High quality human pregnancy data are limited, but azelaic acid has no reported adverse pregnancy effects and animal studies have not shown birth defects. The practical answer is to use an appropriate topical product as directed, rather than assume every formula containing azelaic acid is suitable.23
What can azelaic acid help with?
Azelaic acid cream treats mild to moderate acne by killing or preventing the growth of bacteria on the skin. Topical azelaic acid can also help lighten melasma, the irregular patches of darker skin that can develop on the face during pregnancy. Acne can worsen during pregnancy, particularly in the second and third trimesters.124
For acne, azelaic acid probably gives less improvement than benzoyl peroxide, although benzoyl peroxide should be used sparingly during pregnancy and discussed with your dermatologist. Benefits from azelaic acid cream can take time to appear. Keep progress checks with your care team rather than increasing applications to chase faster results.245
Check the whole product, not just azelaic acid
Look at the complete ingredient list. Avoid products containing retinoids, including retinol, tretinoin and adapalene, or hydroquinone during pregnancy. Azelaic acid being an option does not make those ingredients suitable alongside it. Tell your obstetrician and dermatologist about all medicines and prescription skincare you use, including treatments you started before becoming pregnant.3
Have your clinician confirm the strength, amount and frequency for your particular product. For prescription azelaic acid cream, use the prescription label's schedule at the same time each day and do not apply it more often than directed. These cream directions should not replace the directions for a different gel, serum or combination product.46
How to fit it into your routine
The basics are cleansing, moisturizing and sun protection.3
- 1Cleanse gently, up to twice daily and after sweating.
- 2Apply azelaic acid according to your product's directions. For prescription cream, wash your hands before and after use, keep it out of your eyes and never take it by mouth.
- 3Moisturize regularly. Choose a moisturizer made for your skin type, rather than building a collection that needs its own inventory.
- 4Protect exposed skin with broad spectrum, water resistant sunscreen with SPF 30 or higher, plus shade and protective clothing. Zinc oxide or titanium dioxide sunscreens are options during pregnancy.
With prescription azelaic acid cream, avoid abrasive cleansers and products containing alcohol that dry the skin. Do not add another acne treatment to the same area unless your care team approves the combination. If you miss a cream dose, use it when you remember unless the next dose is nearly due; do not double up.4
If you are treating melasma, sun protection remains central: sunlight can worsen the patches. Azelaic acid is an additional treatment, not a replacement for sunscreen.12
What side effects need attention?
Azelaic acid cream can cause mild irritation, redness, dryness or changes in skin color. Report these if they persist or bother you. Contact your care team promptly for burning, itching, crusting or peeling. A rash, hives or swelling of the face, lips, tongue or throat needs urgent medical attention.4
Before starting prescription cream, tell your care team about asthma or other breathing disease and any previous allergic reaction to azelaic acid. Pregnancy can also bring more sensitive skin, so review irritation rather than adding more treatment.34
Where this answer comes from
- 1Common Skin Conditions During Pregnancyaafp.org
- 2Narrative Review of Skin and Pregnancy: Dermatologic Manifestations and Medication Management During Pregnancypmc.ncbi.nlm.nih.gov
- 3Dermatologist-approved pregnancy skin careaad.org
- 4Azelaic Acid Cream: Uses & Side Effectsmy.clevelandclinic.org
- 5Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha‐hydroxy acid) for acnepmc.ncbi.nlm.nih.gov
- 6Over-the-Counter Medications in Pregnancyaafp.org
