Acne in Pregnancy

The concern on how best to treat acne in pregnancy, without causing adverse effects for the mother and the fetus, has become an important issue with many of the topical and systemic medications for acne available over the counter.

Pregnancy has a dual action on acne. In some, acne lesions clear when they are pregnant; while in others acne appear for the first time during pregnancy! Yet another group will experience worsening of their acne during pregnancy. These contradictory effects are due to the hormonal imbalances occurring during pregnancy.

How to treat acne in pregnancy?

Before answering this question , let us see which medications should be absolutely avoided in pregnancy.

Common Acne Medications to be Avoided for Acne in Pregnancy

1. Oral Retinoids: Absolutely contraindicated in pregnancy and females who may become pregnant. These drugs cause severe birth defects. If females of reproductive age have to be prescribed these medicines, two types of contraception should be followed during the duration and two months after the stoppage of medication.
2. Tetracycline: Because of their adverse effects on bones and teeth, tetracyclines should not be used in pregnancy, breast feeding or in women who may become pregnant.
3. Similarly, due to concerns of absorption through the skin topical tretinoins, topical tetracycline and topical clindamycin used to treat acne should not be used in pregnancy.

Guidelines on How to Treat Acne in Pregnancy

1. As far as possible, avoid all types of medications during pregnancy, especially first trimester (except for folic acid and any other essential medication that your obstetrician may prescribe).
2. Do not use herbal cosmetics or OTC acne products, whether natural or not, in pregnancy. They may contain substances which could harm the fetus.(Do not be under the mistaken impression that all herbal or natural products are safe: Anything under the sun, including the sun, can be harmful to your health.
3. Same holds true for acne in pregnancy. If acne is mild, avoid treatment till delivery and breast feeding are over.
4. Avoid spicy, oily, fast foods. Avoid chocolates and milk products as far as possible. Stick to a balanced, nutritious diet. This is good both for the baby and the mother and has a negative effect on formation of new acne lesions. Follow the dietary recommendations for acne.
5. Do moderate exercises advised by your doctor, see that you get sufficient sleep and find time to relax on a regular basis.
6. If, after all, you decide to treat acne in pregnancy , the following medications may be used under medical supervision:
   • Mild Acne: Topical Benzoyl Peroxide 2.5-5%.
   • Moderate Acne: If benzoyl peroxide alone is not effective, topical erythromycin may be used in the morning along with benzoyl peroxide during night.
   • Severe Acne: When there is a lot of inflamed acne lesions with signs of deep seated nodules and acne cysts developing, systemic medication may be required to avoid getting scars. In such cases, oral erythromycin may be combined with topical benzoyl peroxide. The only problem is that erythromycin may be poorly tolerated in pregnant ladies who have morning sickness or gastric irritation. The medication should be discontinued if severe burning sensation in the abdomen, worsening of nausea and vomiting etc occur.

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