Written by Dr Gerard Ee, MBBS (UK), MRCS (Edinburgh), PGDip Practical Dermatology (Cardiff).

Acne & Pregnancy

Pregnancy is an exciting time for every woman, but along with carrying a new life inside you, your skin, hair and nails experience many changes. During pregnancy, it is often that pimples rear their ugly heads to haunt women once more because acne is a common affliction for pregnant women. The fact is that more than one out of every two pregnant women can expect to develop acne. For some, acne may be severe.

Cause of acne during pregnancy

Acne or acne vulgaris is very common in mums-to-be and often starts in the first three months of pregnancy.

During pregnancy, especially during the first trimester, estrogen and progesterone levels increase therefore increasing the skin’s production of sebum.

This extra sebum together with dead skin cells creates an ideal condition for bacterial growth which can promote inflammation. The first stage of acne usually starts as oily skin; the next stage is the appearance of comedones (white heads and black heads). If the pore becomes inflamed due to the influx of white blood cells, pustules and papules appear. If the inflammatory response spreads to adjacent tissue, this represents cystic acne.

pregnancy articleimage

Managing acne during pregnancy

Mums-to-be need to be careful when it comes to treating acne as some medications can be harmful to your baby. Many prescription and OTC acne medications contain retinoids, a type of vitamin A. Pregnant and breastfeeding mums should avoid using these altogether. It is very important for any pregnant woman to ask her doctor before embarking on a medicated regimen.

Retinoids:These are known to cause birth defects and some retinoids may also increase the risk of miscarriage, especially the acne drug Isotretinoin. Isotretinoin is known under the brand name, Accutane and a number of generic names. It is an oral product used mostly for treating severe acne. It is especially dangerous before and during pregnancy as the drug is known to affect a fetus and cause serious birth defects.

Hydroquinone:This topical depigmenting agent is regularly used for skin lightening products and has a higher absorption rate than other topical treatments, so it is more likely that higher amounts could enter your bloodstream and affect the growth of your baby.

Oral antibiotics:Some antibiotics such as tetracycline, doxycycline, lymecycline and minocycline can cause discolouration to your unborn or nursing baby’s teeth.

Salicylic acid:This is an ingredient found in almost all over-the-counter acne products with Proactive®, Clearsil® and other known brands. Salicylic acid is part of the aspirin family and can help to reduces redness and inflammation. Whilst it’s super effective at cleansing pores, in high doses it’s been shown to cause birth defects and can cause pregnancy complications. So until your baby is born and you stop breastfeeding, it is best avoided.

Hormone Therapy & Medication:This includes the “female” hormone estrogen and the anti-androgens flutamide and the potassium sparing diuretic spironolactone. Spironolactone cannot be taken if you are thinking about becoming pregnant, if you are pregnant, or if you are breastfeeding. Birth defects have been associated with its use.

For most women, outbreaks flair up and then go away again or are limited to a few spots here and there. While getting spots may be irritating, at least they are not harmful so unless you are suffering from a severe case of acne, it is best to avoid treating them with medication. If your acne is mild and you did not suffer from acne before becoming pregnant, you can actually try to control your pregnancy breakout by maintaining a gentle, oil-free and non-comedogenic skincare regime.

However, if your symptoms are really troublesome, below are several treatments that you can use safely in pregnancy, but always consult your doctor before administering any forms of treatment.

Topical Antibiotics: Topical antibiotics such as Erythromycin, Clindamycin and Azelaic acid are considered safe medications by Food and Drug Administration (FDA) for use during pregnancy and pose no known risks to the health of the fetus.

Light Therapy: In my view red and blue light therapy is safe in pregnancy, and it is a reasonable option where topical treatment is not clearing the acne on its own. Blue light activates porphyrins, which are compounds produced by the acne bacteria, and this damages the bacteria. Red light reaches deeper and helps to settle inflammation. A National Skin Centre review of acne treatment in pregnancy and breastfeeding supports the use of blue-violet or red light phototherapy, either on its own or alongside topical treatment. It can be particularly helpful for the inflamed hormonal acne that comes with pregnancy.

Gold Photothermal Therapy: This is my treatment of choice when a pregnant or breastfeeding patient wants more than topical treatment. Fine gold particles are massaged into the oil glands and then activated with a laser, so the treatment acts on the skin itself rather than through the bloodstream. In my view it is safe in pregnancy. A systematic review of 380 pregnant women treated with cutaneous lasers across all trimesters found no harm to mother or baby, and animal studies of the gold particles showed that they clear from the skin within a month, with levels in the organs far below the accepted safety threshold. That research was funded by the device manufacturer. No pregnant patient has been included in a published trial of this treatment, because pregnancy is an exclusion criterion in those studies, so this is my clinical judgement rather than something a trial has tested. Azelaic acid and benzoyl peroxide remain the first-line options, and suitability is assessed individually at consultation.

References
Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013;73(8):779-787. doi:10.1007/s40265-013-0060-0
Wilkerson EC, Van Acker MM, Bloom BS, Goldberg DJ. Utilization of laser therapy during pregnancy: a systematic review of the maternal and fetal effects reported from 1960 to 2017. Dermatol Surg. 2019;45(6):818-828. doi:10.1097/DSS.0000000000001912
Paithankar DY, Sakamoto FH, Farinelli WA, et al. Acne treatment based on selective photothermolysis of sebaceous follicles with topically delivered light-absorbing gold microparticles. J Invest Dermatol. 2015;135(7):1727-1734. doi:10.1038/jid.2015.89. Study sponsored by the device manufacturer.

This page is written from published research and from clinical experience in Singapore since 2012. It is for general education, not medical advice. Whether a treatment suits you, what it may achieve and what it may risk can only be established at a consultation. Dr Gerard Ee is the Medical Director of The Clifford Clinic, a private clinic in Singapore, and treatments discussed on this site are provided commercially.

The Clifford Clinic at 50 Raffles Place, Singapore

Arrange a consultation

Dr Gerard Ee consults and performs this treatment at The Clifford Clinic, 50 Raffles Place, Singapore.

Book a consultation with Dr Gerard Ee