Acne Treatment During Pregnancy

Do you know that there are safe and effective acne treatments during pregnancy?

Early acne intervention reduces scarring and improves skin health, confidence and quality of life.

acne treatment pregnancy clinic Singapore
Many women are afraid of seeking acne treatment during pregnancy because they do not realise that there are safe and effective treatments available.

Why Do I Get Acne During Pregnancy?

Acne is a chronic inflammatory condition of the pilo-sebaceous glands. Affecting more than 80% of adolescents, there are increasing more adults in theirs 20s, 30s and 40s suffering from acne. Acne during pregnancy can be a particularly frustrating time for many women as it can behave erratically. Generally, acne often subsides during the first trimester, but can flare up during the second and third trimester. This is due to an increased in circulating maternal androgens which have a direct effect on sebum (oil) production in the skin. Treatment of acne early helps to prevent worsening of the condition, and to prevent scarring acne in more severe cases.

OUR APPROACH

acne during pregnancy

Treating acne during pregnancy requires a careful, evidence-based approach that prioritizes safety while aiming to achieve effective management of acne symptoms. By utilizing safe topical treatments, considering appropriate systemic options, and supporting overall skin health through non-pharmacological measures, pregnant patients can achieve relief from acne without compromising the health of their baby.

Tips For Acne Treatment During Pregnancy

  1. Gentle cleansing both during morning and evening.
  2. Avoid squeezing and picking at your acne. This increases the chance of scarring.
  3. Use oil-free skin care products, and those that are non-comedogenic and non-acnegenic.
  4. Awareness that acne can be managed during pregnancy.
  5. Safe and effective topical and oral acne treatments available for mild, moderate and severe acne.
fda pregnancy category

what drugs are safe for acne treatment during pregnancy?

The FDA Pregnancy Categories indicate the potential of a drug to cause birth defects if used during pregnancy. Generally, topical and/or oral medications in category A and B can be safely prescribed. Category C medications should only be given if the risks outweigh the benefits to the patient. Category D and X drugs are to be avoided during pregnancy.

Acne Treatment During Pregnancy

It is common for many women to shun acne treatment during pregnancy. This is most often due to the misinformation that all forms of acne treatment during pregnancy are harmful to the foetus. While it can be indeed challenging to treat acne during pregnancy because many of the standard acne treatment  options are not recommended, there remain safe and effective options available. 

topical acne cream treatment Singapore

Topical Acne Treatments

Topical acne treatments in cream and gel formulations are suitable for mild to moderate forms of acne vulgaris. Many of the topical treatments available to treat acne during pregnancy have an FDA Pregnancy Category of B and C. However, not all FDA Pregnancy Category C medications are recommended for use during pregnancy (e.g. retinoid based formulations) due to the theoretical risk of harm to the foetus. 

pregnant woman

Azelaic acid has a FDA Pregnancy Category B rating for the treatment of acne. It is clinically proven to kill bacteria, reduce inflammation, and actively eliminates blackheads and whiteheads. It has an added advantage of treating post-inflammatory hyper-pigmentation (PIH) that is prevalent in Asian skin type.

Benzoyl Peroxide has a FDA Pregnancy C rating, and is safe to use for acne treatment during pregnancy. Benzoyl peroxide is commonly found  over the counter, and comes in various concentrations and formulations (e.g. gels, creams and foams). It is proven to reduce inflammation, kill off bacteria and reduce whiteheads and blackheads. Benzoyl peroxide has the added advantage of reducing bacterial resistance when combined with either a topical or oral antibiotic. The disadvantage is that it has a tendency to stain clothing and bedding. 

Salicylic Acid based facial creams and washes are readily available over the counter. They have a FDA Pregnancy Category C, and are considered safe to use during pregnancy in small amounts. It works by exfoliating skin and reducing comedomes. We advise 2% salicylic acid formulations that are more gentle on the skin. Although well tolerated, it is less effective than Azelaic acid and benzoyl peroxide. 

The only two topical antibiotics safe for acne treatment during pregnancy are Clindamycin and Erythromycin. They both have a FDA Pregnancy B rating. They are most effective for inflammatory acne, and act by killing off bacteria and reducing inflammation. Nowadays, antibiotic formulations are often combined with benzoyl peroxide. This makes sense as the addition of benzoyl peroxide has the benefical effect of reducing bacterial resistance. 

The two most commonly used topical retinoid are Adapalene (e.g. Differin) and Tretinoin, and both have a FDA Pregnancy C rating. Tazarotene has a FDA Pregnancy X rating, which means that it is absolutely contraindicated during pregnancy. Although, topical retinoids are routinley prescribed for comedomal and inflammatory acne, they are not recommended during pregnancy and breastfeeding due to the risks of harm to the foetus and baby.

Oral Acne Treatments

Oral acne treatment during pregnancy may be necessary in the following cases:

  • Failure of topical therapies: If over-the-counter or topical prescription treatments have not been effective in controlling acne, oral medications may be necessary to achieve clearer skin.
  • Persistent inflammatory acne: If acne is causing significant physical or emotional distress, or if it’s leading to scarring, oral treatment may be considered to manage the condition more effectively.
  • Nodulo-cystic acne: Large and deep seated acne associated with pain and scarring.
  • Acne at risk of scarring: If there’s a high risk of acne scarring due to the severity of the condition, oral treatment may be recommended to prevent long-term skin damage.

Before starting any oral treatment for acne during pregnancy, it’s crucial to consult your doctor, to discuss the potential risks and benefits and to ensure the safety of both the mother and the baby. 

Oral antibiotics for acne treatment during pregnancy is given for more severe cases of acne, or acne that is not responding to topical therapies. Generally, most oral antibiotics should only be started in the second or third trimester, because most the the foetal organs are still developing during the first trimester. 

Oral antibiotics that are considered safe and have a FDA Pregnancy Category B rating are Erythromycin, Cephalexin, Amoxicillin and Azithromycin. These are safe choices during pregnancy, however, they should only be prescribed for a few weeks. 

Antibiotics from the Tetracycline group (e.g. Doxycycline and Minocycline) have a  FDA Pregnancy D rating, and thus not recommended to use during pregnancy. They have the potential to stain foetal teeth and bones, and cause bony growth retardation.

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Oral Isotretinoin is absolutely contraindicated during pregnancy and breastfeeding. It falls under FDA Pregnancy Category X. Studies have documented malformation of the foetus face, brain, heart and nervous system. 

Frequently Asked Questions About Acne Treatment During Pregnancy

Yes, hormonal changes during pregnancy can contribute to the worsening of acne. Fluctuations in hormone levels, particularly increased androgen levels, can lead to an overproduction of oil in the skin, which can clog pores and result in acne breakouts.

To help prevent acne breakouts during pregnancy, you can try to maintain good skincare habits, such as cleansing your face twice a day with a gentle cleanser, using oil-free moisturizers and makeup, avoiding picking or squeezing pimples, and keeping your hair away from your face to prevent excess oil transfer.

Yes, making certain lifestyle changes can help improve acne during pregnancy. These include eating a healthy diet rich in fruits, vegetables, and whole grains, staying hydrated by drinking plenty of water, getting regular exercise to promote circulation and reduce stress, and getting enough sleep to allow your body to rest and repair.

If you’re experiencing severe acne that’s causing discomfort, pain, or emotional distress, or if you’re unsure about the safety of any acne treatment options, it’s best to seek medical advice from your healthcare provider. They can provide personalized recommendations based on your individual needs and medical history.

Gentle cleansers containing ingredients like glycolic acid or lactic acid may be safe for use during pregnancy. Natural remedies such as witch hazel or tea tree oil in diluted forms may also be considered, but consult with your doctor before use.

It’s generally recommended to avoid aggressive treatments like laser, chemical peels or microdermabrasion during pregnancy, as they may pose risks to the developing fetus. Consult with your healthcare provider before undergoing any cosmetic procedures.

Pregnancy acne can vary from person to person and may persist throughout pregnancy or fluctuate in severity. In many cases, acne improves after childbirth as hormone levels stabilize, but it may take some time for the skin to return to its pre-pregnancy state.

Dr Moses Ng dermatologist

acne during pregnancy

Safe and effective treatments for acne during pregnancy is well-established. My immediate concern whenever I see a case of acne vulgaris, whether it is mild or severe, is to assess how it is affecting your health. Acne that is not treated can lead to great emotional distress and scarring. This is quite unnecessary in this day and age, where effective acne treatments are readily available.

schedule a consultation for acne treatment during pregnancy in singapore

Acne is a common dermatological concern during pregnancy, affecting a significant number of expectant mothers. The hormonal changes that occur during pregnancy can lead to an increase in sebum production, contributing to the development of acne. It is crucial to manage acne in pregnant patients with a thoughtful approach that ensures both the efficacy of treatment and the safety of the developing fetus.

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References:
  • Zaenglein et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74:945-973.e933
  • Chien Al et al. Treatment of Acne in Pregnancy. J of the Am Board of Fam Med. 2016;29:254-262