The aim of this leaflet

This leaflet has been written to help you understand more about acne in pregnancy. It will tell you what acne is, what causes it, what can be done about it, and where you can find out more about it.

What is acne?

Acne is a disease of the hairfollicle and its gland (pilosebaceous) unit. It usually starts in puberty and  is affected by your hormones, arising in areas rich in sebaceous glands like the face upper back and chest, but it may occur in other places too. You will see black heads (comedones) and pimply bumps (papules and pustules) that tend to flare up. 
Acne may also occur during pregnancy; however the course of pregnancy will not be altered by acne and the baby will not be affected by it.

What causes acne?

Several factors influence acne. Acne or pimples is primarily a result of increased hormone production in your (pregnant) body. Hormones cause glands in your skin to enlarge and boost the production of grease (sebum). Together with dead skin cells, your pores become blocked and certain bacteria (Propionbacterium acnes) increase in number and will lead to an infection (pustule). Acne can vary in severity for each woman and may just be an early pregnancy thing, or may persist throughout your pregnancy. 
Acne during pregnancy is very unpredictable – some women who have battled acne before becoming pregnant may find that their acne improves, and others who have never had acne find that they have the most problems. 

Is acne hereditary?

There appears to be a hereditary tendency (genetic) for acne. This means  children of patients with (severe) acne are likely to get acne as well.   

What are the symptoms of acne?

You don’t usually experience itching or pain unless large nodules and abscesses are present, they may be painful. However, because of the involvement of the face, acne may cause psychosocial problems. The good news is, it usually resolves by itself after puberty or in your case, after pregnancy. 

What does acne look like?

The single features vary individually, but usually  there are a certain number of closed comedones (whiteheads), open comedones (blackheads), papules and pustules, in more severe forms you see abscesses and cysts sometimes leading to scars.   

How is the diagnosis of acne made?

The clinical appearance and the circumstances are usually diagnostic, laboratory tests are not needed.  

Can acne be cured?

Yes, acne can be cured and also, its course is usually self-limited. A variety of treatment strategies can shorten the disease course, reduce the severity and minimize scarring.   

What can I do?

Mild forms of acne (a few black heads and/or a few pustules) usually don´t need special treatment. You may want to follow some general measures:

  • Don’t pick, scratch or pop acne. It may worsen scarring
    However, black heads may be removed carefully
  • Avoid clogging, oil-based make-up (opt for water based instead) and ensure you wash it off each day – or as soon as you no longer need to be ‘made-up’
  • In general, using emollients, make-up or sunscreens light, water-based cosmetics that can be easily washed off are recommended.
  • When washing your face (syndets, lotions and bars for oily skin), don’t scrub it or it may become more angry
  • Reduced intake of sugar, hyperglycaemic grains, milk and milk products but enriched consumption of vegetables and fish may help. 
How should acne be treated if necessary?

If medical treatment is necessary, topical therapy is preferred for the treatment of acne during pregnancy.  
Topical antibiotics, benzoyl peroxide and azelaic acid are considered safe in pregnancy.  
Topical retinoids / Vitamin A derivates (tretinoin, adapalene, tazarotene) must be avoided. However, if a topical product has been used by accident for a short period noharm to the unborn baby is unlikely. 
In severe cases, when oral therapy is necessary, erythromycin is considered safe in pregnancy with  the exception of early pregnancy. Tetracyclines are not safe and must not be used. 
Oral isotretinoin will cause abnormalities in the baby and must not be used during and 4 weeks before pregnancy!  
Moderate and severe forms of acne (more comedones, papules and/or pustules, nodules, abscesses and/or, cysts) need to be treated by a dermatologist. 

Safe for use in pregnancy:

  • topical erythromycin (solution, gel, cream), used twice daily on papules, pustules, abscesses
  • topical clindamycin (solution, emulsion) used twice daily on papules, pustules, abscesses
  • topical metronidazole (cream, gel)may be used twice daily on papules, pustules, abscesses
  • benzoyl peroxide (gel) is used once or twice daily on papules, pustules, abscesses, according to skin tolerance. Benzoyl peroxide may safely be used for acne treatment in pregnancy on a limited area (for example in the face)
  • azelaic acid (gel, cream) has antibacterial, antiinflammatory and keratolytic properties. It is also used for treatment of skin pigmentation, particularly in those with darker skin types. During pregnancy, azelaic acid should only be used on small skin areas, for example facial acne, and avoided in the first three months. 

Oral treatment for acne in pregnancy is reserved for severe forms. If necessary macrolide antibiotics, like erythromycin, may be taken orally; this needs to be discussed with your doctor in each individual case. 

Where can I find more information about acne?

Web links to detailed leaflets:  
Books, magazines:

  • Plewig, Kligman. Acne and Rosacea. Berlin-Heidelberg-New York: Springer-Verlag, 3rd Completely Revised and Enlarged Edition,  2000.
  • Burgdorf, Plewig, Wolff, Landthaler. Braun Falco´s Dermatology. Springer-Verlag, 3rd edition,  2009, 993-1002.
  • Zip C. A practical guide to dermatological drug use in pregnancy. Skin Therapy Letter. com 2006;11 (4).
  • Hale EK, Pomeranz KM et al. Dermatologic agents during pregnancy and lactation: An update and clinical review. Int J Dermatol 2002;41: 197-203.
  • Dawson AL, Dellavalle RP. Acne vulgaris BMJ 2013;346:f2634
  • Kraft J, Freiman A. Management of acne CMAJ 2011;183(7):E430-E435
  • Berra B, Rizzo AM. Glycemic index, glycemic load: new evidence for a link with acne. J Am Coll Nutr. 2009 Aug;28 Suppl:450S-454S.
  • A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial Am J Clin Nutr (2007) 86 (1): 107-115 

While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. Your own doctor will be able to advice in greater detail. 
This leaflet has been prepared by the EADV task force “skin disease in pregnancy”, it does not necessarily reflect the official opinion of the EADV 
July 2013