Acne is a common skin condition that can affect individuals at any stage of life, including during pregnancy and breastfeeding. Hormonal fluctuations during these periods can often trigger or exacerbate acne, causing distress and discomfort. However, Managing acne safely during pregnancy can pose challenges due to the contraindication of certain medications. This guide aims to provide an overview of safe and effective strategies for managing acne during these unique life stages, this guide offers comprehensive insights for pregnant and breastfeeding women navigating the challenges of acne management.
Topical Acne Treatment options for Pregnant Women
Topical treatment options of acne during pregancy are mainly indicated for mild cases
- Azelaic acid
- Antibacterial, comedolytic, and anti-inflammatory.
- it may help to lighten postinflammatory hyperpigmentation.
- Approximately 3-8 % of the medication is absorbed systemically after topical administration.
- It should only be applied to small skin areas.
- It’s best to avoid using it during the first trimester.
- Usage: Thin layer Twice daily.
- Benzoyl peroxide (BPO)
- Antibacterial, comedolytic, and anti-inflammatory.
- Approximately 5% of the medication is absorbed systemically after topical administration.
- Usage: once or twice daily.
- Salicylic acid
- If use is limited to local areas for a limited time, the risk during pregnancy is low.
- Avoid using high concentrations or using under occulsion. (risk of salicylic toxicity)
- Topical clindamycin
- Short-term use of topical clindamycin is safe during pregnancy.
- In patients with a history of gastrointestinal problems, it should be used with caution.
- Twice daily.
- Topical Dapsone
- It can be used only when the advantages clearly outweigh the hazards.
- Twice daily
- Topical metronidazole
- Topical metronidazole is regarded as safe during pregnancy and lactation.
- Twice daily.
- Topical sodium sulfacetamide ± sulfur
- Generally ok to use during pregnancy.
- 1-2 times daily.
Combinations that can be used for treating mild acne in pregnant women
- Topical clindamycin + BPO
- Topical metronidazole + BPO
- Topical Dapsone + BPO
Systemic Antibiotics For Acne in Pregnant Women
Systemic antibiotics for acne are often prescribed to treat moderate to severe acne that is unresponsive to topical treatments. However, certain antibiotics are contraindicated in pregnant and breastfeeding women due to potential adverse effects on the developing fetus or nursing infant. For example, tetracyclines can cause discoloration and hypoplasia of fetal teeth and bones, while sulfonamides and trimethoprim can lead to hyperbilirubinemia and kernicterus in neonates. In cases where systemic antibiotics are deemed necessary for pregnant or breastfeeding women with acne, the following should be considered.
- Oral amoxicillin
- It is not advisable to use this during the first trimester.
- First-trimester amoxicillin use has been linked to an increased chance of developing cleft lip and palate.
- Dose: 250-500 mg twice daily.
- Oral cephalexin
- Safe during all trimesters of pregnancy.
- Dose: 500 mg twice daily.
- Oral erythromycins (base and ethylsuccinate)
- Not recommended during 1st trimester.
- It might be regarded as the antibiotic of choice for treating severe inflammatory acne in pregnant women.
- No research has been done on the drug’s long-term (>6 week) use.
- Due to drug-related maternal hepatotoxicity, erythromycin estolate is contraindicated.
- Dose: 250 mg twice daily or 500 mg twice daily.
- Oral azithromycin
- In cases where patients are unresponsive to or cannot tolerate erythromycin, azithromycin can serve as an alternative macrolide.
- Dose:
- 500 mg weekly pulse for 3 consecutive days with one week intervals. (or)
- 500 mg daily for 3–4 days q10 days for 4 months.
- Oral clindamycin
- Third-line oral antibiotic for treating acne during pregnant.
- Dose: 75-150 mg twice daily
- Oral metronidazole
- In cases of severe, unresponsive acne during pregnancy, it might be an alternative.
- Dose: 250 mg twice daily.
Contraindicated Drugs during pregnancy
Topical drugs
Due to the potential concerns associated with topical retinoids, most experts advise against their use during pregnancy.
- Tretinoin
- Adapalene
- Tazarotene
- Trifarotene
Systemic drugs
- Isotretinoin
- Due to teratogencity, isotretinoin is contraindicated in pregnancy.
- Tetracylicnes
- Beyond the 15th week of gestation, there is a risk of causing permanent discoloration of fetal teeth and inhibiting bone growth.
- Maternal liver toxicity may also result from the use of tetracyclines during the third trimester.
- Additionally, there may be associations between the use of tetracyclines and infantile inguinal hernia, hypospadias, and limb hypoplasia. [Ref]
- Spironolactone
- Due to animal studies showing a risk of feminization and hypospadias in male foetuses, it is contraindicated during pregnancy.
- Trimethoprim-sulfamethoxazole
- Due to antifolate effects, usage during the first trimester is linked to neural tube abnormalities.
- Exposure to trimethoprim-sulfamethoxazole during the first trimester is linked to an increased risk of miscarriage, premature birth, low birth weight, cardiovascular abnormalities, and newborn hyperbilirubinemia.
Sources
- Treatment of Acne Vulgaris During Pregnancy and Lactation: A Narrative Review [Ref]
- Treatment of Acne in Pregnancy [Ref]
- Skin Changes and Safety Profile of Topical Products During Pregnancy [Ref]
- Treatment of acne vulgaris in pregnant patients [Ref]
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