How to Clear Acne Breakouts During Pregnancy

People get acne during pregnancy because changes in hormone levels—most notably progesterone—cause skin oil production to increase. The increased production, in turn, causes the blockage of pores and the breakout of pimples, particularly during the first two trimesters of pregnancy.

Pregnancy acne is common, affecting over 40% of pregnant people. While acne breakouts are highly treatable, there are certain acne medications that can harm the unborn baby and should never be used.

This article explains the cause of pregnancy acne, what it looks like, and what you can (and cannot) do to treat breakouts.

What Causes Pregnancy Acne?

The cause of pregnancy acne is not well understood. It is thought to involve a combination of hormonal and physiological changes that occur during pregnancy as well as a predisposition for acne in general.

How Hormones and Acne Are Linked

Acne vulgaris (the most common form of acne) develops when hair follicles become blocked by dead skin cells, bacteria, and skin oils called sebum produced by the sebaceous glands. The risk of acne increases when sebaceous glands overproduce sebum.

The production of sebum is largely directed by androgens (male sex hormones) which increase production and estrogens (female sex hormones) which decrease production. If androgens are too high or estrogens are too low, acne can develop.

Progesterone, another female sex hormone, also influences sebum production. Although progesterone is essential to pregnancy, it has androgenic properties that not only stimulate sebum production but also cause hair follicles to narrow, making them vulnerable to blockage and acne.

This is why acne breakouts are common during the middle of the menstrual cycle when progesterone levels surge.

Acne and Pregnancy

During pregnancy, levels of estrogen, progesterone, and testosterone (the primary male sex hormone) all increase to support the pregnancy—and will continue to do so right into the third trimester.

During the early part of the first trimester, surging progesterone levels are thought to contribute to the sudden outbreak of acne in some people (in the same way they do during periods). The symptoms may gradually subside over time, only to flare again during the third trimester when testosterone levels are at their peak.

Not every pregnant person will experience acne breakouts. In fact, some people find that their existing acne will spontaneously clear as the surge of estrogen stabilizes sebum production. Others experience no changes at all.

What Does Pregnancy Acne Look Like?

Studies suggest that people who have had acne in the past are more likely to get it during pregnancy. And when it occurs, it tends to be more extensive and severe than they are normally used to.

The symptoms and characteristics of pregnancy acne can vary but often include:

• Acne breakouts involving the face, neck, chest, or back
• Raised lumps that may be reddish or flesh-colored
  
• Firm, deep lumps (nodular acne) along the jawline or chin
• Softer bumps (cystic acne) that may ooze pus
• Pain or sensitivity in breakouts when touched
  

How Is Pregnancy Acne Treated?

Acne can be treated while you are pregnant, but care must be taken when choosing treatments. Topical and oral drugs, both over-the-counter or prescription, may be used depending on the severity of the breakout. Specialist procedures may also be indicated.

Mild to moderate acne cases may be treated with topical drugs like:

• Benzoyl peroxide
• Azelaic acid
• Salicylic acid
• Zinc pyrithione
• Coal tar
• Topical antibiotics like clindamycin, metronidazole, and Aczone (dapsone)

Moderate to severe acne cases may require the addition of oral antibiotics like:

• Penicillin
• Erythromycin
• Amoxil (amoxicillin)
• Keflex (cephalexin)
• Clindamycin
• Tetracyclines
  

For refractory (treatment-resistant) cases, other therapies may be advised, including:

• Oral corticosteroids (steroids) like prednisone
• Intralesional steroid injections with cortisone
• Phototherapy (light therapy)
• Laser therapy
  

Home Remedies

While there is no evidence that home remedies can make acne go away, good hygiene and gentle skincare should be part of an acne treatment plan.

Here are some practices that may help:

• Wash your face twice daily with a gentle cleanser and lukewarm water. Avoid scrubbing.
• Use an oil-free moisturizer and oil-free cosmetics.
• Shampoo regularly, and try to keep your hair off your face.
• Avoid picking or popping pimples to avoid infection and/or scarring.

The role of diet in preventing acne is at best controversial and largely unproven. The same applies to apple cider vinegar, Milk of Magnesia (magnesium hydroxide), toothpaste, and other home remedies.

Prognosis

The good news is that acne associated with pregnancy typically goes away on its own once the baby is born and hormone levels return to normal.

Check with your OB/GYN before resuming any acne medications you normally used before pregnancy as some may not be recommended while nursing. Though no acne treatments are strictly contraindicated, Accutane and Aczone should be avoided due to the unknown risks they pose to breastfed infants.

Summary

Acne during pregnancy is common, caused by increasing levels of hormones that affect the production of skin oil (sebum). Progesterone is the hormone closely linked to this, particularly during the first and second trimesters, but testosterone may also play a role in later pregnancy.

Topical acne medications may be used for mild to moderate acne, while oral drugs and specialist procedures like laser therapy are reserved for more extreme cases. Some acne drugs pose serious risks to the unborn baby and should never be used, like acitretin, isotretinoin, spironolactone, tazarotene, and tretinoin.