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Are you dealing with pregnancy acne? Some women may experience acne during pregnancy caused by hormone changes. This article reviews the causes and best safe treatment options for pregnancy acne, based on my experience in medicine and skin therapy.

Increased oil secretion and enlarged sebaceous glands may lead to:

  • Acne;
  • Pruritic Folliculitis of Pregnancy;
  • Montgomery Glands.

Let’s discuss all three conditions.

What Causes Pregnancy Acne?


The main cause of acne during pregnancy is the increased hormone levels.

Progesterone

Progesterone, also known as the “pregnancy hormone,” rises to the highest to maintain a healthy pregnancy. Progesterone is synthesized in the ovaries at the beginning of pregnancy, and later placenta takes over and synthesizes much more progesterone.

Progesterone is also responsible for stimulating sebum secretion in the oil glands. In addition, it can cause the skin to swell, and this swelling may compress the pores. Compressed, excessively secreting oil glands may become inflamed. The progesterone effect is one of the reasons for acne breakouts during pregnancy.

Testosterone

It was estimated that the levels of testosterone, an androgen, increase after week 28 due to the increased production rate (1). Another study found a 1.7-fold increase in testosterone concentration in serum during pregnancy (2). Higher levels of testosterone are also associated with the young age of pregnant women. The older woman gets, the less testosterone is produced (3). Women with polycystic ovary syndrome and preeclampsia have even higher levels of testosterone (4, 5).

Testosterone is an androgen, and androgens are believed to be critical for preparing the cervix for labor, which explains why they increase in the third trimester (6). Androgens have many receptors on the sebaceous glands and stimulate the growth and secretion of those oil glands (7, 8). Increased over-productive oil glands lead to acne breakouts during pregnancy.

Pregnancy acne is one form of hormonal acne. So, for better understanding I recommend reading this ultimate guide to hormonal acne:

Cortisol

Another hormone involved in acne during pregnancy is cortisol, a stress hormone. It is produced in the adrenal glands, suppresses the mother’s immune system from rejecting the baby, and regulates the blood flow between the placenta and the baby (9, 10).

Cortisol levels begin to rise during the second trimester and reach the highest levels in the last three weeks of pregnancy (11). Cortisol levels are two to three times higher than usual in the last weeks of pregnancy (12). This late-term cortisol surge is associated with lung and brain development (13, 14). Preterm babies (before the cortisol surge) have issues with the lungs and brain.

As I mentioned before, cortisol suppresses the mother’s immune system and the skin’s immune system. Cortisol stimulates sebum production in the oil glands, leading to clogged pores. The skin becomes more susceptible to inflammation.

The rise of cortisol and testosterone levels in the third trimester is one of the leading causes of acne at the end of pregnancy.

Other Causes

Pregnant women may be low on some vitamins very frequently. The deficiency of these essential nutrients might mess up your hormones and lead to acne. Read more about vitamin deficiency acne here.

Does Every Woman Get Acne During Pregnancy?


No, not every woman experience acne during pregnancy. The level of the oil production and severity of symptoms varies from person to person. If you have hormonal acne, face breakouts during your period, or had more severe acne in your teen years, you are more likely to get acne during pregnancy. Women with polycystic ovary syndrome, hirsutism, overweight, and irregular periods tend to have severe acne (15).

Is Acne an Early Sign of Pregnancy?


Although you may break out during pregnancy, or your acne may get worse, it is not a true sign of pregnancy. Acne is associated with many conditions and hormonal changes. Hormonal imbalances may occur without pregnancy and cause acne. If you suspect you may be pregnant, take a pregnancy test or consult your doctor. Be careful with some acne treatments, such as isotretinoin (Accutane) or high vitamin A doses, because these can cause congenital disabilities to the baby.

Does Pregnancy Acne Mean Boy or Girl?


Old wives’ tales say that girls steal beauty from their mother, and pimples on the face mean a girl. Science found that women have higher levels of HCG (human chorionic gonadotropin; pregnancy tests react to HCG and show you double lines or a plus sign) when pregnant with girls compared to boys (16). Injectable HCG is used to treat boys with cryptorchism, and acne is one of the main side effects of this treatment. So, HCG may cause acne, but it is unknown if it can cause acne during pregnancy, especially related to the baby’s gender.

Also, no gender-related differences were found in estrogen and testosterone levels in the mother’s blood. Estrogen and testosterone levels increase steadily throughout pregnancy and do not depend on the sex of the baby (17).

When does Pregnancy Acne Go Away?


There is no scientific evidence on when pregnancy acne should clear up. It depends on the severity of acne and its causes during pregnancy. When hormones and the immune system return to a normal state, your skin will improve, and acne may go away. Sometimes it may take only a few days. But if you had acne before pregnancy, breakouts may continue.

What does Pregnancy Acne Look Like?


It looks like any other acne: whiteheads, blackheads, papules, pustules, or sometimes even severe forms, such as nodules or cysts. The only difference is that your skin may be swollen and more inflamed during pregnancy. Some women may experience body acne (pruritic folliculitis of pregnancy) and Montgomery glands during pregnancy.

What is Pruritic Folliculitis of Pregnancy?


Pimples on a Pregnant Belly
Pruritic Folliculitis of Pregnancy (Essentials Collection Via Getty Images)

The causes of pruritic folliculitis during pregnancy are unknown. It is a rare disease characterized by body acne lesions – papules and pustules (inflamed lesions). Breakouts are localized on the chest or back; occasionally, they may spread throughout the body. Sometimes pruritic folliculitis during pregnancy is caused by fungus. It usually develops in the second or third trimester and spontaneously regresses after delivery (18). Treat this type of folliculitis like pregnancy acne (read below).

What are the Montgomery Glands During Pregnancy?


The Montgomery glands of pregnancy, also called the areolar glands, are a combination of oil and milk glands and are located around the dark area of the nipples. They look like small bumps around the nipple. These glands secrete oil with antibacterial properties to clean the nipples and areola and may release some milk (19).

It is pretty normal to have the Montgomery tubercles if you are not pregnant. They may appear due to hormonal changes around puberty, during pregnancy, or coincide with the menstrual cycle. Rarely these glands may emerge from stress or breast cancer.

Do not try to unclog the Montgomery gland or pop them because they perform the antimicrobial job, and you can introduce infection. If you are pregnant or breastfeeding, simply wash the nipples with water in a shower.

Sometimes the Montgomery glands may become infected and look red, swollen, enlarged, or have a white cap. If these glands become infected and inflamed, the best remedy is to soak the nipples in saltwater (one teaspoon of salt in one cup of warm water). If it does not help, consult your doctor, you may need antibiotic therapy.

How to Treat Acne During Pregnancy?


Pregnancy acne usually resolves on its own after the delivery when hormone levels and immune systems return to a normal state. But if you want to treat your acne during pregnancy, be aware that not all treatments are safe for pregnant women and babies. Always consult your doctor and avoid unsafe or risky treatments.

UNSAFE TREATMENTS FOR ACNE DURING PREGNANCY

Isotretinoin

It is a prescription medication, usually sold under the brand names Accutane, Claravis, and others, and loved by dermatologists very much. Isotretinoin is a type of vitamin A prescribed for severe acne.

Isotretinoin is very teratogenic and is dangerous for your unborn child. It may cause congenital disabilities (heart defects, missing eyes, etc.), miscarriage, and even the baby’s death. Therefore, never take isotretinoin if you are pregnant or intend to become pregnant.

Tretinoin

It is also a retinoid derived from vitamin A. It has a similar molecular structure as isotretinoin. Only tretinoin is a topical cream (Retin A), not an oral medication as isotretinoin. Since the safety of using tretinoin during pregnancy is still lacking, I would definitely include this medication in the “unsafe” category.

Other retinoids, such as adapalene (Differin) and tazarotene (Tazorac), have similar effects as tretinoin and should also be avoided during pregnancy.

Some Antibiotics

While antibiotics, in general, are not prohibited during pregnancy, some of them are unsafe. Streptomycin and tetracycline are teratogenic and should not be used entirely during pregnancy. Streptomycin may cause hearing loss, and tetracyclines (doxycycline, minocycline) may inhibit bone growth and discolor your baby’s permanent teeth. Always consult your doctor before taking antibiotics during pregnancy.

Oral Contraceptives

Another loved treatment by doctors, but the primary purpose of birth control pills is contraception. Therefore, they are not suitable for pregnant women or those who intend to become pregnant. Some studies found that oral contraceptives might be associated with neural tube defects, limb defects, and urinary tract anomalies (20). But don’t worry if you got pregnant while taking birth control pills because most studies found no association between these pills and congenital disabilities.

Anti-Androgens

Hormone therapy is usually prescribed to the women who have high androgens. This kind of therapy include:

  • Spironolactone;
  • Cyproterone acetate;
  • Flutamide

Anti-androgens may cause congenital disabilities and feminization of the male fetus if taken during pregnancy. Be cautious if you intend to get pregnant, and stop taking these medications if you suspect you may be pregnant.

RISKY TREATMENTS FOR ACNE DURING PREGNANCY

Chemical Peels and Acids in Skincare

If you have already had chemical peels before pregnancy and your skin knows them, you may continue having light superficial peels throughout your pregnancy. The same applies to skincare, containing acids (salicylic, glycolic, azelaic acids).

But if you have never tried any acids, pregnancy is not a perfect time to start them. Skin becomes more sensitive during pregnancy and may react to substances that usually would not trigger it. Also, the skin’s immune system becomes suppressed during pregnancy, and the skin may take longer to recover after the chemical peel, and the recovery may be more difficult.

The overall risk of acids during pregnancy is low, but use it only locally and for a limited time.

Benzoyl Peroxide

Benzoyl peroxide is considered safe during pregnancy, but it has a very strong anti-inflammatory and antimicrobial effect and may increase your skin’s sensitivity and adverse reactions. This medication comes in various doses and can be prescribed by a doctor (higher doses) or bought over the counter (lower doses). Stick with lower doses during pregnancy and use it only as a spot treatment.

Peel-off Masks

While most peel-off masks are compatible with the pregnancy, I do not recommend using them during this special time. As I mentioned before, skin becomes sensitive during pregnancy and may react to substances that usually do not respond. Peel-off masks are too harsh for the delicate skin on your face and may leave it irritated. You need to peel off the mask mechanically and may damage the surface of the skin and skin barrier. Also, while peeling off, you may stretch your skin, which results in ptosis (skin dropping) later in life.

If you need to remove blackheads, read this article on blackheads and blackhead-like conditions.

SAFE TREATMENTS FOR PREGNANCY ACNE

Gentle Cleanser

Skincare and Gentle Cleanser For Treating Pregnancy Acne
Treating Acne (Essentials Collection via Getty Images)

Look for a gentle, non-abrasive cleanser that does not contain any acids or skin irritants but deeply cleanses the skin. If your skin gets sensitive during pregnancy, use the non-comedogenic cleanser suitable for sensitive skin.

Anti-Acne Products

I highly recommend using natural ingredients products that do not irritate your skin during pregnancy. Try green tea products, which reduce sebum production and have antimicrobial and anti-androgenic activity (21). You may use clay masks, which absorb oil and prevent acne.

Niacinamide, the vitamin B3, significantly reduces skin oiliness, decreases sebum production, and helps treat acne lesions (22).

If you are not allergic to tea tree oil, you may give it a try. It has antimicrobial and anti-inflammatory properties and calms down the skin’s redness. Do not use pure tea tree oil on the skin. Mix 2 drops of tea tree oil into a carrier oil (jojoba oil, sweet almond oil, grape seed oil, etc.). Or look for ready-made cosmetic products that contain tea tree oil.

For ages, turmeric/Curcumin was known as an anti-inflammatory, antimicrobial, and antioxidant agent in Eastern medicine. It can treat acne effectively by fighting the bacteria on the skin reducing oil production, acne scars, and dark spots. Turmeric is non-irritant and suits sensitive skin. You may make your face mask using turmeric powder or look for already produced skincare.

If you experience mild or moderate acne and want gentle treatment, use aloe vera products. It has antimicrobial, anti-inflammatory, and antioxidant properties. Some people (very few) might be allergic to aloe vera, but generally, it is a safe ingredient.

Before using any new ingredients or formulations on your face, remember to do a patch test on your wrist or behind your ear and observe it for 48-72 hours. Do not use the product if you notice any reactions, skin redness, or itchiness.

Skin Hydration

If I was asked to give only one piece of advice about healthy skincare, that would be hydration. Everybody needs water, so does your skin. No matter if you have dry or oily skin, it needs hydration. Dehydrated skin (which may happen even to the oily) produces even more oil to moisturize your skin, and dry skin cells clog your pores.

Best moisturizer during pregnancy should be non-comedogenic and fragrance-free. Fragrances are among the substances that irritate your skin most of all, and sensitive skin during pregnancy may not tolerate them. Also, strong scents may increase morning sickness.

The best moisturizing ingredients to look for during pregnancy are Aloe vera, hyaluronic acid, sodium PCA, sorbitol, glycerin, niacinamide (vitamin B3). Avoid comedogenic products, such as coconut oil, algae extracts, carrageenans, flax seed oil, etc.

Avoid UV Rays

Applying Sunscreen
Sunscreen To Protect Your Skin (Essentials Collection Via Getty Images)

If you are expecting, sunscreens are a must. Inflamed skin with breakouts is more sensitive to UV rays, and you may develop dark spots in a place of a pimple. People with skin of color are especially sensitive to sunlight if they have acne or other inflamed lesions.

Another reason to wear sunscreen during pregnancy is to avoid dark pregnancy spots, such as melasma (mask of pregnancy). High estrogen levels stimulate pigment-producing cells to synthesize more melanin pigment, and many women experience dark spots.

Best sunscreens during pregnancy should be non-comedogenic and ideally provide hydration or give a mattifying effect. Look for non-water-resistant sunscreens which do not clog your pores.

Note! Do not use any sunscreens that contain oxybenzone! Although it is used in 70% of sunscreen cosmetics, it is a recognized endocrine disruptor, harming reproductive and immune systems and development. Oxybenzone may be harmful to a pregnant woman. It may affect the mammary glands and lactation, which might be a problem once the baby is born (23). Oxybenzone was also associated with a rare congenital disability, called Hirschsprung’s disease.

Oxybenzone has a small molecule that may pass through the skin and placenta get into the bloodstream of the mother and the baby! If used in the early stages of pregnancy, it may inhibit the migration of the neural cells (24). Oxybenzone is also fat-soluble and can stay in the fat under the skin for a more extended period.

The safest sunscreens during pregnancy are mineral/physical sunscreens. The ingredients that give the physical block to the UV rays are titanium dioxide and zinc oxide. Look for zinc oxide because it is the safest sunscreen to use during pregnancy and the only UV-blocker that is broad-spectrum on its own.

Takeaway


Hormonal fluctuations during pregnancy may enlarge oil glands and increase the production of sebum, which may lead to acne, pruritic folliculitis, or Montgomery glands. The three main hormones in pregnancy acne are progesterone, testosterone, and cortisol.

Usually, pregnancy acne goes away after delivery, when hormones and the immune system return to normal. If you need to treat your pimples, avoid isotretinoin and any hormone therapies during pregnancy. Some antibiotics may also be harmful to your baby.

Do not try new products or procedures during pregnancy because the skin gets more sensitive, and its immune system is reduced and may react to the new ingredients or take longer to recover. If you have never tried chemical peels or cosmetics containing acids, pregnancy is not the best time to start using them.

Look for cosmetics with natural active ingredients, such as green tea, niacinamide (vitamin B3), clay, tea tree oil, turmeric/curcumin, aloe vera.

Do not forget to hydrate your skin and apply sunscreen daily!

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Experiencing acne during pregnancy? Find out the causes, types of pregnancy acne, and SAFE treatments. #PregnancyAcne, #AcneDuringPregnancy

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