There are many strange and exciting changes your body goes through when you get pregnant, and it's not unusual to see some of these changes occur on your skin. From sudden breakouts to melasma, aka the "mask of pregnancy," hormones tend to trigger new conditions in the skin, and while there are lasers and creams you can use to treat them, most of them can't be done or used while pregnant. If you didn't know already, your skin care while pregnant will likely look much different than it did before.
To find out which skincare ingredients are safe for pregnancy and what new skin changes women can expect to experience, we asked David Lortscher, MD, CEO at Curology.
You don't need to toss your favorite antioxidant serum—Lortscher says vitamin C can actually be effective in treating melasma.
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 advises. Because only a small amount of topically applied niacinamide is absorbed by the body, it's considered safe for pregnancy.
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.
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," Lortscher says.
Salicylic Acid and Benzoyl Peroxide Cleansers
Although the two most common OTC acne ingredients have been rated in the pregnancy category by the FDA as "risk cannot be ruled out," Lortscher says the low concentrations (2% or less) used in most cleansers and toners are generally considered safe.
Skincare to Avoid While Pregnant
Unfortunately, your favorite wrinkle and acne-busting cream is off-limits during pregnancy. "Retinoids are vitamin-A derivatives," Lortscher explains. "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." While there is is no known risk of birth defects from topically applied tretinoin, dermatologists still advise patients to stop all retinoids—including prescription topicals such as tretinoin (Retin-A), adapalene (Differin, Epiduo), and tazarotene (Tazorac, Avage)—if they are trying to become pregnant, during pregnancy, and while breastfeeding.
High Concentration Salicylic Acid Peels
While OTC cleansers and toners are generally safe for use during pregnancy (think a toner or wash with no more than 2% salicylic acid, used once or twice a day) Lortscher says 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.
How to Treat Melasma
Melasma is a common skin condition in which you experience brown facial pigmentation. Lortscher says this has been reported in up to 70% of pregnant women. "It's thought to be due to elevated estrogen, progesterone, and melanocyte-stimulating hormone levels during pregnancy," he says. But even without treatment (Lortscher advises vitamin C, niacinamide, and sun protection), the melasma won't last forever. "Melasma typically improves or resolves after delivery."
How to Treat Acne
Acne isn't just a teenage skin concern—many people suffer from adult acne, and these chronic breakouts can also occur during pregnancy. Though 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.
Because any topically applied product can be absorbed into the body in small amounts, Lortscher says that it's especially important to consider the effects these treatments might have on the developing fetus. As a general rule, he advises pregnant women to 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."
Of course, all products you are using should be reviewed with your obstetrician once you become pregnant.