Why does acne vulgaris flare or emerge during pregnancy?
Pregnancy changes hormone levels and many body systems, and the skin can show some of these changes [1, 2, 8]. Some pregnant women develop red or pus-filled acne spots on the face, chest, shoulders, or upper back, often during the first or third trimester. This can happen even without a history of teenage acne [1, 2, 8, 9]. Higher levels of androgens and other pregnancy hormones can make the oil glands produce more sebum [1, 2, 5]. When this oil mixes with dead skin cells, it can block a hair follicle and create conditions that support bacteria and inflammation [1, 2, 5, 8].
Normal immune changes during pregnancy may also affect how the skin reacts to inflammation [1, 2, 8]. Pregnancy hormones can increase pigment activity as well, making dark marks, facial melasma, or darkening of the neck more likely [1, 3, 4]. The important point is that acne appears at a time when medicines need extra care. Some ingredients can be absorbed and may reach the baby through the placenta, while others have little evidence in pregnancy [1, 3, 4]. For that reason, review every prescription, over-the-counter acne product, and active skincare ingredient with the obstetric and dermatology teams instead of starting or continuing it without advice [1, 2, 7].
Acne treatments to avoid during pregnancy
Some acne medicines are avoided during pregnancy because they have known or possible risks to the baby [1, 2, 3, 4, 7]. Oral isotretinoin is a powerful retinoid that can cause major birth defects affecting the brain, heart, face, and skull, as well as pregnancy loss [1, 3, 4, 5]. It must not be used during pregnancy, and anyone planning a pregnancy needs to follow the medicine's pregnancy-prevention and waiting-period instructions with the prescribing doctor [1, 3, 5]. Topical retinoids, including tretinoin, adapalene, and tazarotene, are also avoided during pregnancy. Absorption through the skin is low, but guidelines recommend avoiding them as a precaution [1, 2, 3, 4, 7].
Oral tetracycline antibiotics, such as doxycycline and minocycline, are also generally avoided in pregnancy because they can affect developing teeth and bones, with the risk depending partly on the stage and length of exposure [1, 2, 3, 7]. Spironolactone is not used for acne during pregnancy because its anti-androgen action may affect the development of a male fetus [1, 3, 5, 7]. If pregnancy is discovered while using a prescription acne medicine or a topical retinoid, stop the product and contact the obstetrician and prescribing clinician promptly. Share the product name, dose, and dates used so they can assess the exposure and advise on the next step [1, 2, 3].
Options a clinician may consider during pregnancy
Avoiding higher-risk medicines does not mean acne has to go untreated. A clinician can choose from options with more reassuring pregnancy safety information, based on the type and severity of the acne [1, 2, 3, 4, 7]. Topical azelaic acid is often considered because it can reduce inflammation and blocked follicles and may also help with dark marks or melasma [1, 2, 3, 4]. Benzoyl peroxide washes or low-strength leave-on products may also be considered in limited amounts. Skin absorption is low, and the absorbed amount is quickly changed into benzoic acid [1, 2, 3, 7].
For inflamed pus-filled spots, a clinician may consider topical clindamycin or erythromycin, usually with benzoyl peroxide to reduce the chance of antibiotic resistance [1, 2, 3, 7]. Low-strength glycolic acid is another option that may help clear blocked follicles [1, 2, 3]. If acne is severe, deep, and painful, the dermatologist and obstetrician may consider a short course of an oral antibiotic with a more established pregnancy record, such as cephalexin or an appropriate form of erythromycin [1, 2, 3, 7]. The right choice depends on the trimester, the amount of skin involved, other medicines, allergies, and the person's medical history, so the plan should be agreed with the obstetric and dermatology teams [1, 2, 4].
Gentle daily home skincare without irritating the skin barrier
A simple, gentle routine can support the skin barrier while pregnancy acne is being treated [1, 2, 5, 8]. Avoid rough scrubs, stiff loofahs, and squeezing or picking the spots [1, 8, 9]. Squeezing can push inflammation deeper, raise the risk of an abscess, and make dark marks or scars more likely. Pregnancy-related pigment changes can make these marks more noticeable, but it is not certain that every picked spot will leave a lasting mark [1, 3, 9]. Gentle care helps reduce irritation and dryness [1, 5, 8].
Wash the face up to twice a day with lukewarm water and a mild, fragrance-free cleanser [1, 5, 8, 9]. Pat the skin dry and use a light moisturiser labelled non-comedogenic if the skin feels dry; this can help the skin tolerate treatment [1, 5, 8, 10]. In the morning, use broad-spectrum sunscreen to limit ultraviolet exposure and reduce the chance that dark marks and melasma become more noticeable [1, 3, 4]. A mineral sunscreen containing zinc oxide or titanium dioxide is one option during pregnancy, but comfort and regular use matter too. Keep the routine short, introduce one product at a time, and check active ingredients with a clinician [1, 8, 9].
How pregnancy rashes can differ from acne
Not every itchy bump or patch of redness in pregnancy is acne. Some rashes linked to pregnancy need a different assessment [1, 10, 11, 12]. Polymorphic eruption of pregnancy, also called PUPPP, often appears late in pregnancy as very itchy raised red areas that start in stretch marks on the abdomen, usually spare the area around the navel, and may spread to the thighs and buttocks. A clinician can confirm the pattern and advise treatment for the itch [11, 12]. A rarer immune condition, pemphigoid gestationis, may start as itchy bumps around the navel and then form firm, fluid-filled blisters. It needs prompt medical assessment [11, 12].
Intrahepatic cholestasis of pregnancy (ICP) usually causes intense itching rather than acne-like spots. The itching often affects the palms and soles, becomes worse at night, and may begin without a visible rash [11]. ICP involves reduced flow of bile and raised bile acids in the blood, and it can carry risks for the baby. It needs same-day contact with the maternity team for liver tests, bile-acid testing, and a plan for pregnancy monitoring [11]. An unusual rash, blisters, or widespread severe itching therefore needs examination rather than being assumed to be acne [1, 11, 12]. If the bumps itch and feel irritated, read about distinguishing folliculitis from acne bumps.
Warning signs requiring prompt evaluation and clinical care at La Rose
Some symptoms during pregnancy need same-day urgent medical care, and some people may need hospital assessment or admission [1, 2, 7, 11]. Contact the maternity team urgently if severe itching affects the palms or soles, wakes you at night, and starts without a visible rash; this needs testing for intrahepatic cholestasis [11]. Firm fluid-filled blisters, large pus-filled abscesses with fever or shaking chills, severe skin pain, or a warm red area that spreads quickly also need same-day urgent care to check for a serious infection or medicine reaction [1, 7, 11].
For acne, blocked pores, or new dark marks without these warning signs, a routine dermatology consultation can help make treatment safer [1, 2, 4, 7]. At La Rose Clinics, the consultation includes a skin and scalp examination, questions about the symptoms and pregnancy, and a review of medicines, skincare products, and relevant laboratory results. The clinician considers whether the cause is local to the skin or linked to an internal factor, then provides a written plan. Dermatology can coordinate with internal medicine or nutrition when relevant, and the obstetric team should remain involved in medicine decisions during pregnancy. You can request a dermatology consultation through the booking link.
