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Acne Treatment During Pregnancy

What About Oral Medications?

Generally, all oral acne medicines are best avoided in the first trimester, since those first three months are such a critical period of development for your baby. It's during this crucial time that implantation occurs and all the major body organs form, so it's best not to take chances with unnecessary medications. However, if your acne must be treated with oral medicines, some are preferred over others.
Oral Medications That Are Probably Okay
First, let's talk about some of the safer choices. Oral antibiotics can help control acne by controlling the growth of bacteria and reducing inflammation. Several antibiotics that appear to be effective for acne have been classified as pregnancy Category B medicines. Pregnancy Category B is given to medicines that do not cause birth defects to the fetus in animal studies but have not been tested in pregnant women. In general, medicines that are considered pregnancy Category B drugs are generally regarded as safe for use during pregnancy.
Here are some of the oral pregnancy Category B antibiotics that are most commonly used to treat acne:
? Penicillin
Oral Medications You'll Want to Avoid
We've already mentioned that taking isotretinoin greatly increases the risk for miscarriage and birth defects, including defects of the face, palate (the roof of the mouth), heart, and central nervous system. Therefore, this medicine should never be taken during pregnancy.

While isotretinoin can be dangerous if taken at any time during pregnancy, the risk for problems is greatest if the medicine is taken within the two to five weeks after conception. This means the drug may have already caused problems even before a woman realizes she is pregnant. To further complicate the matter, the drug can stay in the body for several weeks after treatment ends. For this reason, it's important for women who are taking isotretinoin to wait at least one month after their last isotretinoin dose before trying to conceive. This one-month time period gives the body enough time to clear the drug. 
Here are other oral acne medications that could cause problems if taken during pregnancy:
  • Tetracyclines: Tetracycline, doxycycline, and minocycline all belong to a group of antibiotics known as tetracyclines. The tetracyclines are not recommended for use in pregnant women, especially women who are more than 15 weeks pregnant. This is because they can cause permanent tooth discoloration if taken during the second half of pregnancy, when the teeth are forming. Because the teeth are still forming in childhood, these medications can cause the same problem if given to children through eight years of age.
  • Spironolactone (Aldactone®): Spironolactone is a diuretic (a "water pill") approved to treat fluid retention, high blood pressure, heart failure, and a few other conditions. Interestingly, the drug is sometimes used "off-label" to treat acne. This is because, in addition to being a diuretic, spironolactone is an antiandrogen, which means it counteracts the effects of androgens. Androgens, as you may recall, are hormones that stimulate the oil glands to make more oil, which can lead to acne. However, androgens are necessary for the development of male fetuses. So, taking spironolactone during pregnancy can cause male fetuses to develop female characteristics.
  • Flutamide (Eulexin®): This medication is another antiandrogen. Although it is approved to treat certain types of prostate cancer, it is sometimes used "off-label" to treat acne. However, as an antiandrogen, it can cause problems in a developing fetus and should not be used during pregnancy.
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