What is the best acne treatment while pregnant?

Pregnancy acne is a skin breakout in pregnant people, possibly caused by hormone changes. Acne is common during pregnancy. In fact, more than half of pregnant people can expect to develop acne. In some cases, the acne may be severe.

The main cause of acne when you're pregnant is the increased hormone levels in the first trimester. The higher level boosts your skin's production of natural oils. It's hard to predict who will develop pregnancy acne. You have a higher risk, though, if you have a history of acne or have acne flares at the start of your menstrual cycle. If you don’t get acne during the first trimester, it's unlikely you'll have breakouts that are out of the ordinary during the second or third trimesters.

Managing acne when you're pregnant can be tricky. That's because many prescription and over-the-counter treatments come with a high risk of birth defects. In general, you should avoid any medication that has even a remote chance of harming your baby.

Pregnancy acne is a natural condition. It usually goes away when your hormone levels return to normal. The safest thing to do is to avoid any prescription acne medications or over-the-counter chemical spot treatments. Instead, you can rely on drug-free home remedies. But before starting any acne treatment when you're pregnant or planning to become pregnant, talk with your doctor about what's best -- and safest -- for you.

Isotretinoin is an oral medication that has revolutionized the way severe acne is treated. But it's especially dangerous when you’re pregnant. That's because the drug can cause serious birth defects.

Any patient who takes isotretinoin, as well as any doctor who prescribes it, pharmacy that dispenses it, and wholesaler who distributes it, must enroll in a special program that's part of a risk-management program to prevent pregnancy and birth defects.

Because the risks are so high, women of childbearing age who take the drug need to be on two forms of birth control starting at least 1 month before they begin treatment. They also need to stay on two forms of birth control for at least 1 month after treatment ends. Also, women must have pregnancy tests before, during, and after treatment.

Other prescription acne treatments that can cause birth defects include:

• Hormone therapy. This includes the hormone estrogen and the anti-androgens flutamide and spironolactone.
• Oral tetracyclines. These include antibiotics such as doxycycline, minocycline, and tetracycline, which can inhibit bone growth and discolor permanent teeth.
• Topical retinoids such as adapalene (Differin), tazarotene (Tazorac), and tretinoin (Retin-A). These products are similar to isotretinoin and should be avoided during pregnancy. Although studies show that the amount of these medications absorbed through the skin is low, there’s a concern they could pose an increased risk of birth defects. Products are required to carry a warning that states it’s unknown if these medications can harm a developing baby or a child that is being breastfed.

For the same reasons, some experts also recommend against using topical treatments containing salicylic acid. This is an ingredient found in many over-the-counter products.

Some experts recommend topical prescription products containing either azelaic acid or erythromycin. Other options include over-the-counter products that contain either benzoyl peroxide or glycolic acid. Only about 5% of the active medication applied to the skin is absorbed into the body. So it's believed that such medications would not pose an increased risk of birth defects.

But it’s important to remember that many topical medications have not been adequately studied in pregnancy. So again, be sure to talk to your doctor before you start any acne treatment.

Pregnancy acne is a natural condition that usually resolves after childbirth. So the safest course of action is good skin care. Here are some drug-free ways to treat pregnancy acne:

• Limit washing to two times per day and after heavy sweating.
• When you do wash, use a gentle, oil-free, alcohol-free, and non-abrasive cleanser.
• Use a cotton pad or washcloth to lightly wash your face (but change and use a clean cloth or pad each time).
• After washing, rinse your skin with lukewarm water. Then gently pat dry and apply moisturizer.
• Avoid over-cleansing. It can overstimulate the skin's oil glands.
• Shampoo regularly. If you have oily skin, it's best to shampoo daily. Avoid oily hair mousse or pomade near the hairline.
• Change your pillowcases frequently.
• Keep your hands off your face because there are bacteria on the fingers.
• Use earbuds. Don’t hold a cellphone against your face.

Above all, avoid the temptation to squeeze or pop your pimples. That can result in permanent acne scars. If you have clogged pores, get a professional facial.

A few months ago, I casually walked into a medical spa for a quick skin analysis. I figured we’d discuss whether peels or microdermabrasion would be best for my acne-prone skin. But when the aesthetician asked me about which medications I was on, I said none, out of habit. However, I casually mentioned my husband and I were starting intrauterine insemination (IUI) in the next month on our quest to get pregnant. And before I could even rest my head on the table, the consultation came to an abrupt end.

I was surprised to learn that even though I’m not pregnant yet, I needed to treat my skin like I am. That meant all of the medical-grade treatments and products I was looking forward to trying were off-limits.

Skin-care for pregnant women and those of us trying to conceive (TTC) can be a fickle mistress. Your hormones might be completely thrown out of orbit after you go off the pill, which can result in oily skin and breakouts. Unfortunately, the treatments you normally turn to might not be pregnancy safe.

Luckily, dermatologists say there are safe skin-care options to try throughout your pregnancy journey. Here’s a look at how to treat your skin when you’re in full on baby-making mode.

Hormone fluctuations from pregnancy or going off birth control can cause acne flareups just when your skin-care options become limited. Fun!

Going off birth control can be both an exciting and confusing time. Even though you’re excited to get that pink plus sign, it can take months—and for some women, even a year or longer, to get a positive pregnancy result. (Most couples—about 84 percent—get pregnant within a year of having regular unprotected sex, but one in eight experience infertility issues.)

If you’re usually on birth control and it helps stabilize your acne, suddenly not taking it can mess with your skin. “If you use birth control for acne, you are decreasing the effect of testosterone on the skin, which in turn helps make acne better,” explains Judith Hellman, M.D., a board-certified dermatologist in New York City. “When you stop, testosterone may increase oiliness leading to clogging, and hence new pimples.”

The good news is that your skin may stabilize after just three cycles off the pill, notes Kendra Segura, M.D., M.P.H., an ob/gyn in Southern California. However, if you’re trying to conceive, figuring out how to treat your skin during these months leaves you in a sort of gray area. Some medications and even common topicals aren’t safe in case you should get pregnant during this time.

The safest course of action for your skin is to act like you are pregnant from the get-go. “I tell my patients that I treat them as if they are pregnant from the time they are trying to conceive,” says Robin Evans, M.D., a board-certified dermatologist in Connecticut. “You may not know you are pregnant until you are often six or more weeks along depending on the regularity of your cycles.“

And pregnancy itself can lead to acne breakouts, too, so the fun just keeps going.

So what should you avoid if you are or could be pregnant?

It might be obvious, but your doctor is likely going to recommend discontinuing most oral acne prescriptions if you haven’t already. “A big no is Accutane, which is a common medication prescribed for cystic acne,” Dr. Segura says. “It contains a high dose of vitamin A, and excessive intake of vitamin A affects the developing embryo and can be teratogenic, or dangerous, for your developing embryo.”

During your preconception phase, Dr. Segura also recommends discontinuing tetracycline, an antibiotic commonly used for acne. It could eventually cross the placenta and affect your developing baby’s teeth and bones.

Topical retinoids—vitamin A derivatives—including over the counter retinol, prescription Retin-A, and the acne topical Differin, are strongly discouraged during pregnancy. The same goes for hydroquinone, which is found in brightening creams.

Often, it’s not entirely clear whether an ingredient can cause pregnancy or developmental complications, but without strong evidence to say something is completely safe, doctors usually advise on the side of caution.

There’s a long list of other skin-care ingredients, products, and medications that may or may not be safe for you during pregnancy, which is why Dr. Segura recommends setting up a preconception appointment with your doctor to discuss. “The preconception appointment is highly important, because there may be other medications a soon-to-be mother may be taking for other medical conditions that she may not be aware of that could be harmful to her growing baby,” she says.

Here are products that doctors say are are pregnancy and TTC safe.

It’s possible to keep your acne under control while you’re TTC and eventually pregnant. It just might take a bit of trial and error to figure out which products work best for your skin type. Plus, it’s probably going to be a bit of a learning curve for most of us to remember which ingredients are pregnancy-safe.

Some you’ll want to keep in mind are glycolic acid, salicylic acid, and benzoyl peroxide, which are generally considered safe. Research on glycolic acid has been limited to animals, but it’s usually considered pregnancy-safe because only a minimal amount is absorbed into the skin. Salicylic acid and benzoyl peroxide shouldn’t pose any risk to a developing baby, research shows, because so little is absorbed through the skin, although some doctors still warn against benzoyl peroxide if you don’t absolutely need it.

Here are five doctor-approved skin-care products you can use while pregnant or trying to conceive: