Associate Professor of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine
Chief of Dermatology, Miami Veterans Administration Hospital
Many pregnant women experience a beautiful, healthy glow and skin that has never looked better, but a number of pregnant women are bothered by pesky acne flares caused by an increase in androgen hormones. To some, acne may seem trivial given the serious problems that could arise during pregnancy, but pregnant patients with acne are often more self-conscious of their ever-changing appearance, which can affect their overall mood and self-esteem.
The good news is that acne that occurs during pregnancy can be safely treated with a number of effective acne treatments—from over-the-counter products to topical or oral medications, depending on acne severity. The key is to consult a board-certified dermatologist to find the acne treatment best suited for each woman’s specific type of acne.
Acne Therapies and Pregnancy
Topical Acne Medications
Because some medications pose a potential risk of birth defects if taken during pregnancy, the US Food and Drug Administration (FDA) established five categories that rate the safety of medications (see sidebar “FDA Medication Categories”). In general, it is recommended that acne medications that fall into Category B be prescribed because they are considered safe medications for use during pregnancy and pose no known risks to the health of the fetus. There are no true FDA-approved Category A medications for acne.
When treating a pregnant patient with acne, I generally recommend starting with these topical medications:
- Over-the-counter acne medications and facial washes
- Glycolic acid (Category N, not rated)
- Topical antibiotics available by prescription (Category B)
- Azelaic acid
Of all the available topical acne medications, I prefer to prescribe topical azelaic acid to treat acne during pregnancy for its added benefit of improving pigmentary problems such as melasma (known as the “mask of pregnancy”) and blemishes.
Oral Acne Medications
In cases where patients are not responding to topical acne medications or if the acne appears to be worsening, an oral acne medication may be an option. Although oral medications are not the first line of treatment for women who develop acne while pregnant, three oral antibiotics—all rated Category B medications—are considered safe and effective:
In rare, severe acne cases, oral corticosteroids may be used to prevent scarring.
There are effective light-based therapies available to treat acne in pregnant patients that may not be responding to other acne treatments. Red and blue light phototherapy are safe and can be used in instances where topical prescription or over-the-counter medications are not working to clear acne, although these treatments are not first-line therapies for treating acne. They are not covered by insurance and must be administered by a dermatologist once a week.
A Personal Decision
Acne is not a condition that should be dismissed because a woman is pregnant; it is important that women feelgood about themselves during pregnancy and particularly postpartum, when the “baby blues,” or postpartum depression, could become an issue. It is really a personal decision to seek treatment for acne while pregnant, and women should consult their dermatologist to understand the options available to them.
Headquartered in Schaumburg, Illinois, the American Academy of Dermatology (AAD), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 17,000 physicians worldwide, the AAD is committed to advancing the diagnosis and the medical, surgical, and cosmetic treatment of the skin, hair, and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair, and nails. For more information call (888) 462-DERM  or visitaad. org. Follow the AAD on Facebook (American Academy of Dermatology) and Twitter (@AADskin).