This sheet is about exposure to topical acne treatment in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.
What are topical acne treatments?
Topical acne treatments are medications that are put directly on the skin in the form of a lotion, gel, cream, or ointment. There are many different topical acne treatments with different generic and brand names. Topical acne treatments can be over-the-counter or prescription. Common active ingredients in topical acne medications have been benzoyl peroxide, azelaic acid, glycolic acid, or salicylic acid. Prescription topical acne medications might include tretinoin, adapalene, dapsone, or antibiotics such as erythromycin or clindamycin. Products will vary in how strong the active ingredient is and how much of the medication is in the product. Prescription treatments usually have higher amounts of the active ingredients than over-the-counter products.
Are topical medications absorbed through the skin?
In general, the skin serves as a good barrier, so only a small amount of the acne medication is likely to be absorbed with topical exposure. The amount of the medication that can reach the developing baby by absorption through the skin is much lower than with medications taken by mouth. However, more of the active ingredients can be absorbed into the person’s blood stream if the skin is broken or irritated and when it is used over a large area of the skin. The more times the medication is applied on the skin, the more of it can be absorbed.
Are there topical acne medications that may be used during pregnancy?
The American College of Obstetricians and Gynecologists (ACOG) has recommendations, and you can discuss them with your healthcare providers. In general, they have suggested topical benzoyl peroxide, azelaic acid, topical salicylic acid, or glycolic acid for treatment of acne in pregnancy.
I use a topical acne treatment. Can it make it harder for me to get pregnant?
While not well studied, use of topical acne treatments is not expected to make it harder to get pregnant.
Does using topical acne treatments increase the chance for miscarriage?
Miscarriage can occur in any pregnancy. Based on the data available, the use of topical acne medications is not expected to increase the chance for miscarriage since only a small amount of the acne medication is expected to be absorbed with topical exposure.
Does using topical acne treatment increase the chance of birth defects?
Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. While not well studied, over-the-counter and prescription topical acne treatments have not been associated with an increased chance for birth defects. In many cases, only a small amount of the acne medication is likely to be absorbed with topical exposure, which means little medication gets into the blood stream so little could reach the developing baby. Because only small amounts applied on the skin are absorbed into the body, it is not likely to increase the change for birth defects or cause problems for the baby.
Salicylic acid is related to aspirin. When a person who is pregnant takes an adult dose (325 mg or higher) of aspirin (acetylsalicylic acid) by mouth, there may be risks to the pregnancy. Low dose aspirin (less than 81 mg/day) has been well studied in pregnancy and does not increase the chance of birth defects or other pregnancy complications. When applied on the skin, the amount of salicylic acid that enters the body would be much less than when a woman takes low dose aspirin. For this reason, it is unlikely that topical salicylic acid would pose any risk to a developing baby.
Are there any topical acne medications that should be avoided during pregnancy?
It has generally been recommended to avoid the use of topical retinoid medications, such as tretinoin (Retin A®) and adapalene. Retinoids, when taken by mouth, are known to cause birth defects. Studies have shown that only small amounts of tretinoin and adapalene are absorbed through the skin and that those who use topical tretinoin during pregnancy did not have an increased chance for birth defects. However, due to the theoretical concerns and the availability of other topical acne products, topical retinoid use is discouraged during pregnancy. Please refer to the MotherToBaby fact sheet on Tretinoin at https://mothertobaby.org/fact-sheets/tretinoin-retin-a-pregnancy/ and https://mothertobaby.org/fact-sheets/isotretinoin-accutane-pregnancy/.
Can I use topical antibacterial or antibiotic medications during pregnancy?
When used on the skin, only a small amount of erythromycin and clindamycin antibiotics are absorbed into the blood stream. This small amount is not thought to increase the chance for birth defects or other pregnancy problems. Studies have shown that only a small amount of antibacterial medication dapsone is absorbed through the skin. Studies looking at topical dapsone in pregnancy include only a very small number of exposed pregnancies; and better studied acne products might be preferred for use in a pregnancy.
What if my topical product contains a different active ingredient other than those discussed above?
There are many topical acne treatments available over-the-counter or by prescription, and some of them may contain other active ingredients that are not discussed in this fact sheet. If you have any questions about the active ingredients in your topical acne treatment, please contact MotherToBaby.
Does using topical acne medication during pregnancy cause other pregnancy complications?
When used as directed, topical acne medications are not likely to increase the chance for pregnancy complications, such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces (2500 grams) at birth)
Does using topical acne medications in pregnancy cause long-term problems in behavior or learning for the baby?
Studies have not been done to see if using topical acne medications can cause behavior or learning issues for the child.
Breastfeeding while using topical acne treatments?
Use of topical acne treatments have not been well studied in people who are breastfeeding. However, since most topical treatments are poorly absorbed by the skin, little, if any, of the medication is expected to pass into the breast milk. Make sure that the medication is not placed on the breast area or in any area that may come in contact with your baby’s skin before the medication has dried. Be sure to wash your hands well after applying the medication. Talk to your healthcare provider about all your breastfeeding questions.
If a male uses topical acne treatments, could it affect fertility (ability to get partner pregnant) or increase the chance of birth defects?
Studies have not been done to see if use of topical acne medication could affect male fertility or increase the chance of birth defects. In general, exposures that fathers or sperm donors have are unlikely to increase the 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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OTIS/MotherToBaby encourages inclusive and person-centered language. While our name still contains a reference to mothers, we are updating our resources with more inclusive terms. Use of the term mother or maternal refers to a person who is pregnant. Use of the term father or paternal refers to a person who contributes sperm.