A Dermatologist on What You Can (and Can't) Use on Your Skin While Pregnant

Updated 04/20/19
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When you get pregnant, all of a sudden your body isn't just yours anymore. It's certainly a strange feeling, but it's an incredibly exciting one too. There are so many changes that occur—from your body shape to your emotional state—but the one area most of us don't expect to change all that much is our skin, especially on our faces. This is something I quickly realized during my own pregnancy. After the first trimester, I noticed large dark spots on my face, mostly on the forehead, cheeks and upper lip.

And it wasn't cute like freckles—it was patchy and irregular. 

After a visit to my dermal therapist, I soon learned about melasma, aka the "mask of pregnancy." Unfortunately, hormones tend to trigger melasma in the skin, and while there are lasers and creams you can use to treat it, most of them can't be done or used while pregnant. So to find out exactly which lotions and potions can be safely applied to the skin during those nine months, I asked David Lortscher, MD, CEO at Curology. Ahead, he shares some insight on the two most common skin conditions women suffer during pregnancy, along with the creams you can use to treat it.

Pregnancy Skin
Cheetah Is the New Black

Melasma

As I mentioned earlier, melasma is a common skin problem in which brown facial pigmentation pops up. Lortscher says this has been reported in up to 70% of pregnant women. Why? "It's thought to be due to elevated estrogen, progesterone, and melanocyte-stimulating hormone levels during pregnancy," he said. The good news? "Melasma typically improves or resolves after delivery," he adds.

How to treat it: Lortscher says niacinamide and vitamin C may help, but sun protection is the most important factor in minimizing melasma—and it costs as little as $5.

Acne

While many attribute acne as a teenage skin concern, more and more people are reporting suffering from adult acne. These chronic breakouts can also occur during pregnancy. While acne often improves during pregnancy, Lortscher says it can occasionally be aggravated, especially in the third trimester. "In some women, acne develops for the first time during pregnancy," he notes. I know firsthand because my mom developed acne in her 30s after her third baby (she'd barely had a pimple before then). 

As any topically applied product may be absorbed into the body in small amounts, Lortscher notes that it's especially important to consider the effects said treatments might have on the developing fetus. So as a general rule, he advises pregnant women minimize the use of any topical medication to only the problem areas of your face. "Skip days when possible, just to minimize overall exposure to any medications at all," he advises. Of course, all products you are using should be reviewed with your obstetrician once you become pregnant.

How to treat it: For acne treatment during pregnancy, you may use over-the-counter skincare products derived from sugarcane, such as glycolic, lactic, and alpha-hydroxy acid-based products and peels. Although the common OTC acne ingredients (namely benzoyl peroxide and salicylic acid) have been rated in the pregnancy category by the FDA as "risk cannot be ruled out," Lortscher says the low concentrations used in most skincare products are generally considered safe.

"Most dermatologists believe OTC cleansers that contain benzoyl peroxide are acceptable for use during pregnancy," he said. "Small amounts applied to the skin—such as a toner or wash with no more than 2% salicylic acid used once or twice a day—are considered likely safe, but there may be more of a concern when salicylic acid is used in higher concentrations, such as in peels, and/or is used over large areas of the body."

What You Can Use

Niacinamide

A form of vitamin B3, Lortscher says this can help acne. "It's anti-inflammatory, the skin reacts very minimally to it, and side effects such as irritation are unusual," he advised. "Niacinamide has not been formally assigned to a pregnancy category by the FDA. Only a small amount of topically applied niacinamide is absorbed, so it is considered safe during pregnancy."

Azelaic Acid

Available by prescription as Azelex 20% cream, Finacea 15% gel, and in certain Curology medications, azelaic acid is an effective topical treatment for acne, rosacea, melasma, and post-inflammatory hyperpigmentation. "Azelaic acid has been assigned to pregnancy category B by the FDA; in patients who need acne treatment, this may be used in the second and third trimester with obstetrician approval," he said.

What You Can't Use

If there's one magical cream every woman should use, regardless of age, it's retinol. "Every non-pregnant person should use sunblock and sun protection during the day and apply retinol or retinoids at night," board-certified dermatologist Sandy Johnson, MD, told Man Repeller. It really is the best cream combination to prevent skin cancer and aging changes to the skin, but here's the catch: As Johnson alludes to, it's something you can't use during pregnancy.

Here's why.

"Retinoids are vitamin-A derivatives and include prescription topicals such as tretinoin (Retin-A), adapalene (Differin, Epiduo), and tazarotene (Tazorac, Avage)," Lortscher explained. "Vitamin-A derivatives, both topical and oral, have the same theoretical risk as oral vitamin A, which in high doses can be toxic to the developing fetus if a woman becomes pregnant while taking it. Topical retinoids carry warnings stating that it is not known if these medications can adversely affect a developing fetus or child that is being breastfed, and thus should be avoided in patients who may be pregnant or breastfeeding."

"It's generally accepted that there is no clear published evidence of side effects other than dryness and irritation to the skin, and that there is no known risk of birth defects from topically applied tretinoin," he continues. "However, we still do advise patients to stop retinoids if they are trying to become pregnant, during pregnancy, and for the duration of breastfeeding."

What has been your main skin concern during pregnancy? 

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