Acne can start or worsen during pregnancy because hormonal changes increase oil and inflammation; it may range from mild spots to deep, painful lesions that scar. Some topical options may be suitable, but oral isotretinoin, hormonal medicines, oral tetracyclines, and generally topical retinoids require avoidance or specialist guidance. The safest choice depends on the exact ingredient, strength, application area, and frequency. Use pregnancy care as a reason to review every acne product with an obstetric clinician or dermatologist.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- Why pregnancy can change your skin
- Which topical ingredients may be options?
- Which treatments should be avoided?
- What should you check before using a product?
- When should treatment be reviewed?
Why pregnancy can change your skin
Pregnancy-related hormonal changes can trigger new acne or make existing acne worse. Breakouts may be small and mild, or they may become deep, painful lesions with a risk of scarring, according to the NHS.
The appearance of acne does not identify which treatment is safe. A product's safety depends on what it contains and how much reaches the body.
Which topical ingredients may be options?
ACOG says pregnancy-compatible over-the-counter options may include benzoyl peroxide, azelaic acid, salicylic acid, and glycolic acid. Check the full label because a product may contain additional active ingredients that change the safety question. ACOG's pregnancy skin-conditions guidance Topical acne medicines usually enter the bloodstream in small amounts.
Absorption can increase when skin is broken or irritated, treatment is frequent, or large areas are covered, according to MotherToBaby. When used as directed, MotherToBaby reports that over-the-counter topical acne treatments have not been associated with increased risks of birth defects, miscarriage, preterm delivery, or low birth weight. The available studies have not established effects on later learning or behavior. MotherToBaby's topical acne treatment fact sheet.
Which treatments should be avoided?
Pregnant patients should generally avoid topical retinoids, including tretinoin and adapalene. UKTIS/BUMPS explains that absorption is low and most reported exposures had unaffected outcomes, but fetal risk cannot be fully excluded. UKTIS/BUMPS guidance on topical isotretinoin gel Oral isotretinoin is strongly contraindicated during pregnancy because it can cause severe, potentially life-threatening fetal abnormalities.
The FDA's iPLEDGE risk-control system remains in place, with further modifications scheduled for November 15, 2026. The FDA's iPLEDGE REMS information ACOG also advises avoiding hormonal acne medicines and oral tetracyclines during pregnancy. Tetracyclines taken after the fourth month can discolor fetal teeth and affect fetal bone growth.
What should you check before using a product?
Bring the product package, ingredient list, or a clear photograph to your appointment. Ask whether the exact formulation is appropriate, rather than relying on a product name or a single familiar ingredient. Useful questions include: MotherToBaby advises asking an obstetric clinician or dermatologist about each product's ingredients, strength, application area, and frequency because evidence differs between topical products and oral or retinoid medicines.
- What are every product's active ingredients and strengths?
- Should I change how often or where I apply it?
- Is the treatment suitable for broken, irritated, or widespread skin?
- Could another product in my routine contain a retinoid, hormonal medicine, or oral tetracycline?
- What should I do if I already used a product before realizing I was pregnant?
When should treatment be reviewed?
Arrange a clinical review when acne becomes deep, painful, widespread, or scarring, or when your current routine contains a retinoid, hormonal medicine, oral tetracycline, or isotretinoin. A review is also useful when a product combines several active ingredients. The ingredient list, amount used, skin condition, and frequency all affect the exposure question, so a clinician can assess the complete routine rather than one ingredient in isolation.