Acne in pregnancy - safe treatments

pregnant woman with acne

Acne breakouts in pregnancy are quite common. Unfortunately, the treatment that can be offered to pregnant women are limited. Nevertheless, acne in pregnancy can be controlled and breakouts reduced.

The first step should be to assess acne severity. If acne is moderate to severe, consider systemic medications," and always document discussions. Her regimen typically includes mild nonabrasive washes containing glycolic acid, plus topical azelaic acid and clindamycin and oral antibiotics. She also recommends a physical sunscreen.

In the past the FDA classified risk of medications by letters: A, B, C, D, X and N. In the new 2015 Pregnancy and Lactation Labelling Rule FDA classifies medications into a few safety categories: "The new FDA categories are 'safe in pregnancy,' 'not safe in pregnancy' and 'uncertain (safety in pregnancy).'

The only acne medications in category B (presumed safe based on animal studies) are azelaic acid, clindamycin and erythromycin that have low anti acne efficacy. The more effective anti-acne topical medications are in category C (uncertain safety – human and animal studies show no adverse events

Category C agents generally considered safe in pregnancy include the following:

1. Benzoyl peroxide – Systemic absorption is minimal, and benzoyl peroxide is metabolized to benzoic acid (a food additive) in the skin.
2. Salicylic acid – Low-dose aspirin is used to treat preeclampsia. The key in acne is to use low concentrations over limited body surface areas.
3. Topical dapsone – Oral dapsone has been used to treat dermatitis herpetiformis in pregnancy. Topical dapsone is likely safe but studies are lacking.

Which topical acne medications one should not be used in pregnancy?

Topical retinoids require caution. With tretinoin and adapalene (the main ingredient in Differin, Epiduo and Epiduo Forte), there have been cases of otocerebral anomalies and anophthalmia with agenesis of the optic chiasma, respectively. Another retinoid, Tazarotene is also contraindicated in pregnancy.

Using oral medications for the treatment of acne in pregnancy

Oral medications should be never used for acne in the first trimester of pregnancy. Category B systemic medications that have been used safely in pregnant patients with acne include cephalexin, amoxicillin, azithromycin and erythromycin. Of these antibiotics, erythromycin seems to be the safest.

Isotretinoin, should NEVER be used in pregnancy.  Low dose of Systemic prednisone (Category C) can be considered for patients with severe acne and/or scarring. Most patients do well with 0.5 mg/kg, for a duration of a few weeks. Prednisone can be combined with a systemic antibiotic.

Another good and safe option to consider in pregnant woman is blue light acne phototherapy. This type of treatment, has antibacterial and ant I inflammatory effects. It was not tested in pregnancy, but seems to be safe and effective.

In conclusion, there are some safe treatments that you can use during pregnancy. The ones people will probably feel most comfortable with are low dose benzoyl peroxide and glycolic acid.

Read more: 

Retinoids in pregnancy

Treatment of Acne in the Pregnant Patient. Jonette E. Keri, M.D., PhD.

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