Acne and Pregnancy
Pimples and other skin eruptions are hallmark of acne vulgaris or acne. This is sometimes chronic condition of the face, back, chest, neck, shoulders, and other areas of the body, which encompasses blackheads, whiteheads, and raised red blemishes with semisolid centers. Acne usually begins around puberty and peaks at age 18 years. However, in some instances, it can occur for the first time between the ages of 20 and 40. Also, it is not uncommon for pregnant women to experience acne breakouts during pregnancy or later.
A variety of medications are prescribed for acne, some can be taken orally, others topically (skin). The route of the exposure is important to consider when assessing the possible risk of these medications during pregnancy. Topical creams and gels are less systemically available than medicines taken orally, ultimately meaning that the fetus is exposed to less of the medication.
Here is a list of various acne treatments and their effects in pregnancy:
Topical treatments that can be used in pregnancy:
1. Benzoyl peroxide:
Benzoyl peroxide is a topical treatment that has antibacterial effects. It is commonly used, and there are no case reports about benzoyl peroxide and birth defects in the literature. So the risk of malformations is low.
Hydrocortisone is a corticosteroid used topically to treat acne. There have been no reproductive studies on its possible risk in pregnancy. A literature review has shown that it does not create malformations but the exposed group did have risk of prematurity.
§ Adapalene: The overall risk of adapalene is undetermined because there have not been any human studies. However, because only trace amounts of the gel are absorbed into the skin, it is unlikely that doses large enough to induce malformations could reach a fetus.
Oral medication that can be used in pregnancy:
§ Erythromycin: Erythromycin is an antibiotic that is commonly prescribed in pregnancy. Human studies have all examined oral exposures. Women exposed in first trimester have shown no increased in birth defects. Hence it is generally assumed that topical erythromycin does not pose a significant increased risk for birth defects.
§ Clindamycin: This antibiotic is related to erythromycin. Studies have shown that this medication is unlikely to significantly increase the risk for birth defects in either its oral or topical form.
Acne medications to be avoided during pregnancy:
Tetracycline: Tetracycline affects the fetal calcification process. Hence, doxycycline and minocycline, structurally similar to tetracycline should be avoided after the first trimester of pregnancy.
Retinoids (topical as well as oral):
Isotretinoin: This medication is contraindicated during pregnancy due to the characteristic malformations it causes. Isotretinoin should be discontinued at least one month prior to attempting pregnancy.
Thus there are a wide variety of medications available for the treatment of acne, many of which pose a minimal risk if applied topically during pregnancy.