How To Treat Acne When You’re Pregnant, According To A Dermatologist

Pregnancy is a whirlwind of change. How can it not be, when your body is growing and feeding a baby? And as your body changes, your routines will too. I’m here to talk to you about your skin care routine. Before my first pregnancy, I regularly saw my dermatologist Shari Marchbein, who helped me get my breakouts under control by prescribing several topical, over-the-counter creams. I had a few blissful months of clear skin — and then found out I was pregnant with my daughter.

My skin was all over the place the first trimester and then a miracle happened: it all just cleared up on its own. (If you believe old wives’ tales, you might think it was because I was having a girl.) However, with my son, my skin was breakout city. In both situations, I knew I had to pivot from what Dr. Marchbein originally prescribed for me, because, as you may or may not know, a lot of common skin care ingredients aren’t recommended for use while pregnant.

It’s not that you need to panic about skincare ingredients, says Dr. Marchbein, but you do have to be mindful of what we know and don’t know about the safety of certain skincare ingredients. “Do I think that something you’re putting on your face is making its way to your uterus? No,” she says. “These topicals don’t migrate — but, since we don’t test on pregnant women, it’s better to be safe than sorry. Especially since there are ingredients and treatments that we know can affect the uterus; either way, the health of mom and baby are of utmost importance, so we rely on science and data and err on the side of caution.”

The skincare ingredients to avoid during pregnancy

As with all things pregnancy-related, dermatologists want to make sure they’re recommending things that are proven safe during a patient’s three trimesters, explains Dr. Marchbein. The first thing most dermatologists will recommend that you stop using if you are trying to get pregnant is spironolactone, a potassium-sparing diuretic that is also used to treat acne because it slows down your body's production of androgen hormones, such as testosterone. Because it affects your body’s hormones, doctors recommend avoiding it during pregnancy due to potential fetal risks.

Accutane is another no-no. The oral anti-acne medication, typically prescribed for intense cases of acne, actually requires two forms of birth control when prescribed (think birth control pills and condoms), because it can cause severe birth deformities. As far as anti-acne topicals, Dr. Marchbein says she steers clear of prescribing Tazorac for her patients, since it can also cause severe birth defects; also on her don’t list are Retin A, Aczone (a topical version of Dapsone) and Winlevi or Differin (an over-the-counter retinoid). “Doxycycline, an oral antibiotic, is also one to avoid using while pregnant, since it can cause a permanent yellowing of your baby’s teeth, a form of a birth defect.”

She also recommends avoiding topical beta hydroxy acids, like salicylic acid, which she says “penetrate deeper into the skin and enter into the oil glands and can potentially be a risk,” though studies note that it is safe during pregnancy. “Hydroquinone, which is used to help treat hyperpigmentation, is also an ingredient to halt while pregnant, because it has a relatively high systemic absorption rate, so it’s just not worth taking the chance,” she adds. She also recommends pressing pause on cosmetic and elective procedures, like fillers and injectables, until you’re done breastfeeding.

If you find out you’re pregnant, immediately stop taking any of the medicines or using any of the topical ingredients mentioned above before starting a new routine.

Okay, so what can you use while pregnant, you ask?

Don’t worry — there are a lot of options. “It also comes down to the comfort of each individual,” says Dr. Marchbein. She suggests working with your dermatologist on your routine, whether it includes over-the-counter prescription gels or not. “There are acne options that are effective — you don’t need to stop everything, but you do need to know what is safe for pregnancy,” she adds.

The anti-acne ingredients that are safe to use while pregnant

Look for these key ingredients if you’re trying to build a pregnancy-safe anti-acne routine, says Dr. Marchbein.

• Alpha-Hydroxy Acids, like glycolic acid: These have a small molecular weight, allowing them to penetrate into your skin easily, targeting acne-causing bacteria, while also helping with hyperpigmentation, overall radiance, and clogged pores.
• Poly-hydroxy acids: These acids don’t even reach as deeply into the skin as AHAs; however, they still reach the level within your skin that is necessary to make a difference in your appearance.
• Azelaic acid: I used this while I was pregnant and can attest to its efficacy. (Note: According to Dr. Marchbein, the 15% prescription amount is the most effective; it works as an anti-inflammatory and is gentle enough even on those with sensitive skin — it also helps target hyperpigmentation and rosacea, in addition to acne.)
• Clindomyacin and erythromycin: Dr. Marchbein notes that erythromycin is often less effective, but both are antibacterial and anti-inflammatory.
• Benzoyl peroxide: This ingredient is best in a wash form or leave on gel; there is also a prescription version of this called Onexton — I also personally used this while I was pregnant. Think of it as an all-over spot treatment.
• Hydrocolloid acne stickers: I also used these while pregnant. “These are also great if you’re a skin picker and to also help breakouts heal,” Dr. Marchbein adds. Try the ones from Starface, Mighty Patch, or Good Light.
• Vitamin C: This powerhouse antioxidant builds collagen and brightens skin.
• Steroid injections: These are also safe for pregnancy and super effective with helping to dial down inflammation.
• In-office extractions: Do not try to do extractions at home — it can lead to inflammation and even scarring.
• Augmentin or Keflex, even certain forms of oral Aurithromyacin: Some dermatologists will prescribe off-label use of these antibiotics, which can all help clear up bacterial skin infections.
• Zinc and titanium-based sunscreens: Zinc is a proven acne-fighting ingredient — plus, it protects your skin from the sun and will prevent hyperpigmentation caused by UVA and UVB rays.
• Niacinamide: Also known as vitamin B3, this skin-soothing ingredient also brightens dark spots.
• Kojic acid and licorice root: These natural ingredients can help with brightening your overall skin tone.
• Bakuchiol: This is a natural ingredient that works as a retinol substitute and helps firm and tone the skin.
• Some LED light therapies: At-home devices with red (for aging) and blue (for acne) LED light can be a good option — just speak to your dermatologist before using to get the all-clear.

You can use most ingredients while breastfeeding.

It should be clear that you have plenty of options to keep your acne safely at bay while you’re pregnant. The takeaway is to always meet with a dermatologist to make sure you’re using the right regimen for your skin’s concerns. And once your baby is born, chances are you can go back to your old routine. “As soon as someone is nursing, I do put my patients right back on the prescriptions and ingredients that are in their typical regimen, since we have studies that show these ingredients absolutely do not get into breastmilk,” notes Dr. Marchbein. Lastly, if you have any additional questions, you can always email your OB-GYN a list of ingredients that concern you (I definitely did this a few times!).

My pregnancy skincare regimen

AM:

1. Splash my face with water and pat it until the skin is damp.
2. Vitamin C serum — I used Beauty Stat Universal C Vitamin C Serum on my face, neck, and chest).
3. Apply Onexton, a prescription acne gel.
4. Apply zinc and titanium oxide-based sunscreens. I love Isntree, DayLong SPF 50+, SuperGoop Mineral Sheer Screen.

PM:

1. Wash my face with Simple Micellar Gel Cleanser — this one is still in the rotation to this day because it’s so good and so gentle.
2. Apply prescription 15% azelaic acid cream.
3. Apply Augustinus Bader The Rich Cream.

Studies cited:

Han, G., Wu, J. J., & Del Rosso, J. Q. (2020). Use of Topical Tazarotene for the Treatment of Acne Vulgaris in Pregnancy: A Literature Review. The Journal of clinical and aesthetic dermatology, 13(9), E59–E65.

Cross, R., Ling, C., Day, N. P., McGready, R., & Paris, D. H. (2016). Revisiting doxycycline in pregnancy and early childhood--time to rebuild its reputation?, 15(3), 367–382. https://doi.org/10.1517/14740338.2016.1133584

Tang, S. C., & Yang, J. H. (2018). Dual Effects of Alpha-Hydroxy Acids on the Skin. Molecules (Basel, Switzerland), 23(4), 863. https://doi.org/10.3390/molecules23040863

Shalita AR, Smith EB, Bauer E. Topical Erythromycin v Clindamycin Therapy for Acne: A Multicenter, Double-blind Comparison. Arch Dermatol. 1984

Pullar, J. M., Carr, A. C., & Vissers, M. (2017). The Roles of Vitamin C in Skin Health. Nutrients, 9(8), 866. https://doi.org/10.3390/nu9080866

Gupta, M., Mahajan, V. K., Mehta, K. S., & Chauhan, P. S. (2014). Zinc therapy in dermatology: a review. Dermatology research and practice, 2014, 709152. https://doi.org/10.1155/2014/709152

Hakozaki, T., Minwalla, L., Zhuang, J., Chhoa, M., Matsubara, A., Miyamoto, K., Greatens, A., Hillebrand, G. G., Bissett, D. L., & Boissy, R. E. (2002). The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer. The British journal of dermatology, 147(1), 20–31.

Dhaliwal, S., Rybak, I., Ellis, S. R., Notay, M., Trivedi, M., Burney, W., Vaughn, A. R., Nguyen, M., Reiter, P., Bosanac, S., Yan, H., Foolad, N., & Sivamani, R. K. (2019). Prospective, randomized, double-blind assessment of topical bakuchiol and retinol for facial photoageing. The British journal of dermatology, 180(2), 289–296. https://doi.org/10.1111/bjd.16918