Key takeaways:
Not every medication used to treat acne can be used during pregnancy. For example, isotretinoin and tetracycline antibiotics should be avoided.
There are a lot of medications that can help clear up your acne while you’re pregnant. But it’s best to check with your healthcare provider before trying one on your own.
Your healthcare provider will help you find the best treatment option for you. And if you’re already using acne products, check with them to make sure they’re still safe to use.
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Pregnancy brings about hormone changes that affect many parts of your body. The sebaceous glands in the skin become more active, leading to more oil production. This can clog pores and lead to acne.
There are many medication choices to treat acne when you’re not pregnant. But pregnancy eliminates some of the most popular treatment options. Read on to find out which medications may be safe during pregnancy — and which ones you need to avoid.
What acne medications are safe during pregnancy?
It’s difficult to be certain which medications are completely safe during pregnancy. That’s because clinical trials are challenging to perform during pregnancy for ethical reasons. So, we tend to use findings from animal studies and real-world experience to assess medication safety during pregnancy.
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The FDA used to have specific categories for medications based on their potential risks during pregnancy. But they’ve since replaced the categories with updated medication labels that improve upon the provided safety information.
With this in mind, what are your options for acne medications? We generally think of two different categories of medications when treating acne: topical and oral medications. If you’re pregnant, below are a few examples that your healthcare provider may consider.
Topical medications
Topical medications are typically first-choice treatments for mild to moderate acne. They’re available as creams, gels, and/or lotions. You can also find certain products as foams, solutions, and cleansers. Some are even available over-the-counter (OTC). But you should check with your healthcare provider before using them on your own.
Azelaic acid
Azelaic acid (Azelex) is generally thought to be safe for use during pregnancy. The exact way it works for acne isn’t known. But it’s been shown to kill bacteria on the skin and lessen inflammation. Azelaic acid is available as a cream for acne. You can find it by prescription or OTC.
The most common side effect of azelaic acid is skin irritation (e.g., burning, itching). It can also lessen the extra pigmentation that can appear after inflammation goes down. This can cause loss of skin color, which may be more noticeable if you have darker skin.
Benzoyl peroxide
Benzoyl peroxide is considered safe for use in limited amounts during pregnancy. It works by killing acne-causing bacteria on your skin. You can find it in both prescription and OTC products.
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The most common side effect of benzoyl peroxide is that it has a bleaching effect and discolors fabric and hair. It can also cause skin irritation, like redness, itching, or burning sensations. Although rare, benzoyl peroxide can cause a serious allergic reaction.
Antibiotics
Erythromycin (Erygel) and clindamycin (Cleocin T) are two topical antibiotics that are often used to treat acne. Both are considered safe for short-term use during pregnancy. They both work by inhibiting the growth of bacteria that can cause acne. They’re only available with a prescription.
Although it’s rare with topical use, both medications can potentially cause severe diarrhea. Otherwise, the most common side effects are skin irritation like burning, dryness, and itching.
Topical antibiotic use can also lead to resistance, which means it stops working as well. To lower the chance of this happening, your healthcare provider may have you use a benzoyl peroxide product along with it.
Oral medications
Oral medications are reserved for more difficult-to-treat cases or when topical medications aren’t an option. This typically includes antibiotics.
Antibiotics work on acne by preventing the growth of bacteria in the sebaceous glands. Some of the same antibiotics used in non-pregnant women can be used during pregnancy — but not all.
If antibiotics are used to treat acne during pregnancy, it’s best to limit their use to only a few weeks. And like topical antibiotics, the addition of benzoyl peroxide is generally recommended to lower the chance of resistance.
Examples of oral antibiotics that are generally considered safe during pregnancy include:
Pregnancy can raise your risk of getting a yeast infection. Taking an oral antibiotic can also raise this risk. Erythromycin and amoxicillin can also cause stomach upset and nausea.
What acne medications aren’t safe during pregnancy?
As mentioned above, it’s hard to say for sure what’s safe to use during pregnancy. But what we do know is that certain medications should be avoided or only used in certain situations.
Medications to avoid completely
Isotretinoin (Absorica) is an oral form of vitamin A (retinoid). We know for sure that it has a high risk of causing birth defects. For this reason, it’s absolutely contraindicated during pregnancy. This means it should be avoided entirely.
Tazarotene (Tazorac) is a topical form of vitamin A. It’s also contraindicated during pregnancy for similar reasons. And while not contraindicated, other topical retinoids (e.g., tretinoin) are typically avoided as well. They’re found in both prescription and OTC products.
Tetracycline antibiotics (doxycycline, minocycline, and tetracycline) are also known to cause problems with an unborn baby’s bone and teeth development. For this reason, they should also be avoided during pregnancy.
Lastly, spironolactone (Aldactone) is an oral medication that’s used off-label for acne. It blocks certain hormones in your body, which could potentially affect your unborn baby. It’s typically recommended to avoid spironolactone during pregnancy.
Medications that might be used in certain situations
There are a few medications that might be used in certain circumstances. That’s because the evidence isn’t clear on the risks in pregnancy.
Salicylic acid
Salicylic acid (Salvax) is a common topical acne treatment. It works by exfoliating the skin to unclog pores. You can find it in a number of OTC products. Along with skin irritation, salicylic acid can cause serious allergic reactions.
Taking salicylic acid (aspirin) by mouth during pregnancy is known to potentially cause birth defects. But it’s not known whether topical salicylic acid has similar risks.
So, it should be used when the benefit outweighs the potential risks. Your healthcare provider may say it’s OK to use a low strength topical product for a short period of time.
Corticosteroids
Oral corticosteroids (e.g., prednisone) may be an option for severe acne during pregnancy after the first trimester. However, some studies with prednisone show slightly more preterm births and miscarriages, as well as a risk of birth defects. But there isn’t enough evidence to confirm this link.
Corticosteroids like prednisone should be reserved for cases where the benefit outweighs the risks. If your acne is severe and nothing else is working, your healthcare provider may have you give a short course of corticosteroids a try.
Prednisone can cause high blood pressure and high blood sugar. High blood pressure and/or blood sugar levels can also happen during pregnancy. Your healthcare provider should monitor these carefully. Prednisone can also cause insomnia, mood changes, and electrolyte imbalances.
What are other things I can do to treat acne while I’m pregnant?
Ask your healthcare provider for tips on putting together a pregnancy skin care routine. This will typically include keeping your skin and hair clean and using oil-free cosmetics. It’s also a good idea to use mild cleansers to avoid irritation.
If you’re wanting to avoid medications, certain laser and light therapies are also considered relatively safe during pregnancy. If you’re interested in a specific procedure, you’ll want to check with your healthcare provider first to make sure it’s safe.
The bottom line
If you’re pregnant and have acne, you may not be able to treat it with the same medications you’ve used in the past. While there are many options considered to be safe, there are some that should be avoided. Your healthcare provider will help you figure out what’s the right treatment choice for you.
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References
American Academy of Dermatology. (n.d.). Is any acne treatment safe to use during pregnancy?
Baldwin, H. (2020). Oral antibiotic treatment options for acne vulgaris. The Journal of Clinical Aesthetic and Dermatology.
Bandoli, G., et al. (2017). A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheumatic Disease Clinics of North America.
Boen, M., et al. (2017). The role of photodynamic therapy in acne: An evidence-based review. American Journal of Clinical Dermatology.
Chien, A. L., et al. (2016). Treatment of acne in pregnancy. The Journal of the American Board of Family Medicine.
Dutil, M. (2010). Benzoyl peroxide: Enhancing antibiotic efficacy in acne management. Skin Therapy Letter.
Food and Drug Administration. (2021). Pregnant? Breastfeeding? FDA aims to improve drug information.
Mayne Pharma. (2021). Tazarotene foam [package insert].
Matin, T., et al. (2021). Benzoyl peroxide. StatPearls.
Preferred Pharmaceuticals. (2021). Clindamycin phosphate topical solution [package insert].
Shutter, M. C., et al. (2022). Tetracycline. StatPearls.
