Acne & Pregnancy
Intro
Skin changes can happen during pregnancy. A study completed in 2018 where 1935 pregnant females were asked to fill out a questionnaire concerning their skin during pregnancy, 74.78% of females reported skin changes during pregnancy, with: 77.4% of them experiencing stretch marks, and 21.6% of them experiencing acne. Another study completed in 2016 with 600 pregnant females saw that 99% of those females experienced skin changes, and that the most common skin changes were hyperpigmentation (87.6%) and stretch marks (72.8%).
In addition to these common skin changes, pregnant females can also experience:
Vascular changes
Changes to the skin of the vulva and the vagina
Gingivitis
Facial and/or body growth
& more!
This is an ongoing series on skin health during pregnancy, and we have been focusing on the more-common skin changes in pregnancy. In this blog post you will learn more about:
What science has to say about why acne happens during pregnancy
What science has to say about skin support during pregnancy
If you want to read the first part of this series, click here to learn about stretch marks during pregnancy.
NOTE: THIS BLOG POST IS MEANT TO BE EDUCATIONAL ONLY, AND IS NOT MEANT TO DIAGNOSE, PREVENT, TREAT, OR CURE. PEOPLE SHOULD ALWAYS CONSULT THEIR TRUSTED LICENSED PROVIDER BEFORE TRYING ANY NEW TREATMENTS
Acne during pregnancy
A prospective study completed in 2020 looking at the prevalence of different types of acne in pregnant females revealed that 56.6% had mild acne, 29.5% had moderate acne, 12.2% had severe acne, and 1.7% had very severe acne, suggesting that females who experience pregnancy-related acne usually experience mild acne. And, a French survey completed in 2014 revealed that those who had acne during pregnancy had some form of acne in the past before pregnancy, and females who experience acne during pregnancy may experience similar flares in future pregnancies. Acne during pregnancy can happen anytime during pregnancy, but it is more prevalent during the third trimester.
The jury is still out on why acne develops and/or gets worse during pregnancy, but there are some interesting science that is helping us understand piece-by-piece as to what is going on:
Hormones play a role in the development of acne, specifically androgens. Androgens, like testosterone, are responsible for activating skin oil glands to make oil. And, when there is a high level of androgens, and enough oil is made, it plays a role in the development of acne (If you want to learn more about the hormones behind hormonal acne, click here to read my blog). And, science indicates that there is a significant rise of androgens during the third trimester, which coincides to when acne is most-prevalent during pregnancy.
If you follow me on Instagram & TikTok, you know that I am all about supporting the skin barrier since skin barrier disruption has been linked to skin irritation, skin redness, rashes, and breakouts/acne (If you want to learn more about the skin barrier, click here to read my blog). And, science indicates that the skin barrier changes during pregnancy! A study completed in 2021 showed that “skin lipids are significantly altered in mid-pregnancy” and that changes in estrogen during pregnancy “make the skin more susceptible to inflammatory factors and lead to more fragile and susceptible skin, weakening the skin barrier along with the lipid alterations.”
So, with what we know right now, hormones seem to play a role in the development of pregnancy-related acne by increasing sebum production in the third trimester, and by changing the skin barrier to make the skin more susceptible to inflammation.
Skin support during pregnancy
Licensed naturopathic doctors (NDs) always try to seek the root cause of a patient’s symptoms. And, in the case of acne during pregnancy, it seems to be driven by naturally-occurring shifts in hormones during pregnancy. Due the the importance of hormones during fetal development, bringing hormones down will be detrimental for the growing baby. With that, the best options will be addressing the other factors that play a role in the development of acne - excess oil, bacteria, inflammation, and more.
Before starting anything new to address acne, make sure to speak to your doctor to see if it is safe for you.
Benyzoyl Peroxide
Benzoyl peroxide is commonly seen in over-the-counter products for acne and commonly prescribed by physicians for acne.
So, how does it work and is it safe during pregnancy?
Literature indicates that benzoyl peroxide has anti-microbial activity against bacteria responsible for the development of acne, and has some mild sebum balancing activity.
According to an article written in 2016 in the Journal of the American Board of Family Medicine on acne in pregnancy, benzoyl peroxide is “considered safe during pregnancy and helps to prevent the development of resistance when used in conjunction with antibiotics.” And, authors of that article write that benzoyl peroxide could be “recommended as baseline therapy.” However, an article published in StatPearls indicates that “The FDA classifies benzoyl peroxide as pregnancy risk category C. The effects of benzoyl peroxide on reproductive health and fetal health are unknown.” So, speak to a provider before trying benzoyl peroxide to see if it is safe for you!
AZELAIC ACID:
From a 2016 review article from the Journal of the American Board of Family Medicine, the authors write, “topical azelaic acid or benzoyl peroxide can be recommended as baseline therapy” for acne in pregnancy. Azelaic acid can be found over the counter and can be prescribed, depending on the potency that a provider recommends. And, according to the American Academy of Dermatology, azelaic acid is “thought to be safe to use during pregnancy.” So, always speak to a provider first before trying anything new to see if it’s worth your while and to get the best dosing and potency recommendations!
Now, how does azealic acid work?
Azelaic acid works by: 1) Having anti-microbial activity against bacteria and yeast responsible for development of acne and folliculitis; and 2) being anti-inflammatory.
SALICYLIC ACID:
Salicyclic acid is a beta-hydroxy acid (BHA) that is commonly used for acne and can be found over-the-counter and can be prescribed. Salicyclic acid has been shown to resurface the skin and breaking up skin cells that are known to play a role in the development of acne, and it has been shown to reduce sebum production - another factor that plays a role in the development of acne.
Now, is it safe during pregnancy?
Salicyclic acid is categorized as Pregnancy Category C, which means that “Risk cannot be ruled out; human studies have not been performed; animal studies may or may not show risk; potential benefits may justify potential risk.” And a review article completed in 2017 indicated that salicylic acid has“significant dermal penetration” and that it is recommend to “limit use to small areas of coverage.” SO, make sure to speak to your provider first before trying niacinamide to see if it is safe for you.
NIACINAMIDE:
Niacinamide (aka nicotinamide) is a B-vitamin derivative that is found in many skincare products to support skin health for those who experience acne and uneven skin tone. Scientific evidence on niacinamide showed that this ingredient inhibits inflammation caused by acne-causing bacteria in addition to lowering sebum production to help prevent acne.
Several studies have also compared the effectiveness of niacinamide to regularly-recommended acne topicals, such as clindamycin. A study completed in 2013 showed that “[niacinamide 4%] and [clindamycin 1%] gels were significantly more efficacious in oily and non-oily skin types”, and another 2013 study showed that niacinamide 5% gel is “as 2% clindamycin gel for treatment of mild to moderate acne vulgaris.” And when compared to benzoyl peroxide, a 2021 study showed that “a combination of 2.5% benzoyl peroxide and 5% niacinamide is more effective than 2.5% benzoyl peroxide alone for mild to moderate facial acne vulgaris.”
Now, is niacinamide safe during pregnancy?
There are no studies about its safety, and there is no US pregnancy category assigned for niacinamide, and is considered “generally safe” despite having no safety studies. SO, make sure to speak to your provider first before trying niacinamide to see if it is safe for you.
BAKUCHIOL:
Bakuchiol is marketed as a “retinoid alternative” and has been pushed by various skincare companies to be safe during pregnancy since RETINOIDS ARE NOT SAFE DURING PREGNANCY. Retinoids are classified as a Pregnancy Category C, which means that is it “Risk cannot be ruled out; human studies have not been performed; animal studies may or may not show risk; potential benefits may justify potential risk.”
What does science have to say about bakuchiol and is it safe during pregnancy?
From combing through the literature, the studies are limited on bakuchiol. Bakuchiol has been shown to have a retinoid-like effect since scientific evidence indicates that it reduces the appearance of sun damage. And, another study revealed that bakuchiol’s effects on sun damaged skin was comparable to retinol. In regards to acne, a study looking at the effect of a product with 0.5% bakuchiol on acne showed that the product “[improved] mild to moderate acne and may be particularly well suited for individuals with skin of color.”
In regards to safety, there are no studies about the safety of bakuchiol during pregnancy.
Antibiotics:
Topical antibiotics: For some individuals, topical antibiotics may be recommended, and erythromycin and clindamycin are common Category B topical antibiotics that may be recommended. Category B means that there is “No risk to human fetus despite possible animal risk; or no risk in animal studies and human studies not done.
Oral antibiotics: Sometimes topical treatments may not be effective for acne, and a licensed provider may look into recommending oral treatment for acne. For those who are not pregnant, there are various oral antibiotics for acne, such as doxycycline, erythromycin, azithromycin, and more. However, some of these have been deemed as Category D, which means that there is “Positive evidence of risk to human fetus, but benefits may outweigh risks of drug.” Oral antibiotics that are rated as Category B are: Erythromycin, azithromycin, amoxicillin, and cephalexin.
Summary & Takeaways
This is the second part of an ongoing series about skin health during pregnancy (If you want to read the first part of this series, click here to learn about stretch marks during pregnancy). We solely focused on acne during pregnancy in this blog post, and focused on why acne happens during pregnancy and what science has to say about acne options that a provider may recommend to their patient. Here’s a summary of this blog post:
Always speak to your trusted provider before buying and starting any new products or treatments to see if it’s safe for you, to get the best recommendations for brands, and to get the best recommendations for how to use them. And take note that retinoids are NOT SAFE DURING PREGNANCY.
Acne can arise during any time during pregnancy, but is more common during the third trimester because of changes in hormones during pregnancy.
There are various topicals that could be recommended, some reported to be safe during pregnancy, while others being safe only for a period of time during pregnancy; safe on a limited area of skin during pregnancy; or not safe at all during pregnancy - highlighting why it is important to speak to a provider first before starting topical acne treatments during pregnancy.
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