So, you're pregnant.
And you're probably excited, and you're thinking of creative ways to tell your family and friends, and you're shopping for little itty bitty clothes, and you're picking out names.
Probably the last thing on your mind is your skin.
Being responsible for a small human being in a world threatened by an increasing water shortage, climate change, and other daunting realities is troubling enough. But before you even get to that part, pregnancy offers its own host of challenges.
Maybe a few weeks or months in, you start to notice that your skin is breaking out, maybe more than usual, or in unusual places, in atypical ways. Maybe once you started breastfeeding, your skin started breaking out like crazy.
Welcome to the world of pregnancy acne.
Acne during pregnancy is, however, not unusual; more than 1 in 2 pregnant people develop acne. It's most common during the first and second trimesters, although it can start later in the pregnancy and can start during breastfeeding, also. Conversely, some women experience their skin clearing up durng pregnancy. Everyone is different. There's really no way to tell for sure, considering your chances are about 50/50 for getting acne during pregnancy.
People experience many physiologic changes during pregnancy, including increases in androgen levels. This might lead to and explain the development or worsening of acne vulgaris. An increase in these hormones during pregnancy, usually leading to an imbalance, can cause the glands in your skin to grow and produce more sebum, an oily, waxy substance. This oil can clog pores and lead to an increase in bacteria (under the right circumstances and with the right composition of sebum), inflammation, and breakouts. Research further indicates that pregnancy can induce long-lasting changes in hormonal balance, which may mean that once you get pregnant and get acne, you may be suffering from it long-term.
Because pregnancy is such a delicate process, it is essential that pregnant women maintain a healthy diet and limit their exposure to substances that may affect the development of the fetus. Thus, pregnancy acne poses a very unique problem because many of the treatment options available to you (even the natural ones) are not recommended for use in pregnant and breastfeeding women because they may affect the way that a fetus forms and develops.
The management of acne in pregnancy is complicated by the lack of clinical studies and pharmacokinetic data in this patient population and safety concerns. Particular challenges include the absence of safety data, discrepancy in safety data between different safety rating systems, and lack of evidence-based recommendations for the treatment of acne during pregnancy.
And yet acne should be treated during pregnancy to prevent worsening, scarring, secondary infection or psychological impairment of the mother. You shouldn't avoid treating your pregnancy acne in the hopes that it will "get better" or just "go away" on its own just because it seems a daunting task to treat. Whether you choose to pursue pharmaceuticals or you choose to try and treat your acne with "natural" remedies, your acne still needs to be acknowledged and treated.
But the problem is that safe products must be chosen. And unfortunately it's not as easy as just choosing "natural" products.
So what are your treatment options? You're pregnant, you have acne, and you want to know what to do next.
As always, make sure you consult your doctor before making any lifestyle changes or adding anything into your routine. I can't stress this enough. No matter what advice you get on the Internet, from what source, nothing can stack up against the advice of a doctor who knows your medical history and particular situation. It's always best to have a learned pair of eyes on your file to ensure you're not taking anything you shouldn't be taking during pregnancy, or you're not on any medications that might be affected by an acne treatment.
Although acne treatment is complicated by pregnancy, thankfully many therapeutic options exist, and the treatment of acne in pregnant women can be safely and often effectively accomplished.
Topical treatments are considered the safest option during pregnancy. They have the best safety profile and minimize the levels of systemic absorption, and therefore have the least risk of fetal exposure. If these are applied properly with a strong emphasis on adherence, excellent results can often be achieved.
But what about for someone who is pregnant?
One review article suggests that for mild or moderate acne, patients who are pregnant can be treated with salicylic acid.
But unfortunately no studies have been conducted in pregnancy on topical use. What we do know is that systemic absorption varies and that, on average, a relatively small amount is absorbed through the skin. Thus, it is unlikely to pose any risk to a developing baby.
However, some doctors might encourage you to avoid using salicylic acid as a chemical peel during pregnancy, as it may increase absorption and risk.
Like with salicylic acid, no studies on the use of this preparation in pregnant patients have been published; however, systemic effects on a pregnant woman and her child would not be expected and therefore use of this product during pregnancy does not appear to be of concern.
When benzoyl peroxide is applied topically, only 5% is absorbed through the skin, and then it is completely metabolized to benzoic acid within the skin and excreted unchanged in the urine (1, 2).
Thus, topical benzoyl peroxide appears to be a safe therapeutic option for acne patients who are pregnant.
Glycolic acid is an alpha hydroxy acid found in many cosmetics used to treat acne. Studies have shown that the topical use of glycolic acid can drastically improve the appearance of acne.
One review article suggests that for mild or moderate acne, patients who are pregnant can be treated with glycolic acid.
There have been several animal studies demonstrating adverse reproductive effects when glycolic acid was administered in high doses, much larger than those used in topical cosmetic products in humans. So, while we know that higher-than-normal doses of glycolic acid in animals can cause adverse effects, this does not necessarily translate to humans.
Studies examining the use of glycolic acid in human pregnancy have not been conducted; however, using topical glycolic acid during pregnancy should not be of concern, as only a minimal amount is expected to be absorbed systemically.
Thus, the topical application of glycolic acid may be useful for pregnancy acne, including mechanical peeling or chemical peeling with glycolic or other alpha-hydroxy-acids.
Azelaic acid topical cream is used to treat mildly to moderately inflamed acne. For acne, it works by killing the bacteria that cause acne and by keeping the skin pores clean.
This medicine is available only with your doctor's prescription (Azelex, Finacea, Finacea Plus), and is considered a safe therapeutic option for patients with acne.
Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women - OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.
It also seems to have positive anecdotal evidence for its efficacy. It seems to be a choice product for dermatologists in pregnant acne patients due to its high rate of efficacy and safety profile.
Tea tree oil
Tea tree oil is widely regarded as one of the more effective topical treatments for acne, even in relatively low doses.
Tea tree oil, when used topically and appropriately, is considered POSSIBLY SAFE when applied to the skin during pregnancy and lactation.
There is some clinical evidence that indicates it is safe to use in the proper dilution and when applied correctly to the skin.
The amount of retinoid absorbed from the skin is generally very low; however, there are 4 published case reports of birth defects in the literature associated with topical tretinoin use, which are consistent with retinoid embryopathy. The role of the topical retinoids in these cases remains controversial (1, 2, 3, 4), as 2 prospective studies that examined use during the first trimester of pregnancy with 96 and 106 women did not find an increased risk of major malformations or evidence of retinoid embryopathy (5, 6). However, until data on larger cohorts are collected, women should not be encouraged to use topical retinoids during pregnancy.
While topical agents may be useful, we may sometimes require oral options to really treat our acne. Oral acne treatments do tend to carry somewhat more risk, however, and are considered a second-line of treatment.
Zinc plays a key role in our body's physiology, since it is involved in the activities of many enzymes. In addition, zinc requirements increase during pregnancy, mainly because of its utilisation during embryogenesis and fetal development. Thus, it appears to be a safe and plausible option for acne treatment, given its rate of efficacy in acne patients.
There are many studies involving the use of zinc supplements during pregnancy. In these studies, more than 2500 pregnant women were given zinc at different doses. None of these studies described any abnormalities, congenital malformation, harmful effects or risk for the fetus associated with the use of zinc during pregnancy at doses below 75 mg/day.
According to the results of the prescription survey, around 10,000 pregnant women and 2000 breast-feeding women are treated each year for acne using zinc gluconate, with only four serious adverse events involving zinc being reported since the initial introduction of the product, and with zinc having a doubtful causal relationship.
This seems to suggest that that use of zinc for acne in pregnant women is beneficial in those with zinc deficiency in specific, but that it has no harmful effects in those without zinc deficiency. Even though zinc may be your best and safest option, it is always still best to consult a doctor prior to beginning supplementation. It is possible to take too much zinc and do damage to yourself and the fetus. So always take supplements, even OTC, under doctor supervision.
Antibiotics should always be taken as a last resort for acne. Acne has many treatment options, and the risks we run when we continue taking antibiotics (resistance, gut damage, etc) usually far outweigh the potential (and often short-term) benefits. With that being said, antibiotics may be a safe, last resort, acne treatment in people who are pregnant.
When necessary, systemic therapies that can be safely added include penicillins, amoxicillin, cephalosporins, erythromycin, clindamycin, and tetracyclines or sulfonamides, depending on the stage of fetal development. According to the guidelines, systemic corticosteroids or systemic erythromycin (the latter not in lactation) can be employed beginning in the second trimester for severe flares of acne and should be started in cooperation with the patient's gynecologist.
Some suggest that antibiotics consisting of tetracyclines, co-trimoxazole and fluoroquinolones should be avoided during pregnancy.
A surveillance study examining oral or topical use of clindamycin reported no increased risk of malformations among 647 women with use in the first trimester. Similarly, there have been no increased rates in adverse outcomes documented in several studies evaluating systemic use of clindamycin in the second or third trimester of pregnancy (1, 2). Furthermore, oral use of erythromycin in pregnancy has not been associated with teratogenicity in several thousand women.
However, given the other health risks associated with using antibiotics for acne, it is still best to avoid them if possible. There are other options available that should be explored with your doctor first.
For obvious reasons, hormonal disruption or interference can affect the way a fetus grows. It is for this reason that hormonal therapy should absolutely be avoided.
Systemic isotretinoin cannot be used in pregnant women.
Both oral and topical retinoids should be avoided.
You may be feeling slightly underwhelmed with the pharmaceutical options available to you. That's OK. There are still other avenues to pursue, but keep in mind that not all options are safe or studied in pregnancy.
Phototherapy is gaining gusto in the acne community as a potential treatment for acne, with blue and red lights in particular.
Thus, adjunct therapy for pregnant acne patients may include phototherapy or laser treatments.
Light-based therapy may be considered as second- or first-line treatment, as monotherapy or in addition to topical and/or oral therapies.
In cooperation with other acne treatments you may be using, one of the most important pregnancy-related acne tips is to have a healthy diet, and to eat lots of fruits, vegetables and foods high in nutrients, antioxidants and fiber.
This goes without saying, but a lot of the time acne (even acne rooted in hormones) can be mitigated by an appropriate diet. People drinking milk, for example, should eliminate it from their diet entirely due to its proven relationship to acne.
If you're looking for more information on what to eat to help keep your skin glowing and clear, check out my book.
Herbal remedies are also gaining popularity as acne treatment options. However, when you're pregnant, you need to be extra careful about what supplements you take and what herbal drinks you consume. Herbal supplements that were perfectly safe for you before pregnancy might cause pregnancy complications or harm your baby.
Unlike over-the-counter and prescription medications, herbal supplements aren't subject to the same research testing, evaluation process, and government regulations and this means that their safety may be entirely subjective. There is no organization monitoring or ensuring the reliability and safety of herbal products. Because of this, the efficacy, strength and quality of a supplement can vary significantly. The content and activity of a product is dependent upon the manufacturer and brand, the harvest time, climate, soil, portion of the plant used, method of extraction, formulation and storage. Numerous studies have also shown that there are inaccuracies with supplement labeling. Often the level of ingredient analyzed differs from the amount stated on the label. So consumers can't always trust what's written on a label.
Many herbs should not be ingested in the form of teas, infusion teas, liquid extracts, dried extracts, tinctures, or supplements because they either lack research to prove they are safe during pregnancy, or they can induce uterine contractions, stimulate menstrual flow, and affect hormones, according to the Natural Medicines Comprehensive Database.
In this case it is best to stick to tried-and-tested methods.
Your treatment regimen will likely need to shift throughout the different stages of fetal development, as distinct safety considerations are raised prior to conception as well as during each of the trimesters of pregnancy. Not to mention your body is going through changes during this entire time, and may require a new approach. You need to be prepared for that - but don't be discouraged. There will always be something to try. Don't try to do it all for yourself - reach out for help if you need it.
If you're looking for more information on things to try, in consultation with the approval of your doctor, check out my book.
At the end of the day, it's hard to say if your pregnancy acne will go away on its own or with time. For some people, pregnancy acne goes away once the pregnancy is over; for others, it persists; for others, it doesn't even start until breastfeeding. The different ways in which pregnancy acne manifests and how long is persists are almost endless.
What is known is that if pregnancy acne is not treated, it can result in unnecessary physical and emotional damage. It is best to nip it in the bud and treat it right away.