Last Updated on January 6th, 2020
Although it goes by its own name, pregnancy acne is really just normal acne brought on by the intense hormone fluctuations during pregnancy. If you haven’t had acne since high school, it can be frustrating when it makes a reappearance, especially at a time when your body is already going through so many other changes, but because pregnancy acne is similar to teenage acne, all the same treatments should work. There are a few acne treatments that you should avoid when pregnant, such as isotretinoin (Accutane) or some antibiotics, but generally, you can treat pregnancy acne like you would treat any acne. There’s already so much to be anxious about during pregnancy, and acne might be the last thing you expected to have to deal with, but it is actually very common—it is approximated that one third of mothers see an increase in acne while pregnant.
This article will explain why so many women experience increased acne during pregnancy, discuss some of the other skin conditions to look out for while pregnant, and provide helpful solutions, including over-the-counter, prescription, and do-it-yourself options.
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Most people have heard of something called “pregnancy glow,” a phenomenon where a woman’s skin seems to glow during pregnancy. Believe it or not, there is actually some truth to pregnancy glow. Many women see an improvement in their acne when their pregnancy begins, and women who don’t have acne sometimes say their skin just seems brighter. At the same time, many women do not experience any pregnancy glow, so don’t feel bad if your skin remains the same or acne worsens, that is very common as well. Pregnancy glow may have some truth to it, but it is a myth that all women will have a beauteous glow their entire pregnancy. Actually, acne often increases around the third trimester.
But why do some women get pregnancy glow? There are plenty of theories, but none have been solidly proven yet. Still, dermatologists suspect it has something to do with the influx of estrogen at the beginning of pregnancy. If you had teenage acne, you know that hormones can have a significant impact on your skin. Hormone levels are constantly shifting and changing throughout pregnancy, and as a result, you could see improved or worsened acne throughout. At first, most women see an improvement because at the beginning of pregnancy, your body boosts its estrogen levels. Researchers can’t say for sure why estrogen helps with acne, but studies show that increased estrogen usually results in decreased acne. One strong theory is that estrogen can balance out androgens, hormones that can increase oil production.
Androgens are typically considered “male” hormones, but like estrogen (a typical “female” hormone), people of every sex produce androgens, just in differing amounts. Most men make more androgens and less estrogen, most women make more estrogen and less androgens, and intersex or nonbinary people could make any combination of the two.
On their own, androgens do not automatically lead to more oil production. If that were the case, men would experience acne significantly more than women, and studies show that the number of men and women who report having acne are very similar. Androgens lead to trouble with acne when the ratio between androgens and other hormones like estrogen is thrown out of balance. If you have naturally low levels of estrogen and naturally high levels of testosterone, that’s not a problem, but if your estrogen levels drop, it could cause more acne. This is because it is the amount of androgens relative to other hormones that matters.
Oftentimes, this is what causes premenstrual acne. Estrogen levels drop when an egg is not implanted to the uterine wall, making the relative amount of testosterone higher, and this causes the skin to produce more oil. In pregnancy though, androgen levels really do rise, not just in relation to estrogen. In the beginning, estrogen increases and skin often clears, but by the third trimester, androgens start increasing as well. When this happens, the skin starts producing more oil (also called sebum), which can often lead to acne.
If you have oily skin, you know that oil and acne walk hand in hand, but why does increased oil cause acne? Sebum is actually one of the three main causes of acne, which also includes inflammation and bacteria. Sebum causes acne by clogging pores and creating blackheads and whiteheads. Contrary to popular belief, blackheads are not caused by dirt, just extra sebum and dead skin cells like whiteheads. The only difference is that a blackhead is in an open pore, so the air oxidizes it and turns it a darker color.
Sebum can also contribute to pimples, because pimples are caused by a specific kind of bacteria that feeds on sebum, called p. acnes. This is the bacteria primarily associated with acne, but whether or not you have acne, p. acnes always live on your skin as part of your body’s natural biome of bacteria. They can even be helpful because they consume sebum, so they can reduce any excess oil you have. When your body starts producing extra sebum, however, it becomes a problem. With a large influx of food, the bacteria’s numbers can increase drastically and cause pimples.
Pimples are created when p. acnes get trapped under the surface of the skin and the immune system sends in agents to fight them off. In the process of killing bacteria, immune system cells are also killed, and all the destroyed cells collect to form pus, which is what gives pimples their white or yellow-ish head. Although it can be tempting to pop pimples, it is generally not a good idea. Usually, pushing on a pimple will only drive the bacteria deeper, and opening the skin could allow for more bacteria to enter. Popping pimples also increases the likelihood of hyperpigmentation or scarring.
Luckily, pregnancy acne is just like regular acne, and all the regular treatments work just the same. There are a few treatments to avoid, for the safety of you and your baby, but we’ll go into detail about those in the next section. This section is about explaining the safe treatment options and how they work to reduce your acne. The best way to treat pregnancy acne is with a gentle skincare system that uses proven acne-fighting ingredients, like benzoyl peroxide, tea tree oil, or salicylic acid.
Although these treatments are generally considered safe to use during pregnancy, you should still discuss them with your doctor before starting treatment.
This is one of the most popular ingredients in acne treatment products. It won’t slow down the increased sebum production caused by the extra androgens produced during pregnancy, but it can dry out oil slightly and kill 99.9% of p. acnes. Benzoyl peroxide is sold over-the-counter or as a prescription, and both are generally considered safe for pregnancy acne. Although benzoyl peroxide is somewhat effective on its own, it works even better when combined with other ingredients, like tea tree oil and salicylic acid.
This is probably the most popular natural acne remedy because it also kills nearly all p. acnes it comes into contact with, and usually reduces redness. Like benzoyl peroxide, it is a safe, effective treatment for pregnancy acne. The only trouble with tea tree oil is that it is very potent, and it can aggravate sensitive skin. When the skin is irritated, it usually becomes inflamed and may even produce more oil, so that could be very counterproductive. To avoid this, tea tree oil should always be diluted, and is generally safest as a spot treatment rather than as an all-over treatment. The exception is if small amounts of tea tree oil are included in a product containing other, more soothing ingredients. Then it may help kill acne-causing bacteria without irritating the skin.
This ingredient may be especially good for treating pregnancy acne because unlike benzoyl peroxide and tea tree oil, its primary focus is exfoliating the skin to reduce sebum buildup. In low concentrations (0.5%-1%) it is pretty gentle with the skin, so it shouldn’t cause irritation or redness. Still, like the other ingredients on this list, salicylic works best when combined with other acne-fighting ingredients that address the other main causes of acne.
The best treatment for pregnancy acne is a gentle skincare system. There are a lot of acne treatment systems out there right now, and some are definitely better than others. Proactiv gets a lot of hype, but they use relatively high concentrations of benzoyl peroxide, which can irritate the skin and cause increased acne over time.
If you’re looking for an inexpensive, reliable way to treat your acne so you can get back to dealing with the millions of other things there are to worry about during pregnancy, we recommend Exposed Skincare. Their products combine over 14 active ingredients that are designed to reduce acne without causing counterproductive irritation or inflammation. Exposed uses benzoyl peroxide, tea tree oil, and salicylic acid, but they also include green tea extract to reduce redness, aloe vera to reduce inflammation, and other natural ingredients that keep your skin healthy.
Most acne treatments are pretty safe, but there are a few that come with significant risks, and should definitely be avoided when pregnant. These include isotretinoin, tazarotene, spironolactone, and to a lesser degree, some antibiotics and retinoids.
You may know isotretinoin by its most popular brand name: Accutane. It is a concentrated derivative of vitamin A, taken in pill form for 15-20 weeks. It is a highly effective acne treatment, especially for cystic or treatment-resistant acne, but it can have profound and long-lasting effects on the body and it is a proven teratogen, meaning it has been proven to cause birth defects. You should never take isotretinoin while pregnant. If you become pregnant while taking isotretinoin, contact your doctor as soon as possible to minimize the effects of the isotretinoin.
Tazarotene is also known as Avage, Tazorac, among other brand names, and like isotretinoin, it is a vitamin A derivative usually reserved for severe acne. It is not recommended during pregnancy either, as it can also cause birth defects.
Spironolactone is commonly used to treat acne because it can reduce oil production by blocking the production of excess androgens. However, it is not safe for pregnancy because your body needs those extra androgens to make your baby healthy and strong.
Isotretinoin, tazarotene, and spironolactone are the big three that the American Academy of Dermatology warns warns about use during pregnancy, but there are other treatments that should also be avoided, or used with caution. Antibiotics are still sometimes prescribed for acne, but some of them, like doxycycline, minocycline, or tetracycline, can cause birth defects if used after a certain point in the pregnancy. Another category most doctors suggest that pregnant women avoid are retinoids. Isotretinoin and tazarotene are very powerful retinoids, but even less intense retinoids have shown the potential for birth defects. The research is unclear, so for now it is best to try other acne treatment options.
Since becoming pregnant, have you noticed dark or gray-ish patches appear on your forehead or cheeks? If so, there’s no need to worry, nothing is wrong, you’re simply experiencing something called melasma, often called “the mask of pregnancy.” Nearly 50% of pregnant women experience melasma, also called “chloasma,” but what is it? Doctors believe that the influx of hormones that come with pregnancy can increase pigmentation in the skin, especially in women of color. The added hormones trigger a release of melanin, and if your skin cells already produce melanin consistently, they are more likely to be triggered by the pregnancy hormones and produce excess melanin, creating dark patches.
When melasma occurs outside of pregnancy, doctors may prescribe hydroquinone, a skin lightening product, but it is not recommended for pregnancy. Studies show that hydroquinone is a teratogen, like isotretinoin, and has a high rate of birth defects if used while pregnant. Instead, most dermatologists recommend that women apply a sheer sunscreen every day to prevent melasma.
Sometimes it’s just a little annoying to have pregnancy acne to deal with on top of all the other things you’re dealing with during pregnancy, but other times pregnancy acne can bring back negative feelings from high school or amplify feelings of disconnect with your rapidly changing body. As with all things in pregnancy, it can feel isolating. This is where finding a pregnancy support group, some fellow moms going through some of your same struggles, can be really helpful. But if you’re more of an introvert or if none of your pregnant friends have pregnancy acne, another form of self-care is do-it-yourself skincare. With this handy guide, you’ll be able to make three fun facemasks to help you de-stress and unwind, while improving your skin.
Honey, Cinnamon, and Lemon Mask
This is the perfect mask for pregnancy acne, because it combines useful ingredients that smell amazing to reduce sebum buildup, kill p. acnes bacteria, and reduce inflammation, addressing all three causes of acne. Honey actually does all three of these on its own, but if you want to amplify the effects, adding cinnamon can help kill more bacteria, and lemon can dry out oil to help exfoliate skin. We do not recommend using cinnamon or lemon without the assistance of honey, however, as they can be too harsh, and if you have a dark skin tone, you may want to exclude the lemon, as it has been known to cause light spots on dark skin.
1 tablespoon of honey
1 teaspoon of cinnamon
½ lemon, squeezed
Combine the ingredients in a small bowl and mix thoroughly. Make sure your honey is pure honey by checking the ingredients. “Honey” should be the only ingredient; if fructose or other ingredients are added, it will be much less effective in treating acne. Once the ingredients are mixed evenly (no pools of lemon juice or pockets full of cinnamon) apply to your face. You can do this using your fingers, but if you’re not the messy type, a cotton ball usually works well too. Let it sit on your skin for 20 minutes to an hour. Read a book, take a nap, soak your feet, whatever you need to do to relax. Take this time out to replenish your body—it is doing a ton of hard work, you deserve (and need!) a break. Once the mask has set for your desired amount of time, rinse with cool water, and do your best not to scrub it off. This will take a while, but scrubbing can irritate the skin and undo all the soothing effects of the mask. Once your skin is clear, pat dry with a soft towel.
Honey, Turmeric, and Yogurt Mask
Honey really is an all-around great home acne remedy, and it serves as a solid base for most facemasks, so it’s in all of our recommended recipes. But this recipe also includes turmeric, an ancient acne remedy that kills bacteria and reduces inflammation. The yogurt is a special addition for pregnancy acne because it contains lactic acid, which can help exfoliate the skin and reduce oil buildup. All of the ingredients in this mask should be safe for all skin tones, so all you’ll need are is some honey, turmeric, yogurt, and thirty minutes to relax!
1 tablespoon of yogurt
1 teaspoon of honey
½ teaspoon of turmeric
Combine the ingredients in a bowl and mix well. Apply mixture to the skin evenly, and let sit for 30 minutes. Rinse with cool water and pat dry with a soft towel.
Honey, Aloe Vera, and Green Tea Mask
If you’ve noticed some inflammation or if your face just feels sort of swollen or puffy, this is the best mask for you. Honey has anti-inflammatory properties, but so does aloe vera and green tea, making this the ultimate soothing mask. Green tea is also a great ingredient for evening out skin tone and reducing redness, so it can help if your skin feels blotchy or broken out. These ingredients are also safe for all skin colors, and all skin types. If you have sensitive skin, this is the mask we recommend, as all its ingredients are gentle and unlikely to irritate the skin.
2 teaspoons of honey
2 teaspoons of aloe vera
1 tea bag of green tea
Steep a green tea bag in hot water for 3 minutes, then remove the tea bag from the water and let it cool. After 5 to 10 minutes, cut the tea bag open and pour the leaves into a bowl. Add the honey and aloe vera and stir until the ingredients are mixed evenly. Apply the mixture to the skin evenly, and let it sit for 20 minutes to an hour. If you have the time to just sit and relax, this mixture can stay on your skin for any amount of time without adverse effects, but if you have limited relaxation time, 20 minutes should do the trick. When you’re ready to remove the mask, simply rinse in cool water and pat dry.
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