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Acne Treatment During Pregnancy

Topical Acne Medications

If you've tried a good skin care regimen, and you're still bothered by acne, your healthcare provider may recommend acne medication. In most cases, you'll start with a medicine that's applied directly to the skin, such as a cream, gel, or lotion. These products, called "topical" medicines, are generally safer during pregnancy than ones you take by mouth. This is because most topical medicines aren't absorbed into the body in large enough amounts to cause significant problems.
The topical antibiotics clindamycin and erythromycin are often tried first for pregnancy-related acne. This is because these antibiotics are generally considered safe for pregnant women. And, when used topically as directed, very little (if any) of the medication is absorbed into the body. Both come in a variety of forms, such as lotions, gels, and foams.
Azelaic acid is another topical medication that is generally considered safe for pregnant women. You can get it as a cream (Azelex®) or a gel (Finacea®). The gel isn't actually approved by the U.S. Food and Drug Administration (FDA) to treat acne, but is sometimes used "off-label" for that purpose. Like clindamycin and erythromycin, azelaic acid is minimally absorbed when used as directed. Also like clindamycin and erythromycin, it's only available with a prescription.
Dapsone gel (Aczone®) is a prescription antibiotic used to treat acne. It hasn't been around as long as the topical forms of erythromycin and clindamycin, so there's less information available about its use during pregnancy. Problems haven't been reported yet, and at this point it appears to be relatively safe. But more information is needed before it can be considered a first-line acne medication during pregnancy.
If you're looking for an over-the-counter (OTC) option, benzoyl peroxide is probably your best bet. Benzoyl peroxide is found in several over-the-counter and prescription acne products. It's not entirely clear that benzoyl peroxide is 100 percent safe during pregnancy, since it hasn't been studied in pregnant women. But very little of the drug is absorbed into the bloodstream with normal use, so it's unlikely the drug poses any significant risks.
Topical salicylic acid is found in many over-the-counter acne products, including creams, face washes, and cleansing pads. You'll read conflicting information about salicylic acid and pregnancy. Some sources recommend against its use, since it hasn't been well studied in pregnancy. Other sources say that because so little of the drug is absorbed through the skin, it isn't likely to pose any significant risks. It's best to check with your doctor. Although the medication is likely safe when used in small amounts on small areas of the skin, all problems can't be ruled out.
Here are some tips for using topical acne medications safely during pregnancy:
  • The best way to prevent breakouts is to apply the medicine routinely, as directed. Using it on individual blemishes or only when breakouts occur won't prevent future pimples.  
  • Be careful when applying products that contain benzoyl peroxide, as it can bleach hair and colored fabrics, like clothing, towels, bed sheets, and pillowcases. Consider purchasing white pillowcases and towels if you're a regular benzoyl peroxide user.
  • You only need to use a small amount at a time. And only use the medicine on a small area. Using it more than directed or on large areas could increase the amount of drug absorbed into the body.
  • Always check with your healthcare provider before using any topical acne medication while you're pregnant -- even over-the-counter ones.
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