Tuesday, September 15, 2009

Acne in Pregnancy

Many adult women struggle with acne. About 50% of pregnant women are afflicted with this condition, whether or not they experienced it before pregnancy. The cause is often hormonal, especially during the first three months when you experience major hormonal fluctuation. Your ovaries produce extra progesterone during the first trimester but by the end of that phase the placenta takes over and many women experience some improvement, perhaps due to the increased estrogen production. But, each person is different and their experiences will vary.

In addition to hormones, hydration needs change with pregnancy and without extra water consumption your body cannot dilute and eliminate the extra oil stimulated by the progesterone and androgenic hormones.

A few lucky women actually find their acne improves in pregnancy, but more often it is a curse of pregnancy. Of course it is not a life threatening condition but there's no reason to abandon your efforts to control it, especially if it affects your sense of well-being. You want to look and feel our best, even in pregnancy!

So, how should you treat this bothersome condition?

First the "don'ts" and "cautions":
  • Avoid topical retinoids such asRetin-A (tretinoin). This medication carries a warning not to use it in pregnancy, though the risk is theoretical, has not been proven (because we don't test drugs in pregnant women), and it would likely take a large amount for absorption to be a problem. But, because it is a vitamin A derivative, it's best to err on the side of caution.
  • Avoid treatments taken by mouth (systemic) unless prescribed by your health care provider who is aware of your pregnancy. Many people take low dose antibiotics such as Tetracycline or Doxycycline to control the bacteria that get into the pores, resulting in acne. These drugs have the potential to stain the baby's teeth and affect bone development so these are discouraged, particularly after about the fifth month of pregnancy.
  • Absolutely avoid Accutane (isotretinoin). It is a systemic, very effective long-term cure for acne but it is a known teratogen, meaning we know it causes serious birth defects in many cases so this should NEVER be used in pregnancy and it is labeled as a Category X drug. Women taking this drug are required to have testing to rule out pregnancy before starting and they pledge to use effective (preferably two) contraceptives during the entire treatment period, including one month after meds are discontinued.
  • Don't take hormones such as oral contraceptives and anti-androgens, often used to treat acne.
  • Avoid touching your pimples which can spread bacteria. Use cotton balls and clean applicators for makeup. Discard old makeup which might be contaminated with bacteria.
  • Avoid scarring by NEVER sqeezing, picking or popping pimples. If you have a big offender at an inopportune time, it would be best to see your dermatologist for emergency care. The doctor can help reduce the inflammation and drain it without causing the scarring and spread of infection that squeezing might do. Most specialists will see their patients in such emergencies if they already have established a doctor-patient relationship, so seeing the doctor before the emergency for ongoing skin care is wise. Getting a same day appointment with a dermatologist as a new patient could be impossible.
Now the "to do list":
  • Cleanse gently with only mild oil-free products. Avoid harsh exfoliation, granular or beaded abrasive face scrubs. These can irritate and worsen sensitive skin. Instead of a standard wash cloth use only your hands or a soft baby cloth, wash for a minute or two and use warm (not hot) water. Acne develops from the inside out and scrubbing will only aggravate the condition by overstimulating the sebacious glands (the opposite of what you need now!). It's a healthy balance of natural oil production we want so twice daily cleansing should be adequate most days. The gentlest cleansers are Cetaphil and Aquanil. You may follow with a water based moisturizer. Toners and astringents may be used, but apply with a clean cotton ball.
  • Try topical treatment such as benzoyl peroxide or salicylic acid (in low concentrations). Benzoyl peroxide is especially helpful as a spot treatment for breakouts. You should always check with your doctor or the Pregnancy Risk Line (800) 822-2229 when in doubt about product safety in pregnancy. They have told us that topical products used sparingly as directed are almost all safe because so little is absorbed beyond the local skin area. The exception is retinoid as listed above. While we don't study drugs in pregnant women like we do others, there has not been any evidence of these increasing risks of birth defects among the many women who have used them in pregnancy. They are category C because there has not been scientific studies on drugs in pregnancy. Any theoretical risk with salicylic acid would be with extensive use on the whole body or when taken orally. If you have such a need, discuss this with your doctor or CNM.
  • Topical antibiotics such as clindamycin are available by prescription.
  • Other topicals include Alpha Hydroxy Acids (AHAs) and Resorcinol and Sulfur. Resorcinol can be absorbed through the mother’s skin, but none of these ingredients have proven to be a risk in pregnancy.
  • Pay attention to your diet. While no particular foods are known to cause acne (oily foods, chocolate, soda, etc.) each individual is different so if you find something that offends your skin, stay away from it. Antioxidents are also good for your skin and these are found in fruits and vegetables, whole grains and soy.
  • Drink plenty of water. It's amazing how many conditions of pregnancy can be helped by staying well-hydrated.
  • Reduce stress as much as possible. Many women report breakouts at stressful times.
  • Exercise daily to stimulate circulation to all parts of your body including your skin, and get plenty of sleep for optimal health.
Quality Health shares these additional ideas:

  • Wash your face

  • with gentle soap twice a day. Harsh cleansers stimulate oil glands and can make skin problems worse.

  • Remove all makeup

  • before going to sleep. Left on overnight, cosmetics can clog pores and lead to breakouts.

  • Avoid pressure on the chin or the face

  • from athletic gear or musical instruments, which may cause chafing or blemishes.

  • Wipe telephone receivers

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