Pregnancy Acne

By the time they are considering having babies, many women think their days of pimples are over, left behind in those challenging younger years. But unfortunately, pimple breakouts and even acne are common during pregnancy and for some women the condition can become quite noticeable and even distressing.

It is estimated that around 50% of pregnant women will develop acne at some stage during their pregnancy. So if you are experiencing pimple outbreaks be reassured, you are not alone.

But not all women will find themselves stepping back in time to their adolescence. Some women actually report their skin is much clearer when they are pregnant and look as if they are almost glowing. This is generally due to the increase in circulating blood volume, giving a ruddy appearance to the face. It is also helped by the extra oil production which occurs in the skin during pregnancy.

What is Acne?

Acne is the term for a skin condition which is characterised by an increase in oil (sebum) production leading to the formation of blackheads and pimples. Ideally, the skin pores remain open and clear, however when acne is present the excessive production of oil can block the pores, forming blackheads and localised infection may develop. Bacteria, combined with sebum, create an infection and inflammatory response. This sequence of events is what leads to the characteristic red and inflamed skin and pustules so typical of acne.

Acne tends to appear primarily on the face but particularly in the “T-zone” which includes the forehead, the nose and towards the chin. Some women also experience acne on their chest and back, particularly across their shoulders.

Acne is more than just one or two pimples. It can include eruptions at various stages of evolution and resolution. At any one time pimples may be forming and others healing which can lead to a sense of feeling as if there is no end to the cycle of acne.

What Causes Pregnancy Acne?

Excessive amounts of hormones are  responsible, in particular oestrogen and progesterone which are the female sex  hormones, but also testosterone and androgen, the male sex hormones. These play  a direct role in the production of sebum. Changes in the amount of circulating  blood sugar and the hormone insulin are also to blame for pregnancy acne. All  of these factors have an effect on oil production – instead of a regular  secretion which is just enough to lubricate the skin and make it supple, there  is too much oil and this is what clogs the pores.

Some people still believe that acne  is an indication of poor hygiene. But we know this is not true. Although  sensible and regular cleansing can help to support an improvement in acne, it  is not a “cure all” for the condition. Many factors influence the likelihood of  getting acne during pregnancy and just being more vigilant about washing the  face is not the solution.

It can be helpful to know that in  most cases, pregnancy acne is a result of excessive hormones. These are  necessary to stabilise the pregnancy and support the baby’s growth. They also  help to direct nutrition to the placenta which is essential to ensure the baby’s survival.

One of the male hormones, androgen,  tends to be highest in the third trimester and it is this which can lead to a  worsening of pregnancy acne as the pregnancy advances. This can also contribute  to excess body hair growth and a thickened appearance to a pregnant mother’s  skin.

What Can Help Pregnancy Acne

  • Wash  your face with a gentle, mild, fragrance free specific facial cleanser.
  • Use  warm, not hot, water.
  • Consider  using an oatmeal scrub to help unblock clogged pores. But make sure you aren’t  too vigorous. During pregnancy the skin can become very sensitive and react to  harsh treatment.
  • Rinse  skin very well and pat dry with a soft towel.
  • Replace  your towel and washer several times each week.
  • You  may want to use disposable soft cotton or fabric pads to cleanse your skin.  Don’t reuse these and look for disposable ones at the supermarket or  pharmacist.
  • Ensure  your towel is dry and does not stay wet in between use.
  • Wash  your face twice a day – more than this can lead to the skin drying out.  However, after exercise you may feel you want to wash your face again.
  • Use an oil free moisturiser or facial serum. Avoid using too much as the excess may  block the pores.
  • Avoid  any sun exposure. Heat and sweat can aggravate acne, making it worse.
  • Change  your pillow case at least twice a week.
  • If  you have long hair and/or a fringe pull your hair back so it’s off your face.
  • Wash your hair regularly to remove oil build up.
  • Drink lots of water and avoid drinking too much  tea/coffee. Two cups a day is fine.
  • Speak with your maternity care provider if you are concerned about your acne.
  • Be careful about washing your hands, particularly if you tend to touch your face a  lot.
  • Ensure you have a good, healthy diet. Minimise your saturated fat intake, aim for at least five servings of vegetables and two serves of fruit each day and include wholegrains.

What Does Not Help to Treat Pregnancy Acne

  • Picking,  squeezing or scratching at pimples. This can lead to further infection and  scars forming.
  • Avoiding  all treats in your diet. Chocolates and sweets do not cause acne. However, it  makes sense to aim for a healthy diet the  majority of time. Occasional treats are fine and help us to stick  with a healthy eating plan.
  • Covering  the skin with makeup, foundation or heavy concealers. Look for cosmetics which  are oil-free, low or hypo allergenic, non comdomegenic (blackhead forming).

What Can I Do to Prevent Getting Acne During  My Pregnancy?

There is not much you can actively  do, other than be sensible about your hygiene and skin cleansing routine. There  is no need to be vigorous or go overboard when cleaning your skin. This will  only lead to aggravation and may potentially increase the risk of introducing  more bacteria into your skin.

If you are generally more prone to  pimples or suffer from acne, then you may find that during pregnancy, this  becomes worse.

What Acne Treatments are Recommended?

If you are considering using a form  of treatment for your acne it is very important that you speak with your  maternity care provider and/or your doctor. Some of the more common acne  medications are contra-indicated during pregnancy as they can lead to birth  defects and complications. Even the topical ointments i.e. those which are rubbed  onto the skin rather than ingested (swallowed), can be risky as they can still be absorbed into the mother’s bloodstream and cross the placental barrier.

Some doctors will prescribed topical (skin applied) creams and products which may contain low dose antibiotics or a form of drying agent. Benzoyl Peroxide, Glycolic or Azelaic Acid are some of the more commonly prescribed options. However, there is still much to be done  in terms of research and assessment when it comes to what is known and proven to  be safe for use in pregnancy.

Overwhelmingly, the vast majority of  health care practitioners are reluctant to prescribe any acne medication in any  form to a pregnant or lactating mother. The only time this is considered is if  all factors have been weighed up and the mother is so distressed by her  pregnancy acne that it assessed to be warranted.

Is My Pregnancy Acne Permanent?

The short answer is no. In the vast  majority of women, pregnancy acne resolves after their baby is born. This can  take a couple of months but most often there is a slow and steady improvement  once the hormones return to their non-pregnant levels.

However, some women who are  breastfeeding still experience more than normal “breakouts” due to the presence  of the lactation hormone, prolactin. But again, once this level settles the  skin generally returns to normal.

Acne Treatments During Pregnancy

There are a range of medications  which are classified as never to be used by pregnant women. These are  considered potentially harmful to the developing baby.

These can generally be classified  into a few different categories

  • Hormonal  therapy
  • Tetracyclines
  • Topical  Retinoids
  • Isotretinoin

All of these are considered potent and potentially teratogenic medications which mean they are capable of disturbing the normal growth and development of an embryo and/or foetus. Women  who are prescribed these medications should not be pregnant and need to be on contraception and advised by the prescribing doctor not to conceive.