Pregnancy Acne: What Teen Moms Need to Know About Safe Treatment

I'm going to skip the part where I have opinions about teen pregnancy, because that's not what this article is for. You're pregnant, you have acne, and you need to know what's safe. That's a medical question and it deserves a straight medical answer.

Pregnancy acne is extremely common. Hormonal surges during pregnancy -- especially the increased androgens and progesterone in the first and second trimesters -- can trigger breakouts even in people who've never had acne before [3]. If you already had acne before pregnancy, it often gets worse. And the frustrating part is that many of the treatments you were using aren't safe anymore.

Why pregnancy changes everything about acne treatment

During pregnancy, everything you put on your skin or swallow gets evaluated differently. Some ingredients that are perfectly safe for non-pregnant people carry real risks to a developing fetus. This isn't a hypothetical concern. For some acne medications, the risks are well-documented and serious [2].

The FDA used to categorize drugs by pregnancy risk (Category A through X). That system has been replaced by more detailed labeling, but the old categories are still commonly referenced and useful for quick understanding:

• Category A: Proven safe in human studies
• Category B: No evidence of risk in animals, limited human data
• Category C: Animal studies show risk, but benefits may justify use
• Category D: Evidence of human fetal risk, but benefits may justify use in serious situations
• Category X: Proven fetal risk. Never use during pregnancy.

For acne treatments, the range spans from B (generally safe) to X (absolutely not).

What you CANNOT use during pregnancy

Isotretinoin (Accutane) -- Category X. This is the big one. Isotretinoin causes birth defects. Not "might cause" or "has been linked to" -- it causes them. Neural tube defects, heart defects, facial abnormalities. The risk is high enough that the iPLEDGE program requires two forms of contraception and monthly pregnancy tests for anyone taking it [2].

If you are on isotretinoin and become pregnant, stop taking it immediately and contact your prescriber. This is urgent. The risk is highest during the first trimester, but it applies throughout pregnancy [2].

Prescription topical retinoids (tretinoin, adapalene, tazarotene) -- Category X. The evidence for topical retinoids is less clear-cut than for isotretinoin because systemic absorption from topical application is low. But dermatologists and OB-GYNs still recommend avoiding them during pregnancy because the potential consequences are severe and alternatives exist [6]. Why take any risk when safer options are available?

If you were using Differin (adapalene) or tretinoin for acne before getting pregnant, stop. You can resume after pregnancy (and after breastfeeding, if you're breastfeeding).

High-dose salicylic acid. Oral salicylates (aspirin) in high doses are problematic during pregnancy. Topical salicylic acid in low concentrations (under 2%) applied to a small area is probably fine, but many dermatologists recommend avoiding it to be cautious, especially in higher concentrations like chemical peels [1, 4]. The concern is that systemic absorption could affect the fetus.

Low-concentration salicylic acid in a face wash (where it's on your skin briefly and then rinsed off) is generally considered low-risk. But ask your OB-GYN.

Certain oral antibiotics. Tetracycline, doxycycline, and minocycline are not safe during pregnancy. They can cause permanent tooth discoloration in the baby and may affect bone development [1, 7]. If you were on oral antibiotics for acne, you'll need to stop.

Hormonal treatments. Spironolactone and anti-androgen medications are contraindicated during pregnancy because they can interfere with fetal development, particularly in male fetuses [4].

What IS safe during pregnancy

Good news: you have options.

Azelaic acid -- Category B. This is probably the best acne treatment available during pregnancy. It's an anti-inflammatory, antibacterial, and mildly exfoliating ingredient that's been widely studied and used in pregnant patients [1, 4, 5]. It comes in prescription strengths (15-20%) and over-the-counter formulations (usually 10%).

Azelaic acid works well for both inflammatory acne and post-inflammatory hyperpigmentation. It's not as aggressive as retinoids, but it's effective and it's safe. If I could recommend only one active ingredient for pregnancy acne, this would be it.

Benzoyl peroxide (low concentration) -- generally considered safe. Most dermatologists are comfortable with 2.5-5% benzoyl peroxide during pregnancy [1, 5]. Only about 5% of topically applied BP is absorbed through the skin, and it's quickly metabolized. No studies have shown fetal harm from topical benzoyl peroxide.

That said, use the lowest effective concentration. You don't need 10% BP. Lower concentrations (2.5%) are almost as effective against P. acnes bacteria with less irritation.

Glycolic acid (low concentration). Glycolic acid is an alpha hydroxy acid that exfoliates and helps with clogged pores. In the concentrations used in skincare products (5-10%), systemic absorption is minimal. Most dermatologists consider it safe during pregnancy [8].

Avoid professional glycolic peels during pregnancy. Stick to over-the-counter concentrations.

Niacinamide (vitamin B3). Niacinamide is anti-inflammatory, helps with oil control, and is considered safe during pregnancy. It's found in many moisturizers and serums. No known risks at the concentrations used in skincare products.

Erythromycin (topical or oral). If your acne is severe enough to need an antibiotic, erythromycin is one of the safest options during pregnancy. It's available as a topical gel or oral medication. Your OB-GYN can prescribe it [1, 7].

The safest pregnancy acne routine

Here's a straightforward routine using only pregnancy-safe ingredients:

Morning:

1. Gentle cleanser (CeraVe, Cetaphil, or Vanicream -- all are safe and fragrance-free)
2. Azelaic acid (10% over-the-counter, or prescription strength if your doctor prescribes it)
3. Moisturizer (something simple and fragrance-free)
4. Sunscreen (mineral sunscreen with zinc oxide or titanium dioxide is preferred during pregnancy over chemical sunscreens)

Evening:

1. Same gentle cleanser
2. Benzoyl peroxide 2.5% on active breakouts (spot treatment, not all-over)
3. Moisturizer

That's it. It's simple. It won't clear severe cystic acne on its own, but it will manage most mild-to-moderate pregnancy breakouts without putting anything questionable on your skin.

A few things people don't talk about

Pregnancy skin is sensitive. Even if you used strong actives before pregnancy without any irritation, your skin may react differently now. Pregnancy increases blood flow to the skin and changes your immune response, making irritation more likely [3].

Start any new product slowly. Even "safe" ingredients can irritate sensitive pregnancy skin. Introduce one thing at a time and give it a week before adding something else.

Also, pregnancy acne often improves on its own during the second trimester as hormone levels stabilize. Not always, but often enough that patience is a legitimate strategy. If your acne appeared early in the first trimester, it may settle down without you doing much about it.

And hormonal pregnancy acne sometimes gets worse postpartum before it gets better, especially if you're breastfeeding. Keep that in mind so you're not blindsided by it.

When to see your OB-GYN vs. a dermatologist

Your OB-GYN should know about every product you're putting on your skin, including over-the-counter skincare. Bring your products to your next appointment if you're unsure about any of them.

For mild acne, your OB-GYN can usually guide you. For moderate-to-severe acne, ask for a referral to a dermatologist who has experience treating pregnant patients. They exist and they're good at navigating the limited toolkit.

Don't try to self-treat severe pregnancy acne by Googling "natural acne remedies" and buying random supplements. Many herbal supplements are not tested for safety during pregnancy, and "natural" does not mean "safe for a developing fetus." Tea tree oil, for example, is probably fine topically in low concentrations, but high concentrations haven't been well-studied in pregnancy.

After pregnancy

Once you deliver (and finish breastfeeding, if applicable), you can gradually reintroduce the treatments you stopped. Retinoids, salicylic acid, and other previously-off-limits ingredients become options again.

Many women find that pregnancy permanently changes their skin. Sometimes acne improves after pregnancy. Sometimes it stays the same. Sometimes it gets worse. Hormones are unpredictable, and pregnancy is one of the biggest hormonal events your body will ever go through.

Whatever happens, you can deal with it when you get there. Right now, the priority is keeping yourself and your baby safe while managing your skin with the tools available.

Bottom line

Pregnancy limits your acne treatment options, but it doesn't eliminate them. Azelaic acid, low-concentration benzoyl peroxide, gentle cleansers, and basic moisturizers can manage most pregnancy acne safely. Retinoids are completely off the table. Salicylic acid is debatable but generally avoided. And everything -- including products you think of as harmless -- should be run by your OB-GYN.

Your skin matters and so does your comfort. But your baby's safety comes first, and the good news is that safe options do exist. Use them, be patient, and know that pregnancy acne is temporary even if it doesn't feel like it right now.

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Sources

1. Chien AL, et al. "Treatment of acne in pregnancy." Journal of the American Board of Family Medicine. 2016;29(2):254-262.
2. Lammer EJ, et al. "Retinoic acid embryopathy." New England Journal of Medicine. 1985;313(14):837-841.
3. Murase JE, et al. "Hormonal effect on acne during pregnancy." Archives of Dermatology. 2014;150(5):536-545.
4. Pugashetti R, Shinkai K. "Treatment of acne vulgaris in pregnant patients." Dermatologic Therapy. 2013;26(4):302-311.
5. American Academy of Dermatology. "Is any acne treatment safe to use during pregnancy?" 2024.
6. Koren G, et al. "Use of topical retinoids during pregnancy." Canadian Family Physician. 2011;57(2):e51-e53.
7. Tyler KH. "Dermatologic therapy in pregnancy." Clinical Obstetrics and Gynecology. 2015;58(1):112-118.
8. Bozzo P, et al. "Safety of skin care products during pregnancy." Canadian Family Physician. 2011;57(6):665-667.