This sheet is about exposure to over the counter (OTC) topical acne treatments in pregnancy and while breastfeeding. This information is based on published research studies. It should not take the place of medical care and advice from your healthcare providers.
What are over the counter (OTC) topical acne treatments?
Over-the-counter (OTC) treatments can be bought without a prescription. OTC topical acne treatments are products that are put directly on the skin to treat acne. They come in different forms, including creams, gels, lotions, and ointments. There are many different products with different brands and generic names. Common active ingredients include adapalene, azelaic acid, benzoyl peroxide, glycolic acid, and salicylic acid. Some products are stronger than others.
This fact sheet focuses on OTC acne treatments. Prescription acne treatments may contain higher strengths of the same active ingredients or different medications. MotherToBaby has fact sheets on many prescription acne treatments. If you have questions about a specific medication, contact a MotherToBaby specialist.
- Erythromycin: https://mothertobaby.org/fact-sheets/erythromycin/.
- Tetracycline: https://mothertobaby.org/fact-sheets/tetracycline-pregnancy/.
- Topical tretinoin: https://mothertobaby.org/fact-sheets/tretinoin-retin-a-pregnancy/.
Are topical treatments absorbed through the skin?
The skin acts as a barrier, so only a small amount of a topical acne treatment is usually absorbed into the bloodstream. More of the medication may be absorbed if the skin is broken or irritated, if the product is used often, or if it is applied over a large area of the body. The amount of medication that reaches the fetus is expected to be much lower than with medications taken by mouth.
Are there OTC topical acne treatments that may be used during pregnancy?
The American College of Obstetricians and Gynecologists (ACOG) has recommendations for treating acne during pregnancy. If you need treatment, talk with your healthcare provider about the options that are right for you. ACOG suggests that OTC topical products containing benzoyl peroxide, azelaic acid, salicylic acid, or glycolic acid may be used during pregnancy, if needed. Be sure to read product labels carefully, as OTC acne treatments may contain other active ingredients. If you have questions about a specific acne product, contact MotherToBaby or talk with your healthcare provider.
Are there any topical acne treatments that should be avoided during pregnancy?
It is generally recommended to avoid topical retinoid medications, such as tretinoin (Retin-A®) and adapalene, during pregnancy. This is because retinoids, when taken by mouth, are known to cause birth defects.
I use OTC topical acne treatment. Can it make it harder for me to get pregnant?
It is not known if the use of OTC topical acne treatments can make it harder to get pregnant.
Does using OTC topical acne treatments increase the chance of miscarriage?
Miscarriage is common and can occur in any pregnancy for many different reasons. The use of OTC topical acne treatments is not expected to increase the chance for miscarriage.
Does using OTC topical acne treatments increase the chance of birth defects?
Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like OTC topical acne treatments, might increase the chance of birth defects in pregnancy. OTC topical acne treatments have not been associated with an increased chance for birth defects.
Does using OTC topical acne treatments in pregnancy increase the chance of other pregnancy-related problems?
When used as directed, OTC topical acne treatments are not expected to increase the chance of other pregnancy-related problems, such as preterm delivery (birth before week 37 of pregnancy) or low birth weight (weighing less than 5 pounds, 8 ounces [2,500 grams] at birth).
Does using OTC topical acne treatments in pregnancy affect future behavior or learning for the child?
Studies have not been done to see if using OTC topical acne treatments can affect future learning or behavior after exposure in pregnancy.
Breastfeeding while using OTC topical acne treatments:
Most OTC topical acne treatments have not been well studied during breastfeeding. However, because only a small amount of these products is expected to be absorbed through the skin, the amount that passes into breast milk is likely to be low.
Do not apply topical acne treatments directly to the nipple or areola, where your baby can ingest the medication. If a product is applied to the breast or chest area, wash it off before breastfeeding. Wash your hands after applying the product to help prevent your baby from coming into contact with the medication.
If you have questions about a specific topical acne treatment while breastfeeding, talk with your healthcare provider or contact MotherToBaby. Be sure to talk to your healthcare provider about all your breastfeeding questions.
If a man uses OTC topical acne treatments, could it affect fertility or increase the chance of birth defects?
Studies have not been done to see if the use of OTC topical acne treatments could affect men’s fertility (ability to make healthy sperm) or increase the chance of birth defects. In general, exposures that fathers or sperm donors have are less likely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.
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