How can I manage acne during pregnancy?

Where should I start?

1. 1Check what you already use. Read the packaging's "Active Ingredient" section rather than relying on the product name; the useful part of the label rarely gets top billing.
2. 2Bring your acne medicines and skin care labels to your pregnancy care provider before starting or changing treatment. Take photos of your current product labels to your appointment, so the bottles can attend without needing their own bag.
3. 3Clean your skin gently, try not to touch it and avoid sun exposure. Acne is not caused by dirt, so harsher cleaning does not address its cause.
4. 4Once your treatment is agreed, follow the specific product directions and your prescriber's instructions. Ask them to confirm the amount, application area, morning or evening use, frequency and when to review progress.

Which acne treatments are options?

• Azelaic acid is a first choice for treating acne during pregnancy.
• Clindamycin is another first choice to discuss with your clinician.
• Benzoyl peroxide is an option for limited use. Agree the extent of use with your clinician rather than treating a larger area on your own.
• Salicylic acid at 2% or less is a second choice. High strength salicylic acid needs caution during pregnancy.
• Oral penicillins or cephalosporins are second choice prescription options when your clinician decides an oral treatment is appropriate.

What should I do about my existing acne medicine?

Retinoids applied to the skin should be avoided, including adapalene. Oral retinoids, spironolactone and clascoterone are also unsuitable during pregnancy. If one is in your current routine, contact your prescriber promptly to review it and arrange an alternative. Have the medicine name and details of your use ready.16

Do not stop unrelated prescription medicines simply because your acne routine needs changing. Decisions about starting or stopping medicines during pregnancy need to balance the benefit of treatment against its risks. Include nonprescription medicines, herbs and supplements in that review, not just prescriptions.4

Does applying a treatment to skin limit exposure?

Many treatments applied to skin have low absorption into the bloodstream, but absorption depends on more than the ingredient. The amount used, area covered, product form, application site and whether skin is wet or dry all matter. Cracks, open wounds and eczema can increase absorption. Tell your clinician if the skin you want to treat is damaged, especially before using a treatment across your chest or back.56

What should I expect, and when should I get help?

Hormonal changes during pregnancy probably contribute to acne, and an existing skin condition can improve or worsen during pregnancy. Treatment should use the lowest effective dose for the duration needed. There is no single strength or application schedule for all the options above; get a specific plan for your chosen medicine rather than borrowing another product's instructions.126

Arrange a review if breakouts persist, become severe or leave scars. You do not need severe acne to benefit from a dermatologist. Stubborn breakouts also deserve a diagnosis check because other skin conditions can resemble acne. Ask your prescriber what reactions should mean stopping your particular treatment and how long to try it before reassessing.267