29 Sep Pregnancy and Acne: Causes, Changes and Treatment Options

Pregnancy is often associated with that much-talked-about “pregnancy glow”.

But what if your skin has other ideas?

Pregnancy and acne are closely connected: hormonal changes can increase oiliness, congestion and breakouts, sometimes even when acne hasn’t been a problem for years. For some women, pregnancy brings clearer, calmer skin. For others, acne becomes a new or worsening issue.

If that sounds familiar, you’re certainly not alone.

Hormonal changes during pregnancy can have a significant effect on the way our skin behaves, and acne is one of the conditions that can flare during this time. It’s something I regularly help women manage during pregnancy and breastfeeding. 

The important thing is knowing how to treat your skin effectively while also making sure that anything you use is suitable during pregnancy. Below, you’ll find what can trigger pregnancy-related acne, when breakouts tend to show up, which ingredients and treatments are considered safe or best avoided during pregnancy and breastfeeding, how to build a suitable skincare routine, when to see a dermatologist, and what changes to expect after pregnancy.

Is Acne Common During Pregnancy?

Yes, acne during pregnancy is relatively common, and almost 50% of pregnant women experience acne.

Pregnancy causes enormous hormonal changes throughout the body, and the skin is very responsive to those changes.

Some women who have never really struggled with spots suddenly find themselves experiencing breakouts. Others may have had acne previously and notice that it becomes more active again. In some cases there are women whose acne actually improves.

Unfortunately, there is no way of predicting exactly how your skin will behave.

What I often tell my patients is that pregnancy doesn’t create one particular “type” of skin. It changes the hormonal environment around your skin, and your individual skin then responds in its own way.

Why Can Pregnancy Cause Acne?

To understand pregnancy and acne, it helps to know a little about how acne develops.

Acne begins within the skin’s sebaceous glands, the oil-producing glands in our skin.

When these oil glands produce more sebum, pores can become blocked. Changes within the follicle can then trap bacteria and lead to inflammation, resulting in blackheads, whiteheads and pimples.

Hormones have a major influence on these glands.

During pregnancy, levels of hormones such as progesterone and oestrogen change considerably. For skin that is particularly sensitive to hormonal fluctuations, this can mean increased oil production and more breakouts, often in the first and second trimesters, though the timing varies from person to person.

This is also why acne can change at other hormonal stages of life, including puberty, around the menstrual cycle, when starting or stopping contraception and during the menopause. Think of skin as a hormonal organ.

When Does Pregnancy Acne Start?

There is no exact timetable.

Some women begin noticing skin changes in early pregnancy, while others develop breakouts later. You may also find that your skin changes several times throughout the pregnancy.

Perhaps your skin feels oily and congested during one trimester, then becomes drier or more sensitive later on.

Acne begins within the skin’s sebaceous glands, and blocked pores can become inflamed when oil, dead skin, and trapped bacteria build up. Pimples can occur on the face, chest, neck, and back during pregnancy.

The most common time for this is the first trimester, though changes can continue beyond it. That’s why I prefer not to treat pregnancy skin according to a rigid formula.

Instead, look at what your skin is doing now.

Has it become oilier?

Are you developing small areas of congestion?

Are you experiencing deeper, more uncomfortable spots?

Has your skin suddenly become much more sensitive to products you previously tolerated?

Your skincare and treatment should respond to your skin, rather than simply following what worked before pregnancy.

Can Acne Get Worse During Pregnancy?

It certainly can, although this isn’t the case for everyone.

Pregnancy acne can start in early pregnancy, often in the first trimester, but the timing varies from one trimester to another. If you already have a tendency towards hormonal acne, pregnancy may trigger a flare, while somebody who had acne in their teenage years but has enjoyed clear skin for a long time might notice spots returning, and others develop breakouts later. 

It is often most pronounced during the third trimester, as shifting hormones can increase oil production. Some of those hormonal changes can also affect treatment choices, because what seems low-risk for your skin may still pose a risk to the fetus.

One of the challenges is that your usual acne treatment may no longer be suitable.

This is particularly important if you were using prescription medications before becoming pregnant, as some can cause birth defects and others should only be used if prescribed after you consult your doctor. Your doctor can help weigh the benefits of treatment against safety concerns.

If you are planning a pregnancy, or discover that you are pregnant while using acne medication, it is important to speak to your doctor or dermatologist about what you are using rather than simply continuing your existing routine.

How Should You Look After Acne-Prone Skin During Pregnancy?

My approach to pregnancy skincare is generally to keep things considered and straightforward.

This is not the time to panic and suddenly introduce six new active ingredients or swap between lots of new skincare products.

Pregnancy can make the skin more reactive, and aggressively treating spots can sometimes leave you with irritation on top of the acne you were trying to manage. Sweat and friction can also aggravate breakouts, so keep hair off the face where possible.

Start with the fundamentals:

• A gentle cleanser.
• A moisturiser suited to your skin.
• Daily sun protection.

Then, where needed, carefully chosen active ingredients can be added to target breakouts to help maintain healthy skin.

The goal is not to strip oil from the skin completely. Even acne-prone skin needs healthy skin and a healthy, intact skin barrier, and excessive cleansing or exfoliation can leave it more sensitive and inflamed.

Simple skincare is often much more effective than constantly changing products, and some acne medications need to be prescribed and reviewed with a doctor during pregnancy. 

Spironolactone is one oral medication that should not be used during pregnancy. If treatment is needed, the risks versus benefits should be weighed with your doctor, as some medications can pose a risk to the fetus.

Which Acne Treatments Can Be Used During Pregnancy?

This is where professional guidance becomes particularly useful.

Pregnancy changes which acne treatments we can safely consider. For example, benzoyl peroxide is one over-the-counter option that can be used during pregnancy according to NHS guidance. NICE also recommends it as an alternative where treatments such as topical retinoids or oral tetracycline antibiotics are unsuitable because of pregnancy. 

Topical azelaic acid is another ingredient that may be considered in pregnancy and can be particularly useful when we’re looking to manage both breakouts and some of the pigmentation they can leave behind. 

Because only small amounts are absorbed through the skin, some topical options are considered safe in pregnancy, though your clinician should still advise what fits your situation best.

 

Which Acne Treatments Should Be Avoided During Pregnancy?

This is particularly important.

Some very effective acne treatments that are commonly used outside pregnancy are not suitable while pregnant.

Topical retinoids such as tretinoin and adapalene should not be used during pregnancy. Oral tetracycline antibiotics are also contraindicated when pregnant or planning a pregnancy. 

Oral isotretinoin, sometimes known by the former brand name Roaccutane, must not be used during pregnancy because it can cause serious harm to an unborn baby and is linked to birth defects. Strict pregnancy prevention measures remain in place for people who can become pregnant while taking isotretinoin because the fetus is especially vulnerable. 

This is why I always recommend discussing acne medication with your healthcare professional when planning a pregnancy.

Don’t assume that something is suitable simply because it is applied to the skin rather than taken as a tablet. Only 5% of topical acne medication is absorbed into the body, but a doctor should still advise on the best option.

Topical azelaic acid is often used during pregnancy and can help clear pores and reduce dark spots. 

Glycolic acid is an over the counter option that is safe for gentle exfoliation and managing breakouts.

Low-strength benzoyl peroxide is also generally considered safe for treating pregnancy acne.

For more severe acne, some oral antibiotics may also be prescribed if your clinician feels they are appropriate.

What About Skincare Ingredients?

Pregnancy can suddenly make skincare feel rather complicated.

Google an ingredient and you can quickly find ten different opinions about whether you should be using it, especially with over-the-counter treatments and other skincare products.

My first piece of  advice is to try not to become overwhelmed.

The priority is to keep your routine simple and evidence-based. If you are uncertain about an active ingredient, particularly a stronger treatment product, ask your dermatologist, GP or pharmacist to advise you.

It is much easier to build a safe routine from a small number of effective products than to try to work out whether every bottle in an elaborate routine is suitable. Oral tetracycline antibiotics should be avoided because they can affect fetal bone and teeth development, and isotretinoin is not used in pregnancy because it can cause severe birth defects.

When Should You See a Dermatologist?

Mild pregnancy acne can often be managed with an appropriate skincare routine.

But you don’t have to simply accept more troublesome acne because you are pregnant.

I would consider seeking dermatological advice if:

• your breakouts are becoming persistent or increasingly inflamed
• you are developing deep or painful spots
• acne is beginning to leave scars or pigmentation
• you are unsure whether your existing acne products are safe

Pregnancy already brings enough change without feeling that you have lost control of your skin as well.

The aim is to find an approach that manages the acne while respecting the very specific treatment considerations that come with pregnancy. Before treating pregnancy acne, check over-the-counter skincare products carefully and consult a healthcare professional before using new medications. If you are unsure about a product, a dermatologist, GP, or pharmacist can advise.

What Happens to Acne After Pregnancy?

Just as skin can change dramatically during pregnancy, it may change again after your baby is born.

Hormone levels shift, sleep patterns change and breastfeeding can also influence which treatments are appropriate. Some women find that their acne settles relatively quickly within a few weeks. Others continue to experience breakouts after pregnancy. There is no single expected pattern.

This is why I think of hormonal skin as a journey rather than a one-off problem. Pregnancy, breastfeeding, contraception and eventually the menopause can all influence the skin at different points in life. Treating pregnancy acne may warrant specialist input if routine measures are not enough.

My Approach to Pregnancy and Acne

Pregnancy acne can be frustrating, particularly when many of the treatments you may have relied on previously are suddenly no longer appropriate.

But there are still options. For me, the starting point is always understanding your individual skin.

• What has changed?
• What type of acne are you experiencing?
• What can we safely use at this particular stage?

From there, we can create a skincare and treatment plan that is effective, manageable and appropriate throughout pregnancy and, where needed, into breastfeeding.

Your skin may behave differently during pregnancy, but that doesn’t mean you simply have to put up with it. With the right advice, we can continue to look after your skin safely throughout this period.

Your skin may behave differently during pregnancy, but that doesn’t mean you simply have to put up with it. With the right advice, we can continue to look after your skin safely throughout this period. If you would like personalised support with pregnancy acne, contact Dr Emma to arrange a consultation.