Acne During Pregnancy
Pregnancy acne is not a special form of acne but acne management during pregnancy can be different, as any medication applied to your skin or taken orally can potentially enter your bloodstream and potentially affect the fetus.
Not all pregnancies impact on acne. Acne during pregnancy can be unpredictable with some women finding their acne actually improves during pregnancy. However if you have hormonal acne it is likely your acne will flare up during the first trimester. Generally acne subsequently improves and often disappears during the last trimester.
The most likely reason for exacerbation of acne during pregnancy is altered hormone levels increasing the skins production of natural oils (sebum). Some think that lowered zinc levels during pregnancy can also contribute. It is known the placenta contains high levels of zinc and that this potentially reduces the bodies zinc stores and that low zinc levels slow skin healing including acne.
Basic skincare is even more important when treating acne during pregnancy as medication options are more limited.
- Avoid picking, squeezing, scratching or popping acne. In short-term it can spread infection, in long-term it can cause scarring.
- Avoid make-up. If you need cosmetics avoid oil-based and use water based ‘non comedogenic’ products. Wash off make-up as soon as no longer needed.
- Wash face twice a day. Use mild cleanser (oil-free, alcohol free, nonabrasive e.g. CETAPHIL). Be gentle and don’t scrub or may aggravate. Use fingertips as washcloths/sponges can irritate sensitive skin. Avoid harsh soaps and over cleansing, as stripping too much oil will actually stimulate the skin to produce more oil as well as cause dry, irritated skin. After washing, rinse your skin with lukewarm water. Then gently pat dry and apply moisturiser.
- Shampoo daily. Especially important if have oily hair. Keep hair off your face.
- Low GI diet. Cut back foods with refined sugar and processed wheat products (white flour, white bread, cake, etc)
- Drink plenty of water. Important for flushing out toxins
- Nutritional Supplements. Zinc is important for skin healing, Vitamin C is important to strengthen immune system and prevent acne from getting infected. Probiotic also important especially if using antibiotics to treat your acne.
Oral Prescription Medications
If oral antibiotics are required then Erythromycin is the antibiotic of choice.
Tetraracyclines: Antibiotics such as tetracycline, doxycycline and minocyline can inhibit bone growth and discolour permanent teeth.
Isotretinoin: Isotretinoin (ROACCUTANE) is an oral medication used to treat severe acne that is especially dangerous when you are pregnant because of a high risk of birth defects. 25-35% of infants born to women exposed to Isotretinoin during the first trimester of pregnancy show a pattern of birth defects and miscarriage. Because of this risk women taking Isotretinoin need to be on two forms of birth control beginning one month, before starting through one month after stopping, and must have a negative pregnancy test one week prior to commencing.
Spironolactone: Spironolactone (ALDACTONE) is a hormonal medication sometimes used to help control acne. If you become pregnant while taking spironolactone stop using it immediately. Whilst there is no evidence of adverse effects during the first trimester, if taken later in pregnancy it can cause problems in male children.
Topical Prescription Medications
Topical prescriptions containing either clindamyin (DUAC, CLINDATECH) or azelaic acid can be used during pregnancy.
Retinoids: Topical retinoids such as adapalene (DIFFERIN, EPIDUO) tazarotene (TAZORAC) and tretinoin (RETIN A) are chemically related to isotretinoin, which is regarded as highly dangerous during pregnancy. Whilst studies show the amount of topical retinoids absorbed after use of topical cream on the face is very low and, although two prospective studies that examined topical retinoid use during the first trimester of pregnancy with 96 and 106 women did not find any increased risks, a safety first approach results in a recommendation that is best to avoid topical retinoid products during pregnancy, until data on larger cohorts are collected. Topical Retinoids are currently classified under Category D.
Topical Medications (OTC)
It is important to realize that many topical medications available over the counter (OTC) have not been adequately studied in pregnancy.
Most experts regard as safe over the counter products that contain either benzoyl peroxide or glycolic acid.
CAUTION: Salicylic Acid
There are a number of large studies of women taking oral low dose acetyl salicylic acid during pregnancy without any adverse effects, however, high doses of oral salicylic acid have been linked to pregnancy complications and current advice would be to avoid oral ingestion of salicylic acid during pregnancy.
No specific studies on topical salicylic acid during pregnancy have been conducted, however as such a relatively small proportion of salicylic acid is absorbed through the skin it is unlikely to pose any risks during pregnancy. Current advice would be that it is safe during pregnancy to use salicylic acid as a cleanser, once or twice a day, which is rinsed off the skin but wise to avoid high percentage strength salicylic acid peels during pregnancy. Some dermatologists suggest only using topical products containing 2% salicylic acid or less during pregnancy.
Alpha Hydroxy Acids (AHAs) such as glycolic acid and lactic acid are regarded as safe.
Azelaic acid as well as topical Vitamin C products can also be used during pregnancy. The use of body or face peels containing higher strength salicylic acid should be avoided during pregnancy.
All retinoid containing peels are contraindicated during pregnancy.