ACNE THERAPIES AND PREGNANCY
Denver, Colorado; March 21, 2014.
Topical acne medications
Because some medications pose a potential risk of birth defects if taken during pregnancy, the Food and Drug Administration (FDA) established five categories that rate the safety of medications.* In general, Dr. Keri recommends prescribing acne medications that fall into Category B, because they are considered safe medications for use during pregnancy and pose no known risks to the health of the fetus. She explained that there are no true FDA-approved Category A medications for acne.
When treating a pregnant patient with acne, Dr. Keri usually recommends starting with these topical medications:
- Over-the-counter acne medications and facial washes
- Glycolic acid (Category N, not rated)
- Topical antibiotics available by prescription (Category B)
- Azelaic acid
Of all the available topical acne medications, Dr. Keri prefers to prescribe topical azelaic acid to treat acne during pregnancy for its added benefit of improving pigmentary problems such as melasma (known as the “mask of pregnancy”) or blemishes.
Oral acne medications
In cases where patients are not responding to topical acne medications or if the acne appears to be worsening, an oral acne medication may be an option. Although oral medications are not the first line of treatment for women who develop acne while pregnant, Dr. Keri mentioned that three oral antibiotics — all rated Category B medications — are considered safe and effective:
In rare, severe acne cases, oral corticosteroids may be used to prevent scarring.
There are effective light-based therapies available to treat acne in pregnant patients that may not be responding to other acne treatments. These light-based therapies are not first-line therapies for treating acne, Dr. Keri noted that red and blue light phototherapy are safe and can be used in instances where topical prescription or over-the-counter medications are not working to clear acne. However, these light treatments are not covered by insurance and need to be administered by a dermatologist once a week.
DR. KERI’S TIPS FOR ACNE PRONE SKIN: BEFORE, DURING, AND AFTER PREGNANCY
- Try to get acne under control before trying to get pregnant. If a woman has acne before pregnancy and is taking an oral medication, her acne could get worse once she stops her current acne medication while pregnant.
- Women should try to maintain a healthy body weight pre-pregnancy. If a woman is overweight before getting pregnant, studies show there is an increased chance that a male child will reach puberty at an earlier age — thus having acne at an earlier age.
- Wash the skin with lukewarm water and mild cleansers or foams. Avoid cleansers that contain beads that scrub the skin; they are too inflammatory for skin that is already inflamed by acne.
- Use a broad-spectrum sunscreen (protects the skin from both UVA and UVB rays) with a Sun Protection Factor (SPF) of 30 or higher every day to protect the skin from pigmentary changes that can occur during pregnancy. Dr. Keri prefers the use of physical sun blockers, which contain zinc or titanium.
- If a woman chooses to breastfeed her baby, she must view medications categorized by the FDA the same way she would during pregnancy.
- Generally, if a medication is safe to use during pregnancy, it is safe to use during lactation.
- Pediatricians are the best resource for questions during lactation. Dr. Keri explained that pediatricians have lactation ratings for medications.
If pregnant women develop acne and are concerned about taking medications, Dr. Keri encourages women to discuss their treatment options with a board-certified dermatologist. Oftentimes, dermatologists and obstetricians can work together to manage a patient’s acne and ensure that all medications used fall into the safest drug categories as outlined by the FDA.
AMERICAN ACADEMY OF DERMATOLOGY EXPERT ADVICE
“Acne is not a condition that should be dismissed because a woman is pregnant because it’s important for women to feel good about themselves during pregnancy and particularly post-partum, when the ‘baby blues’ or post-partum depression could become an issue,” said Dr. Keri. “It’s really a personalized decision to seek treatment for acne while pregnant, and women should consult their dermatologist to understand the options available to them.”