
Because passage of the drug into maternal milk may occur, this
drug should be used during pregnancy or by nursing mothers only
if clearly needed.
On the whole, I recommend that you avoid all oral medicines to
treat acne when you’re pregnant. However, oral erythromycin — if
you’re not allergic to it — may be taken safely if your acne is really
bad. If you’re allergic to erythromycin or it’s not working, your der-
matologist may prescribe another oral antibiotic that can be used
in pregnancy.
Drugs that may be harmful to developing fetuses
The FDA classifies some topical and oral medications as pregnancy
category C drugs. This categorization means that it’s not known
whether the medication will be harmful to an unborn baby. But,
when it comes to benzoyl peroxide, sulfacetamide, and sulfur
drugs, they’ve been around for ages and no evidence has ever
shown them to be harmful to a fetus. With some of the other drugs
mentioned below, definitive evidence isn’t available one way or the
other, so I recommend that you avoid them unless your healthcare
provider or dermatologist says otherwise.
The following acne topicals have been used for many years and are
probably safe to apply during pregnancy and nursing:
Benzoyl peroxide: This drug has been around for generations.
It’s very effective for treating acne and can be purchased over
the counter (see Chapters 7 and 9 where I talk about topical
treatments and the numerous benzoyl peroxide products that
are available). There have never been reports of problems that
came from using benzoyl peroxide during pregnancy.
However, even though benzoyl peroxide is generally consid-
ered to be safe to use during pregnancy, you should be aware
that the FDA classifies it in pregnancy category C. It’s also not
known whether benzoyl peroxide passes into breast milk.
Because this product has been around for so long, when it
was approved, the FDA didn’t require that it be tested to the
extent that drugs are nowadays.
If you’re pregnant or breastfeeding your baby, you shouldn’t
use benzoyl peroxide topical without first talking to your
doctor. You can then decide if the risks are low enough and
the benefits are high enough for you to use it.
If during pregnancy or breastfeeding, you’re advised to use a
benzoyl peroxide combination product, it’s probably wisest to
use one that contains erythromycin such as Benzamycin Gel,
rather than one that contains clindamycin, which I discuss
later in this section.
Sulfacetamide/sulfur combinations: As with benzoyl perox-
ide products, these pregnancy category C agents have been
used safely for many years. Combinations of sulfacetamide
and sulfur are contained in such products as Rosula, Rosac,
Rosanil, Nicosyn, and Novacet.
These medications should be used only when clearly needed
during pregnancy. Discuss the risks and benefits with your
doctor. These medications may pass into breast milk, so breast-
feeding while using these medications isn’t recommended.
The following FDA pregnancy category C topicals are “newer kids
on the block” and aren’t recommended for use during pregnancy:
Topical retinoids: These consist of tretinoin, Retin-A, Differin,
Tazorac, and Avita. Even though there is minimal absorption
of topical retinoids that can potentially reach a fetus, and
there’s no evidence that these agents can harm an unborn
child, you should stop applying them once you think that
you’re pregnant.
Clindamycin: Prescription products that contain this antibi-
otic include Cleocin-T, as well as several generics. The effects
of clindamycin during pregnancy haven’t been adequately
studied. Clindamycin combined with benzoyl peroxide is also
found in the combination products Benzaclin Gel and Duac
Gel (see Chapter 9).
Because clindamycin may appear in breast milk and could
affect a nursing infant, it’s probably not advisable to use
products containing it if you are pregnant or plan to become
pregnant.
Aczone Gel: This agent contains dapsone. There is minimal
absorption of this drug in the bloodstream when it’s applied
topically; however, it’s known that dapsone is excreted in
human milk when taken orally. I talk about this new drug in
Chapter 9.
Clindamycin and benzoyl peroxide are also found in the combina-
tion products Benzaclin Gel and Duac Gel (see Chapter 9).
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