Guide · Acne in pregnancy
Acne during pregnancy what is generally considered safe, what to avoid, and what can wait
Pregnancy can set off breakouts just when many usual acne treatments are off the table. Here is why acne flares, which treatments dermatology and obstetric sources generally consider acceptable or avoid, what changes while breastfeeding, and which facials and devices to postpone.
Quick answer
- Acne during pregnancy is common: surveys suggest up to 43% of pregnant women are affected, and it is often inflamed, can spread to the chest and back, and tends to be worst in the second and third trimesters. Changing hormones are thought to play a part, although the details are not well studied.
- Generally avoided in pregnancy: oral isotretinoin, a known cause of serious birth defects; topical retinoids such as tretinoin, adapalene and tazarotene; tetracycline antibiotics such as doxycycline and minocycline; hormonal treatments such as spironolactone; hydroquinone; and salicylic acid over large areas or as a peel. Many doctors also advise stopping retinol as a precaution.
- Generally considered acceptable, ideally on a doctor's advice: azelaic acid, benzoyl peroxide up to 5%, and topical clindamycin or erythromycin used with benzoyl peroxide. For more severe acne, a doctor may add an oral antibiotic considered suitable in pregnancy, such as erythromycin, azithromycin or cephalexin, chosen with the trimester in mind. Always confirm with your obstetrician first.
- Postpone elective peels, lasers, needling, energy devices and injectables until after pregnancy. SkinRev Lab asks about pregnancy and breastfeeding before any treatment so products can be checked, and it does not prescribe; Dr Sin Yong can assess acne at IN Eternity Clinic, Pacific Plaza, and prescribe options suited to pregnancy when appropriate, priced at consultation.
Why it happens
Why acne flares during pregnancy
Acne during pregnancy is common. Surveys suggest up to 43% of pregnant women have acne, and a 2023 review describes it as typically inflamed, often spreading to the chest and back, and most severe in the second and third trimesters. Shifting hormones and other changes of pregnancy are thought to drive it, although the exact mechanisms have not been well studied.
The same review lists possible risk factors for more severe acne in pregnancy, including being 25 or younger, a first pregnancy, irregular periods before pregnancy and polycystic ovary syndrome, while noting that these links are not well established. Some women break out for the first time; others with long-standing acne find it changes in either direction.
Not every pregnancy breakout is acne. Itchy, same-sized bumps on the chest or back may be folliculitis, and small red bumps around the mouth may be perioral dermatitis. Both are treated differently, so let a doctor look before you start anything new.
At a glance
Acne treatments in pregnancy: generally used, used with care, avoided
This summary reflects a review from Singapore's National Skin Centre and a 2023 dermatology review. Recommendations differ slightly between sources, and your obstetrician and doctor will tailor them to your trimester and history.
Do not stop or start a prescription medicine on your own; if you find out you are pregnant while using one, contact your doctor.
| Treatment (generic name) | In pregnancy | Notes |
|---|---|---|
| Azelaic acid cream or gel | Generally considered acceptable | Only about 4 to 8% is absorbed through the skin; also helps dark marks |
| Benzoyl peroxide, up to 5% | Generally considered acceptable | Very little is absorbed; can bleach towels and pillowcases |
| Topical clindamycin or erythromycin | Generally considered acceptable on a doctor's advice | Used with benzoyl peroxide to limit antibiotic resistance |
| Salicylic acid | Low-strength products on small areas generally considered fine | Avoid large areas, long periods, covering it, and salicylic acid peels |
| Glycolic or lactic acid skincare | Generally considered fine | Very little is absorbed |
| Topical retinoids: tretinoin, adapalene, tazarotene | Avoided | Tazarotene is contraindicated; many doctors also stop retinol and retinal |
| Oral isotretinoin | Contraindicated | Causes serious birth defects; stopped at least a month before trying to conceive |
| Oral tetracyclines: doxycycline, minocycline | Avoided | After about 15 weeks, risk of permanent tooth discolouration and effects on bone growth |
| Spironolactone and other hormonal treatment | Avoided | Stopped at least a month before trying to conceive |
| Hydroquinone | Usually avoided | Relatively high absorption through the skin |
The firm no's
Isotretinoin, retinoids and tetracyclines: why they are avoided
Oral isotretinoin, used for severe or scarring acne, is a known cause of serious birth defects. Among 154 pregnancies exposed to it in a 1985 study, 21 babies were born with major malformations affecting the ears, face, heart, thymus and brain, and the risk of that group of defects was about 25 times higher than expected. That is why it is never used in pregnancy and comes with strict pregnancy prevention. If you become pregnant while taking it, stop and contact your doctor straight away.
Topical retinoids such as tretinoin and adapalene are absorbed in far smaller amounts. A meta-analysis of 654 pregnancies exposed to them in the first trimester, compared with 1,375 unexposed pregnancies, found no significant increase in major birth defects or miscarriage. That is reassuring if you used one before you knew you were pregnant, but the authors said it does not justify using them in pregnancy, and most experts advise avoiding all topical retinoids.
Tetracycline antibiotics such as doxycycline and minocycline are generally avoided, because from about the 15th week they can cause permanent discolouration of the baby's teeth and affect bone growth. Hormonal treatments such as spironolactone are also avoided.
What can be used
What doctors generally use for acne during pregnancy
A review from Singapore's National Skin Centre recommends topical treatment as the first line for acne in pregnant and breastfeeding women, including azelaic acid, benzoyl peroxide, salicylic acid and topical antibiotics such as clindamycin and erythromycin. A 2023 review takes the same stepwise approach: creams and gels for mild to moderate acne, with oral treatment added only for moderate to severe acne.
Azelaic acid and benzoyl peroxide work about equally well, and azelaic acid may be preferred if benzoyl peroxide irritates or dark marks are a problem. Topical antibiotics are paired with benzoyl peroxide to limit resistance. For more severe acne, a doctor may prescribe an oral antibiotic considered suitable in pregnancy, such as erythromycin (not the estolate form), azithromycin or cephalexin, chosen with the trimester in mind; the Singapore review also lists blue or red light therapy as an option.
For a single painful cyst, the 2023 review considered a small triamcinolone injection unlikely to raise the risk to the baby, but advice is limited and varies, so it is decided case by case. An obstetrics review notes that most skin conditions in pregnancy can be managed with topical treatment, with a dermatologist involved for moderate to severe disease or anything that needs tablets.
Your routine
A pregnancy-friendly skincare routine for breakouts
Simple is usually enough for mild acne in pregnancy. If spots are deep or painful, or are leaving marks or dents, see a doctor rather than layering on more products.
Singapore's heat and humidity add sweat and friction, so light textures and loose, breathable clothing over the chest and back also help.
- Cleanse gently twice a day; a benzoyl peroxide or low-strength salicylic acid wash, rinsed off, is generally considered fine.
- Use a light, non-comedogenic moisturiser; heavy creams can block pores in humid weather.
- Apply broad-spectrum sunscreen every morning: melasma often starts in pregnancy, and sun deepens it.
- Check labels for retinol, retinal, adapalene, tretinoin and hydroquinone, and set those products aside.
- Skip home peels and high-strength acid pads; keep acids to low-strength products on small areas.
- Do not pick or squeeze; it deepens marks and raises the risk of scars.
- Bring your products to your obstetrician or doctor if you are unsure about any of them.
Breastfeeding
Acne treatment while breastfeeding
Most topical acne treatments used in pregnancy can continue while breastfeeding. Azelaic acid, benzoyl peroxide and topical clindamycin or erythromycin are generally considered acceptable, but keep antibiotic creams and gels off the breast and nipple area and anywhere your baby's skin touches.
Sources differ on topical retinoids. A 2023 review considers them acceptable while breastfeeding, because only trace amounts reach breast milk, as long as they are kept off the breasts and skin that touches the baby; the Singapore review advised avoiding them in breastfeeding as well as pregnancy. Isotretinoin is not recommended while breastfeeding. If you need an oral treatment, your doctor will choose one that suits breastfeeding.
Some procedures paused in pregnancy, such as injectable skin boosters and microneedling, are still usually postponed while breastfeeding. Tell any clinic or centre that you are breastfeeding before a treatment.
Facials and devices
Which facials and devices to postpone during pregnancy
Evidence on cosmetic procedures in pregnancy is limited and comes mostly from case reports. A 2017 review considered light glycolic and lactic acid peels acceptable, but advised avoiding, or using great caution with, trichloroacetic acid (TCA) and salicylic acid peels, and limiting hair removal to waxing, shaving and creams rather than permanent methods.
Because acne and scar treatments are elective, the conservative course is to keep to gentle facials during pregnancy and leave stronger treatments until afterwards. SkinRev Lab asks about pregnancy and breastfeeding before any treatment so products and suitability can be checked, and some actives are avoided; it does not perform lasers or injections.
| Treatment | During pregnancy | Why |
|---|---|---|
| Gentle cleansing or hydrating facial | Usually possible; tell the therapist you are pregnant | Products can be checked and certain actives left out |
| Gentle extraction of blackheads and whiteheads | Usually possible | Inflamed or painful lumps are not extracted |
| Light glycolic or lactic acid peel | Check with your obstetrician first | Considered acceptable in reviews, but elective |
| TCA, salicylic acid or deeper peels | Postpone | Avoided or used with great caution in pregnancy |
| Lasers, IPL, microneedling and RF microneedling | Postpone | Elective, with limited safety data in pregnancy |
| Ultrasound, radiofrequency or microplasma lifting and tightening, body contouring and muscle stimulation | Postpone | Elective; pregnancy is a standard reason to wait |
| Wrinkle-relaxing injections, fillers and skin boosters | Postpone | Not advised in pregnancy or breastfeeding |
| Waxing | Usually possible; tell the therapist first | Permanent hair removal such as laser waits until after pregnancy |
| Lip blush and other cosmetic tattooing | Postpone | Wait until after pregnancy and breastfeeding |
When to see a doctor
When to see your obstetrician or a doctor about pregnancy acne
Always confirm acne treatment with your obstetrician, and tell any doctor treating your skin that you are pregnant or breastfeeding. Your obstetrician knows your pregnancy; a dermatologist or a doctor experienced with acne knows the treatments. Bringing the two together is the safer way to plan treatment.
See a doctor promptly if any of the following apply.
- Deep, painful lumps or cysts, or acne that is leaving dents or dark marks
- Acne on the chest and back that keeps spreading
- No improvement after six to eight weeks of gentle, pregnancy-appropriate care
- Sudden, severe acne, or acne with other new symptoms
- Itchy bumps, a rash around the mouth, or anything that does not look like your usual acne
- Acne that is affecting your mood or sleep
- Any cream or medicine from before pregnancy that you are unsure about
After the baby
After pregnancy: marks, scars and returning to treatments
Once pregnancy and breastfeeding allow, and your doctor agrees, the options widen again. Dark marks left by pregnancy breakouts often fade with sunscreen and time, and melasma that started in pregnancy may lighten over the following months; marks that persist and any pitted scars can then be assessed for treatment.
If you plan to restart isotretinoin or a hormonal treatment later, talk to your doctor about contraception and timing first. For body changes after pregnancy, see the post-pregnancy recovery guide.
In our network
Pregnancy acne care in our network
At IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, beside Orchard MRT, Dr Sin Yong grades acne, rules out look-alikes and, after a consultation and when appropriate, prescribes treatment chosen for pregnancy or breastfeeding, alongside your obstetrician's advice. Scar and mark procedures are left until after pregnancy. Treatment is priced at consultation by the clinic; WhatsApp +65 8815 3008.
SkinRev Lab, at CityLink Mall #B1-28, linked underground to City Hall and Esplanade MRT, does not prescribe or inject. Before any facial or treatment, the team asks whether you are pregnant or breastfeeding and checks products, and some actives are avoided; device treatments are better left until after pregnancy. WhatsApp +65 8266 9585.
Sources
References & sources
- Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013;73(8):779-787.
- Ly S, Kamal K, Manjaly P, Barbieri JS, Mostaghimi A. Treatment of acne vulgaris during pregnancy and lactation: a narrative review. Dermatol Ther (Heidelb). 2023;13(1):115-130.
- Lammer EJ, Chen DT, Hoar RM, et al. Retinoic acid embryopathy. N Engl J Med. 1985;313(14):837-841.
- Kaplan YC, Ozsarfati J, Etwel F, Nickel C, Nulman I, Koren G. Pregnancy outcomes following first-trimester exposure to topical retinoids: a systematic review and meta-analysis. Br J Dermatol. 2015;173(5):1132-1141.
- Bozzo P, Chua-Gocheco A, Einarson A. Safety of skin care products during pregnancy. Can Fam Physician. 2011;57(6):665-667.
- Trivedi MK, Kroumpouzos G, Murase JE. A review of the safety of cosmetic procedures during pregnancy and lactation. Int J Womens Dermatol. 2017;3(1):6-10.
- Tyler KH. Dermatologic therapy in pregnancy. Clin Obstet Gynecol. 2015;58(1):112-118.
Common questions
Your questions,
answered
Is it normal to get acne during pregnancy?
Yes. Surveys suggest up to 43% of pregnant women get acne, often inflamed and sometimes on the chest and back, and it tends to be worst in the second and third trimesters. See a doctor if it is deep, painful or leaving marks or scars.
What acne treatment is safe during pregnancy?
Azelaic acid, benzoyl peroxide up to 5%, and topical clindamycin or erythromycin used with benzoyl peroxide are generally considered acceptable. Isotretinoin, topical retinoids, tetracyclines, hormonal treatments and hydroquinone are avoided. Confirm any treatment with your obstetrician.
Can I use salicylic acid while pregnant?
Low-strength salicylic acid washes or spot products on small areas are generally considered fine, because very little is absorbed. Avoid applying it over large areas for long periods, under a covering, or as a salicylic acid peel.
Is benzoyl peroxide safe during pregnancy?
It is widely considered acceptable at up to 5%, because very little is absorbed and it is cleared quickly. It can bleach towels and pillowcases and may dry the skin, so a wash or a short-contact routine is a gentle way to start.
I used tretinoin or retinol before I knew I was pregnant. What now?
Stop it and tell your obstetrician. A meta-analysis of 654 pregnancies exposed to topical retinoids in the first trimester found no significant increase in birth defects or miscarriage, which is reassuring, though not a reason to keep using them. Oral isotretinoin is different and needs urgent advice.
Can I get a facial while pregnant?
A gentle cleansing or hydrating facial is usually possible once you have told the therapist you are pregnant, so products can be checked. Postpone strong peels, lasers, microneedling, energy devices and injectables until after pregnancy, and check with your obstetrician if unsure.
Does pregnancy acne mean I am having a girl?
No. One review lists carrying a female baby among possible risk factors for more severe acne in pregnancy, but the link is not well established, and acne cannot predict a baby's sex.
What acne treatment can I use while breastfeeding?
Azelaic acid, benzoyl peroxide and topical clindamycin or erythromycin are generally considered acceptable; keep them off the breast and nipple area. Sources differ on topical retinoids, and isotretinoin is not recommended. Ask your doctor before any oral treatment.
When does pregnancy acne go away?
There is no fixed timeline, and research on what happens after delivery is limited. Rather than waiting, keep treating it with options suited to pregnancy or breastfeeding, especially if it is leaving marks, and ask a doctor to step up treatment when pregnancy and breastfeeding allow.