Pregnancy is often an exciting time for first time moms, but it is also an anxious time as we constantly worry about all the things that may be harmful to our baby. Since being pregnant, I’ve had to change my skin care routine around. In this blog post, I hope to better inform you about what products you can safely on your skin and what products to avoid during pregnancy.
Treatment of many skin conditions becomes elective during pregnancy. The potential of causing harm to baby for treatment has led to a general reluctance among physicians to provide medications during pregnancy and lactation. We do not have any good studies looking at topical medication use during pregnancy since pregnant women are almost universally excluded from any studies. The FDA has developed a safety rating for drugs (ingested or applied) based on on human observations and/or animals studies. Products or medicines with pregnancy category A and B are deemed safe (Figure 1). But these categories often lack rigorous evidence-based studies, which lead to confusion, even among providers. Below are what I recommend to avoid and items that are safe to use.
Products to avoid during pregnancy
- Topical and Oral retinoids. Oral retinoids (isotretinoin) is a known teratogen causing cranial, cardiovascular, and central nervous system malformations. Although the concern for topical retinoids stem from few case reports and subsequent larger popular studies have refuted the association, it is still recommended that pregnant women should avoid all forms of topical retinoids because of the potential risk to the fetus.
- Oral antibiotics. The typical oral antibiotic prescribed for acne including doxycycline and minocycline are pregnancy category D due to damage to fetal teeth and bone. In general penicillin type antibiotics are considered safe during pregnancy, although it is recommended to avoid them unless necessary.
- Topical salicylic acid. This is a beta-hydroxy acid. Salicylic acid is chemically similar to aspirin- a known teratogen and can cause miscarriages. Since aspirin should be avoided during pregnancy, large amounts of topical salicylic acid should be as well. The cutaneous absorption is unknown, but limited use such as spot treatment for acne is probably safe.
Products that are safe during pregnancy
- Benzoyl peroxide. Although denoted pregnancy category C, benzoyl peroxide is metabolized by skin into benzoic acid, which is commonly found in wheat flour, among many other food items, to inhibit bacteria growth. I’ve used and still continue to use Neutrogena Acne Wash nightly as my nighttime cleanser
- Vitamin C serums. Most antioxidant serums, such as vitamin C and or E are usually safe. Make sure to carefully read the product label as some antioxidant serums may contain retinol. Since my topical retinoids are out the door, I’ve been supplementing my skin care regimen with more serums and moisturizers to prevent dryness and antiaging. You guys know I’m a big fan of the Skinceutical’s CE Ferulic serum, and I’ve continued this daily
- Topical prescription acne treatments: Azelaic acid, clindamycin, erythromycin. Unfortunately topical acne treatment during pregnancy is limited to these few prescription items (benzoyl peroxide is mostly OTC). These products are have limited efficacy and do not match up to topical retinoids. However, azelaci acid is great for rosacea patients, and helps to improve discoloration from acne.
- Alpha hydroxy acids. Although studies during pregnancy are limited, these acids have limited skin absorption and is deemed safe by most dermatologist. Glycolic and mandelic acids are two most common forms on the market. Chemical peels done at a derm’s office is also consider a great way to treat acne and discoloration during pregnancy. I have used Vivant skin mandelic 8%.
- Topical steroids. This is generally considered safe. Large scale studies have shown that general use is safe. However super potent topical steroid use during first trimester have been associated with cleft defects. Please see your dermatologist if you have any concerning rash so they can best advise you on the appropriate medicine to use.
- Critical fetal development occurs during the 5-10 weeks gestation, avoid all teratogen or questionable products unless necessary.
- Most topical skin care products (with exception of retinoids) can be resumed and are generally safe when used in limited quantities during the 2nd to 3rd trimester. But please discuss with your dermatologist if you have any concerns before use
- Wear sunscreen. Melasma is a common concern during pregnancy. Sunscreen is safe. For best protection, look for sunscreen containing zinc and iron oxide.
- Moisturize. Eczema is the most common rash seen during pregnancy. Most OTC moisturizers are safe, but I generally prefer mild, non-fragrance products such as Vanicream, Cetaphil, or Cerave. For those with extra flaky skin, can consider AHA containing products such as Eucerin or Amlactin.
- Mild acne can often be treated with topical products under the guidance of your dermatologist. For severe acne, options would include limited oral antibiotic use, in-office chemical peels, or intralesional kenalog injections.
In part two, I’ll be sharing my updated skin care routine, current favorites, and management to common skin concerns during pregnancy.