46. Females only - Pregnancy and Acne
Doctor Jacob here, and we're talking today about acne during pregnancy.
Acne can sometimes disappear during pregnancy, leaving the skin very healthy, but sometimes it worsens during pregnancy. It really depends on the genetic predisposition of the patient. So if there is acne during pregnancy, the question is what can we use which is safe to treat it. If you've listened to some of the other episodes, you may already have somewhat of an idea.
The treatment should be first off topical if possible. There are a couple different medications which are approved by the Food and Drug Administration with a category B rating during pregnancy. Those two are clindamycin topically, as well as azelaic acid topically. As you know, I do not like oral clindamycin because of potential side effects. Benzoyl peroxide, although category C, has been in wide use and many dermatologists consider it safe during pregnancy.
For my pregnant patients with acne, I typically recommend clindamycin lotion at bed time, which can be used kind of like a moisturizing lotion, and then azelaic acid 20% cream in the morning. I also recommend a sulfur-based soap, such as KAVI Aqua, which is a 1% colloidal sulfur soap. Sulfur has been used during pregnancy for decades and decades, and even potentially for centuries if you think about mud treatments or sulfur hot springs, and there's been no risks that have been shown with sulfur. In addition, for very oily patients I recommend a lactic acid based anti-acne toner, and I put a link to that on the pregnancy page on the website, and in addition a qualified aesthetician can perform lactic acid peels.
Some dermatologists feel like glycolic peels are safe during pregnancy, but I personally favor lactic acid based peels during pregnancy. A peel done every three or four weeks can really help unclog the pores and freshen up the skin, even helping moderate cases of acne.
If that regimen isn't working, after around six weeks I revisit the issue and we think about adding in benzoyl peroxide, which as you remember is a category C drug but is in wide use in the world during pregnancy. Although there have been no formal studies of birth defects, there have been no reports of them with benzoyl peroxide either.
As you probably know from listening to previous episodes, for severe cases azithromycin can be considered at a dose of something like 250 mg twice weekly or even three times weekly, like Monday, Wednesday, Friday. I do recommend discussing this with the obstetrician prior to starting it.
There is also the option of oral erythromycin, which is very similar to azithromycin but has less effectiveness for acne. There is a lot of bacterial resistance against erythromycin, so it doesn't really work well and it causes a lot of stomach upset and loose stools.
In general, I recommend avoiding salicylic acid based products, retinol and retinoids, tetracycline, doxycycline and minocycline, sulfamethoxazole trimethoprim, which is also known as Bactrim, Septra or Sulfatrim; isotretinoin, also known as Accutane, spironolactone and birth control pills. These agents should not be used during pregnancy.
In addition to lactic acid based chemical peels done every few weeks, manual extractions, which is taking a comedone extractor and having an aesthetician manually extract the clogged pores can be considered, because we're kind of limited on what we could use. We don't have any vitamin A products ready to help do that, so between the chemical peels and some manual extractions, many patients with mild to moderate acne, in addition to using some clindamycin lotion can really see a wonderful improvement in pregnancy. It's the severe cases of nodulocystic acne that are really tough to treat, because our options are limited.
I'm Doctor Jacob, we'll see you next time.
Mild Acne - Moderate Acne - Severe (Cystic) Acne - Hormonal Acne - Acne During Pregnancy - Acne & Breastfeeding - Retinol - Anti-acne Cleanser - Anti-acne Toner - Benzoyl Peroxide - Zinc Monomethionine & Fish Oil - Pimple Spot Treatment - Blemish Treatment - Scar Treatment - Sunscreen - Moisturizer - Avoiding Exacerbators - Comedogenic Ingredient List - Azelaic Acid - Birth Control Pills - Clindamycin - Doxycycline - Isotretinoin - iPledge - Spironolactone - Minocycline - Bactrim (SMX/TMP)