Acne During Pregnancy: Causes and Safe Treatment

Acne during pregnancy is one of the most common and annoying side effects of pregnancy. Due to hormonal changes, skin suddenly becomes oilier, with inflammatory lesions, blackheads, and painful subcutaneous nodules appearing. This is unexpected for many women: during adolescence, their skin was almost perfect, but during pregnancy, breakouts began for the first time. [1]

From a medical perspective, pregnancy acne is the same as acne, only triggered and aggravated by changes in hormonal levels, sebaceous gland function, and the immune system. It's not a matter of "toxins in the blood" or "pollution," as pseudoscientific sources like to claim. It's based on a fairly well-studied set of mechanisms: increased sebum production, clogged pores, bacterial proliferation, and inflammation around the hair follicles. [2]

It's important to understand that acne almost never means there's something wrong with the baby. It's often a cosmetic and psychological issue, not a sign of a threatened pregnancy. The danger stems not so much from the breakouts themselves, but from improper care and self-medication with harsh products and medications prohibited during pregnancy, including retinoids, which can actually harm the fetus. [3]

The good news is that there are plenty of safe approaches to skin care and acne treatment during pregnancy. Most cases of mild to moderate acne can be controlled with a proper home routine and proven topical treatments. More severe cases require the attention of a dermatologist and obstetrician, but even in this situation, a specialist has treatment options that are safe for the fetus. [4]

This article explains in detail why acne occurs during pregnancy, how to distinguish between normal acne and dangerous conditions, what skincare products and medications are considered acceptable, and what should be avoided. The material is based on current recommendations from dermatological and obstetric communities and is aimed at expectant mothers who want to understand their skin rather than simply "tolerate" it. [5]

Table 1. Key facts about acne during pregnancy

Question	Short answer
How common is this?	Very often, especially in the first trimester
Is it dangerous for a child?	Almost always no, it's a problem with the mother's skin
The main reason	Hormonal changes and increased activity of the sebaceous glands
Is it possible to treat?	Yes, but with the selection of safe means
What is really dangerous	Self-medication with retinoids, some antibiotics and hormonal drugs

Why do acne appear during pregnancy?

The main driver of breakouts during pregnancy is hormones. From the first weeks, levels of progesterone and other hormones increase, increasing sebum production by the sebaceous glands. Sebum becomes thicker, more easily clogging hair follicles, and comedones—closed and open plugs in the pores—form. This is a fundamental stage, without which inflammatory acne does not occur at all. [6]

The second important factor is changes in the skin's sensitivity to androgens, the hormones that stimulate the sebaceous glands. Even with normal androgen levels, the skin can react more strongly to them due to restructuring of the receptors. Therefore, a pregnant woman's blood tests for hormones may be "perfect," yet the breakouts are still noticeable. This explains why it doesn't always make sense to look for a "hormonal imbalance" in tests. [7]

The third component is changes in the skin microbiome. Saprophytic bacteria, including members of the genus Cutibacterium, live in the orifices of hair follicles and normally coexist peacefully with the body. When pores become clogged and sebum accumulates, this microflora begins to proliferate, and its waste products irritate the follicle walls and trigger inflammation. Red, painful papules, pustules, and deeper nodules develop. [8]

General factors also play a role: stress, lack of sleep, dietary changes, and exacerbation of chronic illnesses. During pregnancy, women often change their skincare routines, starting to use new creams or makeup, sometimes with overly dry or overly thick textures. These experiments can further clog pores and provoke breakouts, especially if the skincare routine isn't adapted for oily or combination skin. [9]

It's worth dispelling some myths. Acne doesn't solely stem from "the baby's gender," "bad blood," or "poor diet." Sweets, refined carbohydrates, and excess dairy products can exacerbate breakouts in some people, but they're not the only or primary factor. Diet is just one part of the overall recommendations, not a magical "skin clearer." [10]

Table 2. Main mechanisms of acne during pregnancy

Mechanism	What's happening
Hormonal changes	The activity of the sebaceous glands increases, increasing the production of sebum
Changes in skin sensitivity to hormones	Even with normal androgen levels, the skin reacts more strongly
Clogged pores	Sebaceous plugs form comedones, and the skin becomes bumpy.
Bacterial proliferation in pores	Saprophytic bacteria grow more actively in a lard-rich environment
Inflammation	Red, painful and purulent elements appear

What do pregnancy rashes look like and how are they different from other conditions?

Classic pregnancy acne most often appears on the face – the forehead, cheeks, chin, back, and chest. Breakouts can include blackheads (open comedones), whitish subcutaneous bumps (closed comedones), red, inflamed pimples, and pustules. Sometimes larger, painful nodules appear, located deeper in the skin and heal slowly. [11]

An important feature is the combination of different types of elements. Non-inflammatory comedones, inflammatory papules, and pustules can be present simultaneously on a single area of skin. The surrounding skin is usually oily and shiny, with enlarged pores. In some women, acne worsens before menstrual-like bleeding in early pregnancy and at certain stages of pregnancy, when hormonal fluctuations are particularly noticeable. [12]

Acne differs from allergic rashes in that it is localized primarily in seborrheic zones and forms discrete "pimples" rather than continuous itchy patches and blisters. Allergies are often accompanied by severe itching, swelling, and sometimes watery eyes. The lesions appear quickly over large areas of skin and disappear just as quickly after eliminating contact with the allergen or taking antihistamines. With acne, itching, if present, is usually moderate and not the main symptom. [13]

In addition to common acne, specific dermatoses can occur during pregnancy, such as polymorphic eruption of pregnancy, pemphigoid gestationis, and pruritus associated with intrahepatic cholestasis. These conditions can be accompanied by a maculopapular rash, blisters, severe itching, and can be localized around the abdomen and stretch marks, not just in seborrheic areas. It's important to distinguish them from common acne, as the management strategies and risks for mother and fetus differ in these situations. [14]

Therefore, if you experience an unusual, rapidly worsening rash, severe itching, blisters, yellowing of the skin or sclera, or scratching all over your body, it's best not to attribute it to "hormones" but to consult a doctor. Your doctor will be able to differentiate uncomplicated acne from specific pregnancy-related dermatoses and, if necessary, refer you to a dermatologist or gastroenterologist. [15]

Table 3. Differences between acne and some other rashes during pregnancy

State	What does it look like?	What is typical
Acne	Comedones, red and purulent pimples in seborrheic areas	Most often oily skin, enlarged pores, moderate pain, slight itching
Allergic rash	Small spots, blisters, sometimes bubbles	Severe itching, rapid onset after contact with an allergen, spreading throughout the body
Polymorphic eruption of pregnancy	Papules and plaques around the abdomen and stretch marks	Severe itching associated with rapid stretching of the abdominal skin
Pemphigoid gestationis	Blisters and blisters on a background of redness	Severe itching, possibly involving the trunk and extremities
Intrahepatic cholestasis	Often without obvious elements, but with intense itching	Itching of the palms and feet, possible yellowing of the skin and mucous membranes

When a rash is a reason to urgently see a doctor

Most cases of acne during pregnancy are mild to moderate and do not require immediate attention. However, there are signs that require immediate attention. These "red flags" include the rapid appearance of multiple painful nodules and pustules, especially with a fever and deterioration in general health. In this situation, furunculosis, severe acne, or other purulent-inflammatory processes are possible, requiring systemic treatment. [16]

Urgent consultation is also necessary if the rash is widespread and accompanied by severe itching, blisters, swelling, shortness of breath, or a tightness in the throat. This could be a severe allergic reaction or the onset of anaphylaxis, requiring immediate medical attention. In such cases, trying to treat the skin with cosmetics or waiting for it to "go away on its own" is unsafe. [17]

A significant reason for an urgent visit to the doctor is the combination of a rash with symptoms of a systemic disease: severe weakness, fever, pain in the right hypochondrium, dark urine, light-colored stools, and yellowing of the skin and eyes. This may indicate liver dysfunction, intrahepatic cholestasis, or another pathology that goes beyond "simple skin problems." [18]

Even in the absence of alarming symptoms, it's worth making an appointment with a doctor if the rash significantly impairs quality of life: it hurts, interferes with sleep, is accompanied by severe discomfort, and significantly worsens emotional state. Psychological stress, constant dissatisfaction with appearance, and withdrawal from social and work activities due to acne also negatively impact pregnancy, and this aspect of the problem deserves no less attention than the skin inflammation itself. [19]

Finally, a consultation is essential if a woman has already begun self-treating with retinoids, high-concentration harsh acids, or systemic acne medications and then discovers she is pregnant. A doctor will help assess the risks, adjust treatment, and, if necessary, refer the woman for additional testing and a genetic consultation, rather than leaving the pregnant woman alone with her anxiety. [20]

Table 4. Red flags for rashes in pregnant women

Sign	Possible problem
The sudden appearance of multiple painful nodules and abscesses with fever	Severe inflammatory reaction, furunculosis, complicated acne
Rash all over the body, severe itching, swelling, shortness of breath	Severe allergic reaction
Rash plus pain in the right hypochondrium, jaundice, dark urine	Possible liver damage, intrahepatic cholestasis
Severe deterioration of general condition, chills, weakness	Systemic infection or other severe pathology
Self-medication with retinoids or prohibited medications during pregnancy	Potential risk to the fetus, requires medical evaluation.

Diagnosis: What does a doctor do?

In most cases, a detailed examination and skin examination are sufficient for a doctor to diagnose acne during pregnancy. The specialist will determine when the rash began, which areas of the body are affected, how the symptoms have changed, and what skin care products and medications have been used. It is also important to collect information about any associated medical conditions, medications taken, and the course of the current and previous pregnancies. [21]

A dermatologist evaluates the skin type, the number and nature of breakouts, and the presence of comedones, inflammatory lesions, nodules, and hardening. If necessary, a dermatoscopy is performed—an examination of the skin under magnification with a light source, which helps distinguish acne from other dermatoses, vascular, and pigmented lesions. Skin biopsies for acne are rarely performed and are usually performed when another pathology is suspected. [22]

Laboratory tests are usually not required for uncomplicated acne. They may be necessary if there are signs of a systemic disease, suspected liver, thyroid, or adrenal dysfunction, or severe symptoms of inflammation. In such cases, the doctor may order a complete blood count, biochemical analysis, liver function tests, and other tests based on the clinical picture, not just the type of rash. [23]

Sometimes a woman comes to the doctor after independently using several topical and systemic medications. In this situation, an analysis of possible drug interactions becomes an important part of the diagnosis. The doctor collects information about retinoids, hormonal agents, antibiotics, and other medications that may have been used before or during pregnancy to assess potential risks and adjust further treatment. [24]

For severe cases of acne or when the diagnosis is unclear, a dermatologist may consult with an obstetrician-gynecologist, hepatologist, endocrinologist, and other specialists. This multidisciplinary approach is especially important if the rash is accompanied by systemic symptoms, organ dysfunction, and the need to select medications that are as safe as possible for the mother and fetus. [25]

Table 5. What questions may the doctor ask during an appointment?

Question	Why is it needed?
When and where did the first rash appear?	Helps to assess the relationship with the onset of pregnancy and other factors
What skin care products and medications have you already tried?	Important for understanding effectiveness, side effects and risks
Is there itching, pain, fever?	Helps differentiate acne from other dermatoses and infections
Have you had similar skin problems before?	Allows you to understand whether this is a new problem or an exacerbation of an old one
Do you have any concomitant diseases and what medications are you currently taking?	Affects the choice of safe treatment

Non-drug care and lifestyle

Proper daily skin care is the foundation of acne control during pregnancy. Gentle facial cleansing twice daily is recommended, using non-aggressive gels or foams for oily and combination skin that are free of alcohol and strong fragrances. Over-washing and harsh scrubs only increase irritation, disrupt the skin barrier, and stimulate sebaceous gland activity, ultimately worsening breakouts. [26]

After cleansing, it's helpful to apply a lightweight, non-comedogenic moisturizer. Even oily skin needs moisture, otherwise it reacts with even more sebum production. Moisturizers containing hyaluronic acid, glycerin, niacinamide, and ceramides are well-suited for pregnant women, provided there is no intolerance, and the safety data for these ingredients is considered favorable. [27]

Sun protection is another important element. Many acne medications and cosmetics increase the skin's sensitivity to UV rays, and pregnancy itself predisposes to pigmentation. Mineral sunscreens based on zinc oxide or titanium dioxide are considered preferable, as they are minimally absorbed through the skin and have a good safety profile for pregnant women. They should be applied daily, even on cloudy days. [28]

Regarding nutrition, there are no strict "anti-acne diets" with proven effectiveness, but there are observations that a diet high in fast carbohydrates and sweets worsens acne in some people. Moderately limiting sugary drinks, baked goods, and French fries, and partially switching to low-glycemic index foods (vegetables, whole grains, legumes) can benefit not only the skin but also the overall course of pregnancy. Drastic and strict diets are contraindicated during pregnancy. [29]

An important part of skincare remains avoiding the habit of squeezing pimples. Mechanical trauma to the skin increases the risk of scarring, post-inflammatory pigmentation, and secondary infection. If you're considering a facial, it's best to discuss it with a dermatologist or cosmetologist who is familiar with the specifics of working with pregnant women and will use gentle techniques and products. [30]

Table 6. Basic recommendations for skin care during pregnancy

Stage	What to do
Cleansing	Twice a day with a mild product without alcohol and aggressive surfactants
Moisturizing	A lightweight, non-comedogenic cream with a simple formula.
Sun protection	Daily mineral cream with a doctor-selected SPF
Makeup	Non-comedogenic decorative cosmetics, thorough makeup removal in the evening
Habits	Do not squeeze pimples, do not use rough scrubs or hard brushes

Drug treatment: what is considered relatively safe

For mild to moderate acne during pregnancy, topical treatments with a well-studied safety profile remain the first-line treatment. These include low- and medium-strength benzoyl peroxide and azelaic acid. International and European dermatological associations consider these substances acceptable during pregnancy when used correctly on limited areas of skin. [31]

Azelaic acid has anti-inflammatory, keratolytic, and moderate antibacterial properties, helping to reduce both comedones and inflammatory lesions, as well as post-inflammatory pigmentation. Systemic absorption when applied topically is minimal, and available studies show no increased risk of congenital anomalies, making this ingredient one of the most preferred during pregnancy. [32]

Benzoyl peroxide reduces bacterial load and has a weak comedolytic effect. It can be slightly drying and sometimes irritating, so careful consideration is given to the concentration, frequency of application, and combination treatment with a moisturizer. Research shows that when applied topically, a small portion of the substance is absorbed and then quickly metabolized by the body. When used judiciously, the drug is considered conditionally safe during pregnancy. [33]

Topical antibiotics that can be used during pregnancy under strict indications and in limited courses include clindamycin and erythromycin. They are often combined with benzoyl peroxide to reduce the risk of bacterial resistance. These medications are prescribed by a doctor if there is a pronounced inflammatory component and other topical medications are ineffective. Long-term use of antibiotics without treatment is unacceptable. [34]

Additional approaches sometimes considered include peels with mild fruit acids and low-concentration salicylic acid, as well as light and laser therapy for acne. Low concentrations of salicylic acid in small areas are considered acceptable, but aggressive chemical peels and procedures with limited research during pregnancy require extreme caution and discussion with a dermatologist. [35]

Table 7. Topical medications most commonly used during pregnancy

Preparation	Role	Peculiarities
Azelaic acid	Basic therapy for mild to moderate acne	Good safety profile, reduces inflammation and pigmentation
Benzoyl peroxide	Antibacterial and comedolytic effect	Dryness and irritation may occur, adjust concentration and frequency accordingly.
Topical clindamycin	In case of severe inflammation	It is prescribed in short courses, often in combination with benzoyl peroxide.
Topical erythromycin	Alternative to clindamycin	Risk of resistance, use as directed by a doctor
Mild acids (eg glycolic)	Supplement to care	Avoid aggressive peels only after doctor's approval.

Medicines and procedures that are contraindicated during pregnancy

There is a group of acne medications that are strictly contraindicated during pregnancy due to a proven high risk of severe fetal malformations. These include systemic retinoids, particularly isotretinoin. This medication causes serious organ malformations and is therefore prescribed only to women with reliable contraception. If pregnancy occurs, it should be discontinued immediately and the situation discussed with a doctor. [36]

Topical retinoids, including tazarotene and adapalene, also belong to this group. Although absorption through the skin is significantly lower than with oral administration, there is insufficient data on their complete safety during pregnancy, and some forms have shown adverse effects in experiments. Therefore, international and national guidelines advise against topical retinoids during pregnancy, whether in prescription or cosmetic products. [37]

Spironolactone, a drug sometimes used to treat hormonal acne in non-pregnant women, is a particular concern. It affects sex hormone metabolism and can disrupt fetal development, so it is strictly contraindicated during pregnancy, and discontinued beforehand if conception is planned. [38]

Some antibiotics commonly used for acne outside of pregnancy are also not recommended. Tetracyclines, especially in late pregnancy, can damage fetal teeth and bones, and certain antibacterial regimens lack sufficient safety data for pregnant women. Choosing a systemic antibiotic for severe acne during pregnancy is a matter for a dermatologist and obstetrician, not a topic for independent experimentation. [39]

Aggressive cosmetic procedures, such as deep chemical peels, intensive laser procedures, and injection techniques, should be approached with caution. Currently, there is little data on the safety of many of these procedures during pregnancy, and the potential risks to the mother's skin and overall health are quite real. Most specialists advise postponing radical interventions until after pregnancy and breastfeeding. [40]

Table 8. Basic acne remedies that are prohibited or highly undesirable during pregnancy

Group	Examples	Reason for the ban
Systemic retinoids	Isotretinoin and analogues	High risk of severe developmental defects
Topical retinoids	Tazarotene, adapalene, high-dose retinol	Insufficient safety data, risk to the fetus
Systemic antiandrogens	Spironolactone	Impact on the development of the fetal reproductive system
Some antibiotics	Tetracyclines and others as determined by a specialist	Risk of bone and tooth damage, other side effects
Aggressive cosmetic procedures	Deep chemical peels, intensive laser treatments	Insufficient data, risk of complications and skin damage

Prevention, prognosis and psycho-emotional aspects

It's impossible to completely prevent acne during pregnancy because hormonal changes can't be reversed. However, you can reduce the severity of breakouts and the risk of complications by establishing a sensible skincare routine and reviewing your makeup kit in advance. It's advisable to discuss your current acne treatment regimens with a specialist while planning your pregnancy and promptly discontinue potentially harmful medications, replacing them with safer options. [41]

The prognosis for acne during pregnancy is generally favorable. For many women, breakouts peak in the first trimester, then gradually diminish or disappear completely by the second half of pregnancy or after childbirth. For others, on the contrary, their skin improves during pregnancy. There is no universal pattern, but in the vast majority of cases, it is a temporary phenomenon. [42]

The psychological aspect of the problem is no less important than the medical one. Changes in appearance, swelling, weight gain, pigmentation, and rashes can severely impact self-esteem and increase anxiety. Support from your partner and loved ones, communication with your doctor, and, if necessary, a psychologist, help you perceive these changes as a temporary price to pay for pregnancy, rather than a "catastrophe." It's normal to worry about your appearance, but it's important not to withdraw or be ashamed to seek help. [43]

It's important to remember that striving for perfect skin at any cost during pregnancy is unjustified. Safe, evidence-based, and reasonable solutions are far more important than aggressive experiments. With the right choice of care and medications, a balance can be found between the mother's comfort and the baby's safety. A dermatologist and obstetrician/gynecologist are allies in this regard, not "prohibitive controllers." [44]

After childbirth and the end of breastfeeding, the range of approved procedures and medications expands. Then, more intensive treatments can be discussed again, including retinoids, aggressive peels, and hardware-based procedures, if truly necessary. It's important to discuss with your doctor in advance when and with which treatments it's wise to begin, to avoid harming yourself or your baby. [45]

Table 9. What really helps to “survive” acne during pregnancy

Direction	Practical steps
Care	Gentle cleansing, moisturizing, sun protection, non-comedogenic cosmetics
Medicines	Use only products with proven safety as prescribed by a doctor.
Lifestyle	Rational nutrition, sufficient sleep, feasible activity
Psychological support	Talk about your experiences and, if necessary, consult a psychologist.
Plan for the future	After pregnancy, discuss with your doctor more active treatments if needed.

FAQ

Does acne during pregnancy harm the baby's health?
Acne itself almost never affects fetal development. It's a localized inflammation of the mother's skin. Risks arise only with the use of prohibited medications, severe systemic infections, or severe complications not directly related to acne. The main thing is to avoid self-medication and consult with your doctor before starting treatment. [46]

Can I use my usual retinol cream if it's already effective against acne?
If you become pregnant, it's best to stop using products containing retinol and other retinoids, even if they're only used topically. There's no data on their complete safety, and some medications in this group have been proven to cause severe birth defects when used systemically. Safer alternatives for treating acne during pregnancy include azelaic acid and benzoyl peroxide. [47]

How safe are salicylic acid spot treatments?
Low concentrations of salicylic acid applied to small areas of skin are considered safe during pregnancy by most experts. However, high concentrations and large areas are not recommended due to potential systemic effects. When choosing a specific product, it's best to discuss the ingredients with your doctor or dermatologist. If in doubt, azelaic acid or mild fruit acids may be preferable. [48]

Is it necessary to treat mild acne or can I just wait for it to resolve on its own?
For mild acne that doesn't cause pain or significant psychological discomfort, proper care and monitoring are sufficient. Topical treatment is considered if the acne is persistent, leaves pigmentation and scarring, or significantly impairs quality of life. The decision should be made in consultation with a doctor, who will help select the gentlest and safest option. [49]

What if acne is severe and topical treatments aren't helping?
In this situation, a dermatologist with experience working with pregnant women is needed. The doctor will assess the need for systemic antibiotics with an appropriate safety profile, possible device-based treatments, and inpatient monitoring. Sometimes the treatment plan is developed jointly by the dermatologist and obstetrician to optimally balance efficacy and safety. Self-administration of strong medications is unacceptable. [50]