- Acne 101
Acne in Pregnancy
Safely manage acne during pregnancy.
Hormonal shifts can trigger breakouts while you are expecting. Because many standard acne medications are avoided in pregnancy, treatment is chosen for safety – generally after the first trimester and in coordination with your obstetrician.
Therapeutic Options in pregnancy
Acne often flares during pregnancy as hormone levels change. The goal is to keep skin under control with options considered safe for you and your baby – tailored by trimester and coordinated with your OB/GYN.
Topical
Our stance on topical therapy is to wait until after the first trimester to initiate treatment, unless we receive approval from the patient’s obstetrician. Beyond the first trimester, we prescribe topical therapies:
- Metronidazole
- Azaleic Acid
- Clindamycin
- Benzoyl Peroxide
Currently, there are no topical acne medications that have demonstrated unequivocal safety in pregnant humans in clinical trials. – This was formerly known as pregnancy category A – Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester (and there is no evidence of a risk in later trimester), and the possibility of fetal harm appears remote.
There are however data from pregnant animals showing safety during pregnancy. This was formerly known as pregnancy category B- Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well controlled studies in pregnant women.
Several topical medications for the treatment of acne do fall under the former category B labeling: metronidazole, azaleic acid and clindamycin.
Other medications such as benzoyl peroxide fall under the previous category C labeling –There are no controlled studies in women or studies in women and animals are not available, and risk to the fetus is unknown. However, studies conducted with topical benzoyl peroxide have demonstrated less than 5% systemic absorption. Since benzoyl peroxide is rapidly metabolized into benzoic acid (which is rapidly cleared), maternal use is not expected to result in fetal exposure to benzoyl peroxide.
Studies are controversial as to whether topical retinoids produce birth defects. Therefore, this class is generally not recommended in pregnancy.
Oral Therapy
Antibiotics such as zithromax, amoxicillin and cefadroxil may be used if the severity of acne warrants systemic treatment.
Traditional tetracycline class antibiotics for acne are not recommended during pregnancy due to concern regarding defects in enamel and bone. Metformin, a medication for the treatment of diabetes, can sometimes be helpful in the control of acne. It may be prescribed by an OB/GYN or primary care physician during pregnancy if the benefits outweigh the risks.
Peels and Light
Lasers (e.g., 532 KTP) are safe during any stage of pregnancy and do not have any systemic absorption or impact on the fetus. After the first trimester, use of glycolic acid chemical peels is felt to be a safe adjunct in the treatment of acne. Other peels such a salicylic acid and VI Peel do not have adequate safety data to justify their use.
Frequently asked questions
Is it safe to treat acne during pregnancy?
Many standard acne medications are avoided during pregnancy, so treatment is chosen for safety. As a rule we start therapy after the first trimester and coordinate the plan with your obstetrician.
Which topical treatments are used for acne in pregnancy?
Beyond the first trimester we prescribe topicals that have a reassuring safety profile, including metronidazole, azelaic acid, clindamycin, and benzoyl peroxide.
Why wait until after the first trimester to start treatment?
Our stance is to hold topical therapy until after the first trimester unless your obstetrician approves earlier, because the first trimester is the most sensitive period of fetal development.
Is benzoyl peroxide safe to use while pregnant?
Studies of topical benzoyl peroxide show less than 5 percent systemic absorption, and it is rapidly broken down into benzoic acid and cleared, so maternal use is not expected to expose the fetus. As always, use is coordinated with your OB.
How is my pregnancy acne plan decided?
Treatment is tailored by trimester and coordinated with your OB/GYN. We select options considered safe for you and your baby and avoid medications that do not have established safety in pregnancy.
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About Craig Singer MD Dermatology
Located in Bingham Farms, Acne Center Of Michigan was founded by Dr. Craig Singer, a board-certified dermatologist.
We specialize in the treatment of acne and acne scarring, offering numerous therapeutic options tailored to each patient’s needs.
Dr. Singer experienced significant acne when he was in college and has personal experience with his teenage children’s acne as well. He has helped thousands of patients look their best.
Acne Center of Michigan offers the most advanced acne treatments, drawing from both traditional and alternative approaches. Dermatologists across the region refer their most complex acne-scar cases to Dr. Singer, and patients travel from across Michigan, neighboring states, and Canada for his care.
Board-Certified
Dermatologist
Thousands of patients
Helped look their best
