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Pregnancy Acne

Feb 17, 2022 | 2 minutes Read

Many women think their days of pimples are over, left behind in those challenging younger years. But unfortunately, breakouts and even acne are common during pregnancy. For some women the condition can become quite noticeable and even distressing.

It is estimated that around 50% of pregnant women will develop acne at some stage during their pregnancy. But not all women will find themselves stepping back in time to their adolescence. Some women actually report their skin is much clearer when they are pregnant and look as if they are almost glowing. This is generally due to the increase in circulating blood volume, giving a ruddy appearance to the face. It is also helped by the extra oil production which occurs in the skin during pregnancy.

What is acne?

Acne is the term for a skin condition which is characterized by an increase in oil (also known as sebum) production leading to the formation of blackheads and pimples. Ideally, the skin pores remain open and clear. But when acne is present, the excessive production of oil can block the pores, forming blackheads. A localized infection may develop. Bacteria, combined with sebum, create an infection and inflammatory response. This sequence of events is what leads to the characteristic red and inflamed skin and pustules so typical of acne.

Acne tends to appear primarily on the face but particularly in the T-zone which includes the forehead, the nose and, the chin. Some women also experience acne on their chest and back, or even across their shoulders.

Acne is more than just one or two pimples. It can include eruptions at various stages of evolution and resolution. At any given time, pimples may be forming and others healing, which can lead to a sense of feeling as if there is no end to the cycle of acne.

What causes pregnancy acne?

Excessive amounts of hormones are responsible for pregnancy acne. These play a direct role in the production of sebum. Changes in the amount of circulating blood sugar and the hormone insulin are also to blame for pregnancy acne.

All these factors have an effect on oil production instead of a regular secretion which has just enough oil to lubricate the skin and make it supple. If there is too much oil it clogs pores.

Some people still believe that acne is an indication of poor hygiene. Although sensible and regular cleansing can help to support an improvement in acne, it is not a cure-all for the condition. Many factors influence the likelihood of getting acne during pregnancy.

It can be helpful to know that in most cases, pregnancy acne is a result of high levels of hormones. These are necessary to stabilize pregnancy and support the baby's growth. They also help to direct nutrition to the placenta which is essential to ensure the baby's survival.

One of the male hormones, androgen, tends to be highest in the third trimester. It is this which can lead to a worsening of pregnancy acne as the pregnancy advances. This can also contribute to excess body hair growth and a thickened appearance to a pregnant mother's skin.

What can help pregnancy acne

  • Wash your face with a gentle, mild, fragrance free specific facial cleanser.

  • Use warm, not hot, water.

  • Consider using an oatmeal scrub to help unblock clogged pores. Make sure you aren’t too vigorous—during pregnancy the skin can become very sensitive and react to harsh treatment.

  • Rinse your skin very well and pat dry with a soft towel.

  • Replace your towel and washcloth several times each week.

  • You may want to use disposable soft cotton or fabric pads to cleanse your skin.

  • Ensure your towel is dry and does not stay wet in between uses.

  • Wash your face twice a day. Any more than this can lead to the skin drying out.

  • Use an oil-free moisturizer or facial serum. Avoid using too much product as excess may block the pores.

  • Avoid any sun exposure. Heat and sweat can aggravate acne.

  • Change your pillowcase at least twice a week.

  • If you have long hair and or bangs, pull your hair back so it's off your face.

  • Wash your hair regularly to remove oil build up.

  • Drink lots of water and avoid drinking too much tea or coffee. Two cups a day is generally acceptable.

  • Speak with your maternity care provider if you are concerned about your acne.

  • Wash your hands often, particularly if you tend to touch your face a lot.

  • Ensure you have a good, healthy diet. Limit your saturated fat intake, aim for at least five servings of vegetables and two serves of fruit each day, and include wholegrains.

Things that can aggravate pregnancy acne

  • Picking, squeezing, or scratching at pimples. This can lead to further infection and scars forming.

  • Chocolates and sweets do not cause acne. However, it makes sense to aim for a healthy diet the majority of time.

  • Covering the skin with makeup, foundation, or heavy concealers. Look for cosmetics which are oil-free, hypo allergenic or non-comedogenic.

What can I do to prevent getting acne during my pregnancy?

There is not much you can actively do, other than be sensible about your hygiene and skin cleansing routine. There is no need to be vigorous or go overboard when cleaning your skin. This will only lead to aggravation and may potentially increase the risk of introducing more bacteria into your skin.

If you are generally more prone to pimples or suffer from acne, then you may find that during pregnancy, this becomes worse.

What acne treatments are recommended?

If you are considering treating your acne it is very important that you speak with your maternity care provider and or your dermatologist. Some of the more common acne medications are contraindicated during pregnancy as they can lead to birth defects and complications. Even the topical ointments—those which are rubbed onto the skin rather than ingested—can be risky. They can still be absorbed into the mother's bloodstream and cross the placental barrier.

Some providers will prescribe topical creams and products which may contain low-dose antibiotics or a form of drying agent. However, there is still much to be done in terms of research and assessment when it comes to what is known and proven to be safe for use in pregnancy. It is safer, if possible, to avoid any medication or lotions.

Overwhelmingly, most health care practitioners are reluctant to prescribe acne medication in any form to a pregnant or lactating mother. The only time this is considered is if all factors have been weighed up and the mother is so distressed by her pregnancy acne that it assessed to be warranted.

Is my pregnancy acne permanent?

The short answer is no. In the vast majority of women, pregnancy acne resolves after the baby is born. This can take a couple of months, but most often there is a slow and steady improvement once the hormones return to their pre-pregnancy levels.

However, some women who are breastfeeding still experience more breakouts due to the presence of the lactation hormone prolactin. Once this level settles, the skin generally returns to normal.

Acne treatments during pregnancy

There are a range of medications which are classified as never to be used by pregnant women. These are considered potentially harmful to the developing baby. These can generally be classified into a few different categories:

  • Hormonal therapy

  • Tetracyclines

  • Topical Retinoids

  • Isotretinoin
All of these are considered potent and potentially teratogenic medications. Teratogenic means they are capable of disturbing the normal growth and development of an embryo and or fetus. Women who are prescribed these medications should not be pregnant and need to be on contraception. They are advised by the prescribing provider not to conceive.

If, however, you are taking acne medication and have conceived, it is important that you speak with your maternity care provider, your doctor and or a pharmacist immediately and they will advise you on what you need to do.

The information of this article has been reviewed by nursing experts of the Association of Women’s Health, Obstetric, & Neonatal Nurses (AWHONN). The content should not substitute medical advice from your personal healthcare provider. Please consult your healthcare provider for recommendations/diagnosis or treatment. For more advice from AWHONN nurses, visit Healthy Mom&Baby at health4mom.org.