- Pregnant women face challenges choosing treatment for acne as many established therapies are not recommended due to the risk of causing harm to both mother and child
- Those with a history of acne or who routinely experience acne breakouts before menstruation are more prone to develop acne during pregnancy
- Pregnancy acne is usually temporary, and will likely clear up once hormones return to normal, a few months after giving birth
Pregnancy acne is a common occurrence among pregnant women. While little research has been conducted on this topic, there have been several small studies. One common conclusion is that the prevalence rate for acne for pregnant women is about 40%. Symptoms can range from mild to severe and can develop at any time during the pregnancy.
Does Pregnancy Cause Acne?
Acne vulgaris is one of the most common reasons for which patients visit their dermatologists; those with a history of this condition can experience an increase in severity during pregnancy.
It can also develop in those accustomed to clear skin due to the higher levels of androgen that occur during pregnancy. This increases the skin’s sebum (oil) production, resulting in a greater likelihood of clogged pores and acne breakouts.
Another cause is water retention. When pregnant, the body naturally retains water to protect the fetus and this has negative consequences for skin. More fluids means more toxins are circulating within the body which are then released through the skin’s pores. This can cause pore buildup which results in blemishes.
When does pregnancy acne begin?
Pregnancy acne can begin at any time but is most likely to develop during the first and second trimesters. This is when androgen hormone levels and the accompanying increase in oil production typically occur. Acne can become particularly severe during the third trimester when androgen levels are especially high.
How to Know if Pregnancy is Causing Your Acne
If you recently found out you were pregnant and began developing acne at the same time, or if you are pregnant and not typically prone to acne but are noticing occasional or consistent acne flare-ups, you may be experiencing pregnancy acne.
If you haven’t yet taken a pregnancy test, doing so will confirm if pregnancy is the cause of your sudden onset of acne.
Safe Treatments for Acne During Pregnancy
Pregnancy acne typically resolves once hormone levels return to normal after pregnancy.
You can wait it out or turn to natural solutions that are drug-free, as these are the safest solutions. Prescription acne medications or over-the-counter (OTC) chemical treatments can all have a detrimental effect on your pregnancy.
That being said, there are some established acne treatments that are safer to use than others during this time. However, one major drawback is that very little research has been conducted on pregnancy and acne treatments.
As such, it is best to err on the side of caution and consult with your doctor or dermatologist first to understand the risks and side effects that may result from using any product to treat your acne – whether OTC, prescription or natural remedy.
Azelaic acid is an organic compound found in grains such as wheat and barley. As a topical application, it effectively treats acne by exfoliating the top layer of skin, prompting cell turnover and preventing pores from blocking.
This acid also suppresses keratin production, which is known to increase during pregnancy. Excess keratin can plug hair follicles and appear as small bumps or pimples. Azelaic acid is considered a safe treatment during pregnancy.
Benzoyl peroxide is a common and very effective ingredient found within many OTC and prescription medications. It can clear and exfoliate pores, address oiliness, reduce inflammation and fight Propionibacterium acnes bacteria that causes acne.
The Food and Drug Administration (FDA) classifies benzoyl peroxide as a pregnancy risk Category C, meaning it is generally considered to be safe. Topical absorption is said to be only 5% and easily eliminated from the body. However, there have been no specific studies on benzoyl peroxide use during pregnancy to support this claim.
Erythromycin is an antibiotic used to treat inflammatory bacterial infections such as acne. It effectively kills acne-causing bacteria, and reduces redness and inflammation. It is considered to be safe as a topical application for inflammatory acne. Oral erythromycin is prescribed for moderate to severe cases but only for several weeks.
Antibiotics are typically prescribed alongside other medications such as benzoyl peroxide to decrease bacterial resistance.
Salicylic acid is another acne treatment you can buy OTC and is generally considered safe for short-term use. As with benzoyl peroxide, only a small proportion is absorbed through the skin and is therefore unlikely to interfere with the baby’s development. Again, no studies have been conducted in pregnancy and topical use.
Salicylic acid is related to aspirin and aspirin should not be consumed while pregnant as this can cause birth defects.
Natural Remedies for Pregnancy Acne
Natural DIY remedies for pregnancy acne are far safer than OTC or prescription treatments as they don’t contain chemical and synthetic ingredients. Natural remedies, such as the following, can offer relief from acne symptoms in a gentle, safe way.
Apple cider vinegar
Apple cider vinegar contains acetic, citric, lactic and succinic acid, all of which are effective in killing P. acnes. It can also exfoliate and soften skin, balance pH levels, and reduce inflammation and redness.
To use as a skin care treatment, mix one part raw, unfiltered apple cider vinegar to three parts distilled water. Using a cotton pad, apply the mixture to any affected areas of skin in the same way as you would a toner.
Honey is an antioxidant and has antibacterial and antiseptic properties. It can inhibit the growth of acne-causing bacteria and soothe inflamed skin. To use it as an acne treatment, rinse your face and then apply the honey directly to any blemished areas. Allow to rest for 20–30 minutes before rinsing off. Follow-up with a moisturizer suited to your skin type.
Zinc is an essential mineral that plays an important role in the body’s immune system and supports cell division and wound healing. Research has determined there is a link between higher zinc levels and lower severity of acne.
Zinc has been found to have no effect on fetus development. The National Institutes of Health (NIH) recommends 11–13 mg of zinc daily for women who are pregnant or lactating.
Acne Treatments to Avoid During Pregnancy
There are several acne treatments that must be avoided during pregnancy as they have been determined to interfere with development and cause birth defects. Other treatments have not been studied so the question remains as to safety.
Isotretinoin (Accutane) is an oral acne medication that poses several health risks and is especially dangerous if you are pregnant. It can cause serious birth defects and must be avoided if you are pregnant or thinking of becoming pregnant.
Topical retinoids such as adapalene, tazarotene and tretinoin, should also be avoided during pregnancy as they have not been determined to be safe. One study examined women who were exposed to tretinoin during their first trimester and did not find an increase in adverse effects or birth defects. However, it is still safer to avoid exposure to topical retinoids while pregnant as more research is needed to determine its safety.
The use of hormone therapy to treat acne, including estrogen, flutamide and spironolactone, can cause birth defects. Spironolactone has the potential for a fetal feminizing effect on a developing male fetus.
Certain antibiotics prescribed for acne also pose great risks to a pregnant mother and her baby. Tetracycline, doxycycline and minocycline are associated with maternal liver toxicity, permanent tooth staining of the child and deformities.
Acne can occur anytime during the course of a pregnancy, and is most likely to occur in those who have a history of acne or typically experience acne before their menstrual cycle. Fortunately, skin tends to clear up a few months post pregnancy, once hormones return to their normal levels.
Safe treatments for pregnancy acne are limited to milder natural remedies, as traditional prescription treatments can cause serious adverse effects for both mother and child.
The safest option is choosing a natural, gentle remedy. Apple cider vinegar, honey and zinc all contain powerful natural properties to soothe inflammation, kill bacteria, exfoliate skin and clear pores.
- Al Mazrou, L., Bahkali, S., Househ, M., Al Shahrani, W. (2016) The Prevelance of Acne in Pregnancy Among Saudi Women, the Myth of Gender Relation, a Multicenter Study. 8th World Congress on Healthcare & Medical Tourism. https://www.longdom.org/proceedings/the-prevelance-of-acne-in-pregnancy-among-saudi-women-the-myth-of-gender-relation-a-multicenter-study-8417.html
- European Academy of Dermatoloy and Venereology. (2019) Acne in Pregnancy. https://www.eadv.org/cms-admin/showfile/EADV%20Pregnancy%20TF_%204.%20Acne%20in%20pregnancy.pdf
- Chien AL, Qi J, Rainer B, Sachs DL, Helfrich YR. Treatment of Acne in Pregnancy. J Am Board Fam Med. 2016 Mar-Apr;29(2):254-62. doi:10.3122/jabfm.2016.02.150165
- Awan, S. Z., & Lu, J. (2017). Management of severe acne during pregnancy: A case report and review of the literature. International journal of women’s dermatology, 3(3), 145–150. doi:10.1016/j.ijwd.2017.06.001
- Matin T, Goodman MB. Benzoyl Peroxide. [Updated 2020 Nov 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK537220/
- Bozzo, P., Chua-Gocheco, A., & Einarson, A. (2011). Safety of skin care products during pregnancy. Canadian family physician Medecin de famille canadien, 57(6), 665–667. ncbi.nlm.nih.gov/pmc/articles/PMC3114665/#!po=83.3333
- Wang Y, Kuo S, Shu M, Yu J, Huang S, Dai A, Two A, Gallo RL, Huang CM. Staphylococcus epidermidis in the human skin microbiome mediates fermentation to inhibit the growth of Propionibacterium acnes: implications of probiotics in acne vulgaris. Appl Microbiol Biotechnol. 2014 Jan;98(1):411-24. doi:10.1007/s00253-013-5394-8
- McLoone, P., Oluwadun, A., Warnock, M., & Fyfe, L. (2016). Honey: A Therapeutic Agent for Disorders of the Skin. Central Asian journal of global health, 5(1), 241. doi:10.5195/cajgh.2016.241
- Medline Plus. (2021) Zinc in Diet. https://medlineplus.gov/ency/article/002416.htm
- Chaffee, B. W., & King, J. C. (2012). Effect of zinc supplementation on pregnancy and infant outcomes: a systematic review. Paediatric and perinatal epidemiology, 26 Suppl 1(0 1), 118–137. doi:10.1111/j.1365-3016.2012.01289.x
- Choi, J. S., Koren, G., & Nulman, I. (2013). Pregnancy and isotretinoin therapy. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 185(5), 411–413. doi:10.1503/cmaj.120729
- Kaplan YC, Ozsarfati J, Etwel F, Nickel C, Nulman I, Koren G. Pregnancy outcomes following first-trimester exposure to topical retinoids: a systematic review and meta-analysis. Br J Dermatol. 2015 Nov;173(5):1132-41. doi:10.1111/bjd.14053
- Ebede, T. L., Arch, E. L., & Berson, D. (2009). Hormonal treatment of acne in women. The Journal of clinical and aesthetic dermatology, 2(12), 16–22. ncbi.nlm.nih.gov/pmc/articles/PMC2923944/
- Rothman KF, Pochi PE. Use of oral and topical agents for acne in pregnancy. J Am Acad Dermatol. 1988 Sep;19(3):431-42. ncbi.nlm.nih.gov/pubmed/2971690