Jun 23, 2019

Treating Acne in Pregnancy

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By Jordan V. Wang, MD, MBE

During pregnancy, existing acne can get worse or even pop-up out of nowhere. This is a time that is full of hormone surges and over-activity when added stress is the last thing that anyone needs. Unfortunately, treating acne while pregnant can be quite difficult. Which medications will work? Which ones are safe to use? Will my baby be okay?

Managing Acne During Pregnancy

At this year's annual medical conference of the American Academy of Dermatology, Dr. Jonette Keri, Associate Professor at the University of Miami and Chief of Dermatology at the Miami VA, discussed approaches to managing acne in pregnant women. This meeting brought together over 18,500 attendees to Washington, D.C. for a gathering of the top experts.

When treating pregnant women, everyone aims to use the safest available medications through the safest route. For acne in this particular situation, it is always best to use topical medications first before switching to any oral medications.

What's Safe?

Unfortunately, some of the most effective medications for treating acne may not be the safest, so keeping realistic expectations is very important. The U.S. Food and Drug Administration (FDA) has created a system of categorizing medications for use during pregnancy. In a very simplified version, they range from Category A (what has been shown to be safe in humans), Category B (what has been shown to be safe in animals), Category C (uncertain safety), Category D (unsafe), and Category X (highly unsafe).

Some of the safer topicals in Category B include azelaic acid, clindamycin, and erythromycin, while some of the topicals in Category C include benzoyl peroxide and salicylic acid. Benzoyl peroxide is thought to be safe by most physicians since it has minimal systemic absorption, while salicylic acid is thought to be safe if low concentrations are used very minimally. Other topicals, such as tretinoin and adapalene, are also Category C, but there have been reported cases of adverse effects. Tazarotene is Category X and should not be used.

Dr. Keri discussed a potential regimen that pregnant women would be safe using:

1. Mild washes containing glycolic acid, benzoyl peroxide, or salicylic acid. 

For more extensive acne:

2. Topical azelaic acid or topical clindamycin can then be added and used in small amounts. 

3.  If severe enough acne present, then there are several safe oral antibiotics that can be used.

If pregnant, please check with your dermatologist or obstetrician to make sure that you are correctly using safe medications for your acne.