What are the other Names for this Condition? (Also known as/Synonyms)

• Acne during Pregnancy
• Gestational Acne
• Pregnancy and Acne

What is Acne in Pregnancy? (Definition/Background Information)

• Acne is a common skin condition that causes inflamed, red spots/lesions to appear on the face, neck, shoulders, and other regions. The condition occurs when the pilosebaceous follicles become clogged with dead cells and oil
• Acne in Pregnancy can either worsen the existing acne skin condition or bring about ‘new’ acne. The reason behind this is thought to be due to hormonal changes
• The treatment of Acne during pregnancy is usually challenging and difficult due to the restriction in the use of commonly used medications to treat acne. It is very important that a healthcare expert be consulted for acne treatment during pregnancy
• The treatment measures may include the use of certain topical medications, changes in topical care, and other modalities. With suitable treatment, the prognosis of Acne in Pregnancy is generally excellent

Who gets Acne in Pregnancy? (Age and Sex Distribution)

• Acne in Pregnancy is more commonly observed during the first six months of pregnancy (in the 1st and 2nd trimester)
• Acne can also worsen during the third trimester
• There is no racial or ethnic predilection

What are the Risk Factors for Acne in Pregnancy? (Predisposing Factors)

Generally, there are no identified risk factors for Acne during Pregnancy.

• Women with multiple pregnancies (twins, triplets, etc.) may be at an increased risk since the condition is hormonally-influenced
• Some factors, such as certain cosmetics, may aggravate the existing condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acne in Pregnancy? (Etiology)

Acne in Pregnancy is believed to be induced by hormonal fluctuations.

• The hormones that play a role in the development or aggravation of this condition are predominantly androgens, which are known to increase sebum (oil gland material) production
• Increased sebum (oil) production leads to the initiation of acne; excess oil mixes with dead skin cells to plug the pilosebaceous follicle openings leading to acne
• Women with existing acne may experience a worsening of the condition during pregnancy

What are the Signs and Symptoms of Acne in Pregnancy?

The signs and symptoms of Acne in Pregnancy are as follows:

• The face, neck, chest, back, and shoulders, are usual sites of acne skin lesions
• The presence of non-inflammatory lesions such as whiteheads and blackheads(open and closed comedones). These are the initial acne lesions
• The appearance of inflammatory lesions that may include papules, pustules, cysts, or nodules,
• Nodules and skin cysts  are deep in the skin and are more likely to cause scarring of the skin

How is Acne in Pregnancy Diagnosed?

• Acne in Pregnancy is diagnosed through a simple physical examination and medical history evaluation
• The healthcare provider may also ask many questions related to the individual’s age, current medications, cosmetics, body lotions used, other medical conditions, infections, etc.
• If secondary infections develop, then a culture  may be done
• Invasive methods, such as skin biopsy, are typically not required; acne diagnosis can be made through a physical examination itself

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acne in Pregnancy?

Some of the complications of Acne in Pregnancy include:

• Development of severe forms of acne requiring more intensive treatment
• Treatment difficulties due to restricted use of certain medications due to pregnancy
• Increased psychological stress during pregnancy
• Permanent pitting and scarring of the skin

How is Acne in Pregnancy Treated?

It is very important to consult a healthcare provider to treat Acne during Pregnancy. Many commonly used medications to treat acne are not usually used. Also, self-medication and home remedies must be completely avoided. When pregnancy is being planned and begins, it is important to take the advice of a healthcare expert for acne.

The following medications SHOULD BE AVOIDED during pregnancy:

• Topical creams and gels containing retinoids (including tretinoin and tazarotene). The over-the-counter retinoid compounds retinol and retinyl palmitate should also be avoided
• The retinoid adapalene is not known to be teratogenic and is available OTC. It should be used with due consideration and consultation with a professional during pregnancy
• Certain oral antibiotics, such as fluoroquinolones, doxycycline, minocycline, tetracycline, and sarecycline, should be avoided as treatments for acne during pregnancy
• Spironolactone should not be used during pregnancy
• Isotretinoin, which is a known teratogenic agent (having a high potential to cause fetal defects), must be avoided during times in which pregnancy is possible or planned. A woman must have two negative pregnancy tests before beginning isotretinoin, altogether avoid pregnancy, during the isotretinoin course (usually 20 weeks) and for two menstrual periods after cessation
• Many medications unrelated to acne treatments are teratogenic (can cause birth defects). It is prudent to check all medications one is taking before and during pregnancy to be safe, and always inform all healthcare providers about one’s pregnant state

The following treatment measures may be used for Acne in Pregnancy:

• Topical gels and creams that contain benzoyl peroxide, clindamycin, erythromycin, and azelaic acid, either singly or in combination thereof
• Lotions and washes containing less than 2% salicylic acid are considered safe during pregnancy
• Short-term oral cephalexin or erythromycin-class antibiotics can be used
• A short course of oral prednisolone for severe cystic or nodular acne may be considered after the first trimester has passed
• Light-based treatments are safe to use during pregnancy
• Some laser treatments might be safe, but these have to be evaluated individually
• Some patients can identify certain foods or other agents which flare their acne. These have to be avoided more carefully

Taking care of oneself, being clean and hygienic (especially face and hands), avoiding the urge to touch/break the lesions, avoiding oily make-ups and creams, drinking lots of water, etc., are all simple practices that can prevent the worsening of acne.

How can Acne in Pregnancy be Prevented?

Currently, it is not possible to prevent Acne during Pregnancy, which is caused by hormonal factors.

• There are factors that either contribute to acne formation or aggravate the severity of its state. Factors that can be controlled have to be recognized to achieve an early recovery from acne
• Bringing about slight changes to the diet, refraining from certain foods or heavy or oily cosmetic products, and maintaining proper self-care can be beneficial to acne care

What is the Prognosis of Acne in Pregnancy? (Outcomes/Resolutions)

• The prognosis of Acne during Pregnancy is generally excellent with appropriate treatment
• In some women, the condition may be severe and may require to be treated for a longer duration, especially since the treatment can be challenging due to restricted medication use

Additional and Relevant Useful Information for Acne in Pregnancy:

• There is no evidence to prove that oily foods and chocolate-based products influence acne
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition

The presence of dirt on the body is not a causative factor for acne; but it helps to be clean and hygienic