Treatment of Acne Vulgaris During Pregnancy and Lactation: A Narrative Review

Abstract

Acne vulgaris frequently affects women during pregnancy and lactation. Hormonal and physiologic changes in pregnancy contribute to the pathogenesis of acne during the various phases of pregnancy. Several effective acne treatments commonly prescribed in the general population are contraindicated during pregnancy or lactation. There is a lack of guidelines and updated resources on acne management in these populations. In this narrative review, we summarize existing evidence on the safety and efficacy of acne treatments during pregnancy and breastfeeding. Acne management in pregnancy and lactation should follow a stepwise approach based on severity to minimize risk. Topical therapies, such as benzoyl peroxide, azelaic acid, or keratolytics, can be used to treat mildto-moderate disease. Moderate-to-severe acne may require systemic treatments, including penicillin, amoxicillin, cephalexin, and erythromycin, with special consideration for trimester-specific teratogenicity of medications and relevant medical history of the mother and infant. For refractory cases, oral or intralesional corticosteroids as well as laser and light therapies may be considered. This review provides an updated reference to aid patient-physician decision-making on acne management in these special populations.

Guide to the management of acne in primary care

“…In patients who are pregnant, breastfeeding or considering pregnancy, topical benzoyl peroxide, azelaic acid and topical antibiotics are considered to be safe. 11…”

“…The agents most commonly prescribed include topical benzoyl peroxide, azelaic acid, antibiotics and retinoids. In patients who are pregnant, breastfeeding or considering pregnancy, topical benzoyl peroxide, azelaic acid and topical antibiotics are considered to be safe 11 …”

Acne and Pregnancy: A Clinical Review and Practice Pearls

“…25 Although the medication likely is safe, it is better to minimize its use during the third trimester to reduce the theoretical risk for hyperbilirubinemia in the neonate. 17,[26][27][28][29] Azelaic Acid-Azelaic acid effectively targets noninflammatory and inflammatory acne and generally is well tolerated, harboring a good safety profile. 30 Topical 20% azelaic acid has localized antibacterial and comedolytic effects and is safe for use during pregnancy.…”

Prescribing for pregnancy: chronic skin diseases

“…The evidence on the use of azelaic acid in pregnancy and in lactating patients is limited. The studies available suggest that it is safe 58 61. The systemic amount available following topical application is low and therefore is likely to be low risk 17.…”