What Causes Pregnancy Acne and How Can You Treat It?

From morning sickness to heartburn, women can experience many uncomfortable symptoms while pregnant. While troublesome, these symptoms are typical during pregnancy. But, some women also have a more surprising and visible symptom: acne. 

Here, we’ll discuss what causes pregnancy acne and how you can treat it in a way that’s safe for you and your growing baby.

When does pregnancy acne start?

Acne can happen at any time during pregnancy. But most women who develop it will start to notice blemishes around 6 weeks into their pregnancy. Some women might not even know that they are pregnant at this point. So, the sudden appearance of acne could be one of the earliest hints that you may be pregnant. 

Typically, pregnancy acne will improve during the first trimester. But more serious facial and body breakouts will show up in the third trimester, which usually happens when maternal androgen hormone levels start to peak.

Why does acne appear during pregnancy?

Two key factors are responsible for pregnancy acne: changes in your hormone levels and in your immune system during pregnancy.

During pregnancy, women go through extreme hormone changes. A hormone called progesterone is responsible for helping create an ideal environment for an unborn baby. Androgen (male hormones) levels also rise during pregnancy and play a role in getting your body ready to deliver. 

These hormone changes can also cause the glands in your skin to secrete (produce) more oil. This oil is called sebum. The excess sebum can clog your pores and lead to a buildup of bacteria — two primary causes of acne. Also, changes in your immune system that happen during pregnancy might cause more breakouts.

Does getting acne during pregnancy mean you’ll have a boy or a girl?

There’s an old wives’ tale about pregnancy acne and what it means for the sex of your baby. According to the tale, if you have pregnancy acne, you’re more likely to be pregnant with a baby girl. This is because the baby girl’s hormones combined with your own are more likely to cause acne during pregnancy. 

But there seems to be little truth to this tale. Your hormones — not the baby’s — decide what types of pregnancy symptoms you may experience, including acne.

How to treat acne safely during pregnancy

Since researchers don’t test medications on pregnant women, pregnancy acne can be a challenge to treat. This means, we don’t know for sure how safe they are. Several acne medications are dangerous for pregnant women because they can cause birth defects. So if you have pregnancy acne and wish to treat it, always talk to your prenatal care provider first. They can help you figure out what treatment works best for you.

Common treatment options for acne in pregnancy include topicals (medications applied to the skin), pills, and procedures. 

But topicals are the first-choice treatment for pregnancy acne. That’s because applying the medication to your skin greatly lowers how much medication is absorbed into your bloodstream. With this treatment, it’s best to use a thin film over a small body surface area.

While some medications may be harmful for pregnant women, the following topical treatments have not been linked to birth defects in humans: 

• Azelaic acid helps with clogged pores, kills acne causing bacteria, lessens inflammation, and can improve dark marks.

• Glycolic acid lessens sebum, exfoliates dead skin cells, and brightens your skin.

• Benzoyl peroxide kills acne causing bacteria and stops bacteria from becoming resistant to antibiotics.

• Salicylic acid breaks down clogged pores and should only be used on small body surface areas.

• Topical antibiotics, like Clindamycin or erythromycin, kill acne causing bacteria but should be used with benzoyl peroxide to prevent resistance. You will need a prescription from your provider for these medications.

Oral medications (pills) are a last resort for pregnancy acne. They’re an option for short-term use if your acne is cystic and scarring. Antibiotics that can be used for pregnancy acne include:

• Erythromycin

• Azithromycin

• Amoxicillin

• Cephalexin

Besides medications, some procedures you can do during pregnancy to improve your breakouts include:

• Clogged pore extractions: This procedure uses a tool to manually remove the contents of clogged pores.

• Chemical peels: An acid is applied to the skin to remove dead skin cells. Peels are most useful in clogged pore acne. 

• Cortisone injections: Small amounts of diluted cortisone are injected into cystic acne to calm the inflammation. But this procedure should be done only by a dermatologist.

• Light therapy: Red and blue light exposure can help reduce acne causing bacteria. Over-the-counter and in-office versions are also available.

Unsafe pregnancy acne treatments

According to the American Academy of Dermatology, pregnant women should always avoid these acne medications:

• Isotretinoin (Claravis, Accutane, Sotret): Isotretinoin is a powerful, vitamin A-based acne treatment that is known to cause several severe birth defects. Never take isotretinoin if you are pregnant, think you may be pregnant, or are trying to become pregnant.

• Topical retinoids, like tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac): These treatments belong to the same drug class as isotretinoin. Even though topical medications are applied to the skin, they can be absorbed into your bloodstream and then passed on to your baby.

• Spironolactone (Aldactone): Spironolactone — a medication commonly used to treat acne and high blood pressure — is a hormone that could negatively affect a growing baby. To prevent any issues, many healthcare providers recommend using it during pregnancy.

• Tetracycline antibiotics, like tetracycline, doxycycline, and minocycline: These antibiotics can cause permanent damage to the growing baby’s teeth and bones.

What are some natural treatment options for pregnancy acne?

Instead of — or along with — other treatment options, some women may want to try more natural choices for pregnancy acne. Here are a few ways you can try to reduce breakouts without medications:

• Clean your face twice daily. Ingredients in many soaps can irritate the skin, so try a cleanser that doesn’t contain oils, alcohols, or soaps. Don’t scrub too hard since this can irritate your skin and make acne worse.

• Drink lots of water to flush out toxins. Drinking lots of water will improve your skin’s health and your overall health. Aim for at least eight 8-oz. glasses of water each day.

• Eat a healthy, balanced diet. Avoid foods that cause quick spikes in blood sugar (also known as high glycemic index foods). 

Pregnancy acne prevention

You can’t completely prevent pregnancy acne. But the following steps can help reduce acne and acne-related issues:

1. Wash your face with a gentle cleanser every morning and night.

2. Stick to non-comedogenic products that don’t clog your pores.

3. If you have oily hair, shampoo more often and try to keep the hair off your face.

4. Change your pillowcase often. 

5. Avoid picking or popping blemishes.

6. If you notice more breakouts, see a dermatologist early on to discuss a safe and effective regimen.

Does pregnancy acne go away?

Pregnancy acne should calm down after delivery, usually as your hormones settle down. If it doesn’t go away completely, more treatment choices are available to you than while you were pregnant.

Why trust our experts?

Written by:

Maryann Mikhail, MD

Maryann Mikhail, MD, is a board-certified dermatologist and medical writer based in South Florida. She is the founder of Waverly DermSpa in Fort Lauderdale and holds a voluntary faculty position at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami MIller School of Medicine.

Reviewed by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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