Acne In Pregnancy; treatment options
By Dr Davin Lim
Cutis Dermatology, Brisbane.
- The best ingredients to use are Azelaic acid, Salicylic acid 2% wash, Benzoyl Peroxide, Niacinamide
- The usual recommended treatments include: AHA peels, LED Phototherapy, Zinc supplements and an acne diet
- Do NOT use retinoids during pregnancy
- Safety profile is of utmost importance
Why does acne flare up in pregnancy?
Hormones & stress, possibly contributed by diet. It is fence sitting, however 50% of acne cases worsen with pregnancy whilst 50% improve. Chances are, if you are reading this paragraph, you fall in the former catagory. An influx of androgens in the first and second trimesters can cause the oil glands in your skin to grow and produce more sebum — an oily, waxy substance. Sebum can clog pores and lead to bacteria, inflammation, and breakouts.
What treatments are safe in pregnancy?
Category A, B medications are safest in pregnancy these include the following topicals-
Azelaic acid, topical erythromycin gel, zinc & erythromycin gel, topical clindamycin, along with spot treatments such as salicylic acid.
Most dermatologists agree that salicylic acid wash, namely 2% is safe, as is BPO or Benzoyl Peroxide.
Physical treatments such as pulse dye lasers, IPL with blue filters, low level laser emission devices such as Omnilux Blue – Omnilux Red, Heallite & filtered light sources are safe. High concentrations of salicylic acids, namely greater than 5% used in ‘large area peels’ are unclassified. Majority of dermatologists would prefer AHA peels as systemic absorption is negligible.
Sulfur is an old remedy that is safe in pregnancy. A favourite amongst dermatologists include 5% sulfur in Calamine lotion.
What treatments are unsafe in pregnancy?
Above all, avoid retinoids. This includes oral retinoids such as isotretinoin but also topical retinoids such as adapalene, tretinoin, & tazarotene. Topical retinoids carry an infinitely small, some say negligible risk of teratogenicity, however legally, one has to follow Product Information (PI). If you find out you are pregnant when you are using topical retinoids, cease immediately & inform your obstetrician. There is no need to worry. Oral retinoids on the other hand can give a foetal malformation rate of approximately 30-50%. A wash out of one month is required for patients on isotretinoin.
Other medications NOT compatible with pregnancy include Doxycycline, Minocycline & Tetracyclines.
What treatments are not classified as SAFE or UNSAFE in pregnancy?
Grey zone for some treatments including salicylic acid peels at 5% or greater. There is a theoretical risk of salicylism, however this is infinitely small. Grey zone also applies to retinol, retinyl palmitate & retinaldehyde. These are precursors to retinoic acid & require conversion. Directions include ‘Cease in the event of pregnancy.’ This is precautionary, for more information on your particular product contact the product information hotline of the company. Each company will have their own standing orders.
Topical dapsone is another medication in the grey. I know that oral dapsone has been used in pregnancy for treatment of extreme skin disorders such as dermatitis herpetiformis, & acne fulminans. This can be discussed with your obstetrician & treating medical dermatologists.
BPO or benzoyl peroxide falls in this category however the absolute majority of dermatologists would classify this as safe in pregnancy and lactation. If unsure, check with your medical prescriber.
How do you approach acne in pregnancy?
As always the foundation of any acne treatment lies in diet, lifestyle modifications & simple face washing & make up tips. Please refer to the relevant sections on this website or visit @drdavinlim (Instagram) for more information & tips.
Diet: Consume less sugar, less dairy, eat more vegetables & protein
Washes: Salicylic acid as tolerated. You do not need to go past 2%. Wash once a day, any more can lead to skin irritation. You can also choose to wash with BPO or benzoyl peroxide. Do not use both as you will end up with an irritant reaction. Choose wisely, salicylic acid if you have blackheads, BPO if you have lumps and bumps.
Zinc Supplements can be a good thing. 60 to 80 mg zinc daily.
Creams: Include azelaic acid. You do not need to see a doctor for this. Formulations range from 10 to 15%. Use nightly. Niacinamide is another option as this has acne fighting properties.
Sunlight or phototherapy: Sensible sunlight can actually improve acne. This is because the bacteria in your skin produce chemicals called porphyrins. These are sun light sensitive chemicals that can kill c.acnes, the bacteria implicated in acne. You can apply sunscreen prior to exposure as the wavelengths that kill bacteria actually go through the sunscreen. Expose affected areas in the early to mid morning sun, and again in the afternoon. 2-5 minutes depending on where you live. Remember, this dermatologist is giving you sensible advice regarding UV exposure. This treatment is well known by dermatologists worldwide. It is called sensible natural phototherapy. Other sources of phototherapy include acne masks. Neutrogena had one, but it was recalled due to potential eye problems with the LEDs.
Professional help: your family physician or a medical dermatologist can assist you from here. There are many safe treatment options for you during pregnancy.
*Disclaimer: I am a procedural dermatologist & not a medical dermatologist. I do not treat acne. If you require a consultation please book to see my colleagues @cutis_dermatology
How can a medical dermatologist or doctor help?
Failing the measures listed above, doctors can prescribe topicals including erythromycin & clindamycin gel/lotions. These topicals are classified as safe in pregnancy. In severe cases a short course of erythromycin anti-inflammatory abs can help. Dermatologists can prescribe medical phototherapy in the blue & red wavelengths to target c.acnes bacteria. You may have heard of a treatment called Kleresca (BioPhotonic marketing). Don’t ask for the orange photodynamic gel but ask for the 2 blue wavelengths of light that are emitted by the Kleresca lamp. That can help kill bacteria in your oil glands.
If you are struggling with acne during pregnancy or conception, please book an appointment with my colleagues @cliniccutis. I do not treat medical conditions such as acne as my work is entirely procedural (I cut, laser, inject, & peel).
Davin’s Viewpoint on Acne Treatments in Pregnancy
Ideally patients should have their acne in remission prior to pregnancy, however in this busy world this is not often possible. What is not talked about is the prevalence of acne in women undergoing conception. Say you have acne prone skin in your late teens to early twenties, what do most family physicians & medical dermatologists do? They start you on oral contraception before medications like Accutane. The OCP or oral contraceptive pill can do wonders for your skin, namely reduce the effects of androgens on your oil glands. Just like that oil is controlled and your outbreaks are gone. The most frequently prescribed pills include agents such as drospirenone (Yaz, Yasmin) or cyproterone acetate (Juliette, Diaene, Brenda). What do you do when conception is due? Stop the pill, and your acne comes back at the most inconvenient time of your life.
Hence all along you may have a predisposition to getting acneiform or acneic skin, this was masked by the anti-androgens prescribed for many years of your young adult life. This clinical picture is not uncommon. The other side of this is the hormonal influx of pregnancy hormones. This stimulates your oil gland & bang! Acne.
In the vast majority of cases sensible & safe skin care can markedly reduce acne. Diet & natural phototherapy will make a good impact on most. If you are struggling with acne during pregnancy, consult your family physician. Failing that a medical dermatologist can help.