Pregnancy · Obstetrician First · CityLink Mall
Acne often starts or flares in early pregnancy, just when many of the usual acne medicines have to be set aside. This page explains what is avoided, what is generally used once your obstetrician agrees, and how Dr Sin Yong plans the rest for after delivery and breastfeeding.
Androgens and progesterone rise in pregnancy, with the sharpest change in the first trimester. Both increase sebum, so acne can begin for the first time, return after years of clear skin, or worsen. If you had acne before, or tend to break out before your period, a flare in pregnancy is more likely. Acne that follows the menstrual cycle outside pregnancy is covered on hormonal acne in adult women.
Pregnancy also changes the skin around the acne:
Types
Most acne in pregnancy is mild or moderate. Some flares calm down in the middle or later months, some carry on until delivery, and some appear only after the birth.
Two things are settled at the first visit. Dr SY confirms that the spots are acne, because itchy pregnancy rashes and folliculitis can look similar. And every product you were using before you knew you were pregnant is checked, starting with any retinoid, tetracycline or hormonal acne medicine, so that your obstetrician can be told.
The Decision
Where there is no good evidence on safety in pregnancy, the default is to wait. Dr SY does not prescribe against your obstetrician's advice, and if the two have not yet been in touch, a note or a call comes first. If oral treatment is needed, it is decided with your obstetrician, with referral to a dermatologist where appropriate.
Set aside in pregnancy. Oral isotretinoin must not be taken in pregnancy because of the serious risk to an unborn baby. Oral tetracyclines are avoided because they are deposited in developing teeth and bone. Topical retinoids belong to the same family as isotretinoin; very little is absorbed, but they are avoided as a standard precaution, and a cosmetic retinol counts as a retinoid. Hormonal anti-androgen treatment and hydroquinone are set aside too.
Generally used, once your obstetrician agrees. Azelaic acid is often the first choice, and it also helps marks while hydroquinone is off the list. Topical clindamycin is used in combination, for a set period. Benzoyl peroxide, and glycolic acid in low-strength products, are kept to small areas. Where acne is severe, an oral antibiotic from a group regarded as compatible with pregnancy may be chosen with your obstetrician. Beneath it all sit a mild cleanser twice a day, a plain moisturiser and broad-spectrum sunscreen, which also limit how dark marks become; see post-inflammatory hyperpigmentation.
After delivery and breastfeeding, the full acne treatment pathway is open again.
At Atelier
Elective procedures are put off in pregnancy: there is no safety evidence for them, acne does not make them urgent, and the skin and face are still changing. At Atelier this includes:
A Hydrafacial is assessed case by case, with the acid step and boosters adjusted or left out. For a single painful cyst, warm compresses and your topical treatment help; squeezing does not.
Breastfeeding
Breastfeeding usually allows a little more than pregnancy. For each medicine, the question is whether a meaningful amount reaches breast milk and whether that matters to your baby, and the default is still to ask first. Anything applied to the chest is kept away from the nipple and areola, and washed off your hands before feeding.
| Treatment | In pregnancy | While breastfeeding |
|---|---|---|
| Oral isotretinoin | Not taken | Not taken |
| Oral tetracyclines | Avoided | Prolonged courses avoided; a short course is a doctor's decision |
| Topical retinoids and retinol | Avoided | Usually deferred until feeding ends |
| Hormonal anti-androgen treatment | Avoided | Decided with your doctor |
| Hydroquinone | Avoided | Deferred |
| Azelaic acid, benzoyl peroxide, topical clindamycin | Generally used on limited areas, after advice | Generally regarded as compatible, on small areas kept off the breast |
| Elective lasers, radiofrequency, focused ultrasound, injectables | Deferred | Usually deferred; some devices assessed individually |
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