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Notes: Pregnancy & acne meds

Weevil

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Research on pregnancy & Dan's regimen: so far the concensus seems to be that AHAs and azelaic acid creams are the only safe products for both acne and melasma; but just recently it was posted on Acne.org that the FDA has reclassed BP as a category 1 drug, "safe & effective" so BP should be OK too (I confirmed this online...here's the official article link: http://govpulse.us/entries/2010/03/04/2010...drug-facts-form

But I probably will give up the BP if I do get pregnant, and use organic, raw, unpasteurized Apple Cider Vinegar as a toner, along with the AHA, just to be safe.

-webmd.org:Pregnancy Acne: What to Do

Even if it's been years since you've seen a zit, don't be surprised if pregnancy brings out a bumper crop, particularly around your mouth and chin.

"These are the most common areas for acne to occur during pregnancy, and if you don't treat it right away, it will continue until you deliver, and sometimes even after baby is born," says Marmur.

Although some over-the-counter preparations can help, dermatologist Sumayah Jamal, MD, PhD, says you must choose wisely.

"You should not use any products that contain benzoyl peroxide, salicylic acid, or any of the retinoids. They are not safe to use during pregnancy," says Jamal, an assistant clinical professor of dermatology and microbiology at NYU Medical Center in New York City.

What you can try, she says, are sulphur-based topical products, as well as those containing glycolic acid or alpha hydroxy acids, or any at-home microdermabrasion treatment.

If these don't help, says Jamal, there are topical prescription drugs that offer good results. "These include erythromycin cream and azelaic acid -- both very safe to use during pregnancy."

And while Jamal does not advise using oral antibiotics for acne during pregnancy, Marmur says for patients who don't get results with topical treatments, prescription oral erythromycin is considered safe to use.

"It should not cause a problem, and if your acne is really making you miserable, this can help," she says.

What also works: switching to a foundation for oily skin, or using loose powder mineral makeup. Both have oil-blotting properties and won't irritate skin with acne.

"You can also use a mattifying product underneath your makeup to soak up excess oil, or dab your face with blotting papers during the day to help remove excess oil," says Jamal.

-babycenter.com:

Is it common to be more prone to acne when you're pregnant?

Pregnancy can trigger acne or make existing adult acne worse. (On the other hand, some women with acne-prone skin report a decrease in breakouts during pregnancy, so you never know.)

Higher levels of hormones called androgens are at least partly responsible for pregnancy breakouts because they can prompt the sebaceous glands in your skin to get bigger and boost production of an oily substance called sebum.

This extra sebum, combined with the shed skin cells that line your hair follicles, blocks your pores, creating an environment in which bacteria can rapidly multiply. All this can eventually lead to the inflammation and skin eruptions of acne.

Acne during pregnancy can be mild, moderate, or even severe, and it can occur at any time during the pregnancy. It may come and go, or it may last the entire pregnancy, says Andrea Cambio, a dermatologist in Cape Coral, Florida.

Is there anything I can do about pregnancy acne?

There's no way to prevent the problem, but here are some tips that may help:

Wash gently with a mild soap or cleanser twice a day.

Don't scrub your face with a washcloth, since that can irritate the skin and make the problem worse. Instead, use your hands to gently wash your face.

Pat your skin dry rather than rubbing it.

If you use moisturizer, make sure it's oil-free.

Don't squeeze, rub, or pop your pimples – it'll aggravate the problem and could lead to scarring.

If you wear makeup, use products that are water-based rather than oil-based and that are labeled "noncomedogenic" or "nonacnegenic," meaning they won't clog your pores and cause breakouts. Be sure to wash your makeup off thoroughly before going to bed, too.

Ask your doctor or midwife before using medicated gels or lotions. A number of over-the-counter and prescription products help clear up acne, but some of the ingredients aren't safe for pregnant women or haven't been well studied in pregnancy. If your acne is severe, you may need to see a dermatologist.

Are all prescription acne medications off-limits to pregnant women?

It's particularly important to avoid the oral prescription drug Accutane (isotretinoin), which can cause serious birth defects. Also avoid tetracycline, doxycycline, and minocycline – sometimes prescribed for acne – which can cause teeth and bone abnormalities in the fetus.

Cambio says it's considered safe to use topical prescription antibiotic creams containing erythromycin or clindamycin, but she always recommends that a pregnant woman check with her caregiver first, just to make sure.

Keep in mind that your pregnancy isn't all bad for your skin! While you may have to put up with some new blemishes, as you circulate more blood and retain more water you may find that your complexion is more radiant than ever before.

-babypartner.com says BP OK: "Benzoyl peroxide during pregnancy

Benzoyl peroxide is a keratolic and antimicrobial medication. That means it promotes the softening and removal of the outer layer of dead cells from the surface of the skin and has antibacterial properties.

Benzoyl peroxide is used in many topical acne treatments such as lotions, creams, gels and masks. In some preparations it is combined with other medications including antibiotics, retinoic acid and sulfur or salicylic acid.

How benzoyl peroxide works

Benzoyl peroxide works by slowly releasing oxygen that helps to fight bacteria, a primary cause of acne. It also contributes to the peeling and drying of the skin which helps to reduce blackheads and whiteheads.

Benzoyl peroxide and pregnancy

Only trace amounts of benzoyl peroxide is absorbed by the skin when applied to the face. Many doctors consider benzoyl peroxide safe to use during pregnancy and there have been no recorded problems by women who have used the medication during pregnancy.

Common brand names

Benza W

Benzagel

BenzaShave

Clear By Design

Clearasil

Cuticura Acne Cream

Del-Aqua

Desquam

Fostex

Neutrogena Acne Mask

Noxzema Clearups

Oxy 10

Oxy 5

PanOxyl

Stri-Dex Maximum Strength

Theroxide

Common side effects

dry skin

peeling of the skin

Manufacturers of benzoyl peroxide products remain more cautious and recommend that benzoyl peroxide should not be used during pregnancy unless it is considered essential. If you have any doubts about using benzoyl peroxide during your pregnancy you should consult your doctor.

Benzoyl peroxide may pass into breastmilk and if you are using benzoyl peroxide you should consult your doctor before breastfeeding.

There are no side effects unique to children over the age of twelve. Studies of the effects of benzoyl peroxide on children under the age of twelve have not been completed.

Known food interactions

An allergy to cinnamon or foods containing benzoic acid may increase the risk of developing an allergic skin rash when using benzoyl peroxide. You should consult your doctor.

drug interactions

Consult your doctor before using benzoyl peroxide if you are taking any of the following drugs, medications or supplements, since excessive skin irritation and other problems may result:

abrasive skin cleaners

medicated cosmetics

oral contraceptives

prescription or non-prescription acne medication

resorcinol

salicylic acid

sulfur

tretinoin

Reasons to consult your doctor

Contact your doctor immediately if you experience any of the following:

blistering

burning

crusting

severe redness and swelling of the skin

-americanpregnancy.org says BP OK: "When choosing over-the-counter medicated acne cleansers and treatments, it is advised that you consult with your health care provider first. There are products that contain benzoyl peroxide, which have been recommended safe for pregnant women to use. However, there are over-the-counter medications that you may want to avoid such as products containing salicylic acids. Always consult your health care provider before taking ANY medications during pregnancy, whether prescription or over-the-counter"

-safefetus.com says BP is a Category C drug and "Studies on animals show adverse effect and toxicity on fetus. No adequate and well controlled studies done on pregnant women. Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.

-fetalexposure.org says yes to BP, and contradicts safefetus.com. It's the most complete article I've found, but it's dated Feb/2000:

"Acne and Pregnancy

Vol 7#5, February 2000

Kathleen O’Connell, BA; Megan Shepard, BA; Kelly Ormond, MS, CGC; Eugene Pergament, MD, PhD, FACMG

A variety of medications are prescribed for the treatment of acne, some taken orally, others topically. When assessing the possible risk of these medications during pregnancy, the route of the exposure is important to consider. Topical creams and gels are less systemically available than medicines taken orally, ultimately meaning that the fetus is exposed to less of the medication. As with any decision about medication during pregnancy, the potential risks must be weighed against its benefits for the patient. Since there are various acne medications available, it may be possible for a woman to find a combination of medications that is both effective and does not put her pregnancy at risk for major malformations. This newsletter examines various medications used in the treatment of acne.

Common medications

Benzoyl Peroxide (Benzac, Benzamycin, Beroxyl, Desquam, Triaz, Vanoxide)

Benzoyl peroxide is a topical treatment for acne that has antibacterial effects and induces skin peeling. About 5% of each topical dose is absorbed sytemically. There are not any animal or human reproductive studies on benzoyl peroxide, and therefore its potential teratogenic risk is undetermined. However, benzoyl peroxide is commonly used, and there are no case reports about benzoyl peroxide and birth defects in the literature. This, combined with its topical exposure, provides some reassurance that the risk of malformations is likely to be low.

Hydrocortisone (Vanoxide-HC; w/ benzoyl peroxide)

Hydrocortisone is a corticosteroid used topically to treat acne and other dermatologic conditions. There have been no reproductive studies on topical exposures to hysdrocortisone specifically, and as such its risk in pregnancy is undetermined.

A literature review of oral cortisol exposures during pregnancy did not find an increased risk for malformations in the exposed group, but it was found that the exposed group did have an increased risk for prematurity and other complications for the mother and fetus (Aron et al., 1990). The doses in the studies reviewed were presumably much larger than a dose from a topical exposure. Fraser et al. (1995) surveyed 468 women exposed to all corticosteroids in general, and noted no significant increase in birth defects. However, this study did note an increase in cleft palate versus that expected (2 vs. 0.2). Because an increase in clefting has been observed in mice exposed to corticosteroids (Fraser et al., 1951), this finding is of potential concern.

Most other studies of oral and inhaled corticosteroids have not found a significant increase in birth defects or in clefts specifically (Czeizel and Rockenbauer, 1997; Fitzsimons et al., 1986; Rodriquesz-Pinella and Martinez-Frias, 1998; Schatz et al., 1997). Finally, a retrospective study by Czeizel et al. (1997) followed 191 women exposed to topical cortisone during pregnancy and found no significant increase in birth defects. In summary, although there is a potential connection between oral corticosteroids and cleft palate identified in the human and animal studies by Fraser et al. (1951 and 1995), it is unlikely that a topical exposure to hydrocortisone significantly increases the risk of birth defects, including oral clefts.

Salicylic Acid (Sal Ac)

Salicylic acid is used to treat acne, warts and other dermatological problems. There are no studies specifically looking at topical salicylic acid in pregnancy. Oral salicylic acid (aspirin) has not been associated with an increase in malformations if used during the first trimester, but use in late in pregnancy has been associated with bleeding, especially intracranial bleeding (Rumack et al., 1981). The risks of aspirin late in pregnancy are probably not relevant for a topical exposure to salicylic acid, even late in the pregnancy, because of its low systemic levels. Topical salicylic acid is common in many over-the-counter dermatological agents, and the lack of adverse reports suggests a low teratogenic potential.

Antibiotics/Anti-infectives

Erythromycin (A/T/S 2% acne gel, Benzamycin, Emgel, Erycette, T-Stat, Theramycin)

Erythromycin is an antibiotic that is commonly prescribed in pregnancy. Although often taken orally to treat infection, it is also used topically for acne. Erythromycin crosses the placenta minimally; the fetal blood concentration is only 2-10% of the maternal serum concentration, and the medication is quickly metabolized by the body.Takaya et al. (1965) found no increased malformations in mice exposed to 1-20 times the human dose. Human studies on erythromycin have all examined oral exposures. Retrospective studies of 79 and 6972 women exposed in first trimester had no significant increase in birth defects (Heinonen et al., 1977; Briggs, 1998). Jick et al. (1981) examined the prescription records of women exposed to erythromycin during the first trimester and also found no increase in birth defects (n=100-200). Because of these studies and the fact that this medication is commonly prescribed, it is generally assumed that topical erythromycin does not pose a significant increased risk for birth defects.

Clindamycin (Cleocin)

Clindamycin is an antibiotic related to erythromycin and available both orally and topically for the treatment of acne. It has been studied in both mice and rats at doses up to 180 mg/kg/day without teratogenic effects (Weinstein et al., 1976; Philipson et al., 1976).The retrospective Michigan Medicaid study identified 647 women exposed to clindamycin in the first trimester (both oral and topical exposures) and did not note an increased risk for major malformations. Furthermore, a study of 104 women exposed to clindamycin in the second and third trimesters did not suggest an increased risk for prematurity or placental complications (McCormack et al., 1987). This medication is unlikely to significantly increase the risk for birth defects in either its oral or topical form.

Tetracycline

Tetracycline is an antibiotic taken orally to treat acne. This medication belongs to a family of antibiotics that includes minocycline and doxycycline. The half-life of tetracycline is 11-22 hours, so most of the medication is removed from the body in 5 days.Two retrospective studies found no increase in the incidence of major malformations when women were exposed to tetracycline in the first trimester (Heinonen et al., 1977; Briggs, 1998). However, discoloration of deciduous teeth and the crowns of permanent teeth was seen in children who were exposed to tetracycline after the fourth month of gestation. Studies performed by Cohlan et al. (1961), Kline et al. (1964) and Kutscher et al. (1966) established that infants exposed to tetracycline in utero after the fourth month of gestation may have discoloration of deciduous (â€babyâ€) teeth, cavities, and enamel hypoplasia in their teeth. It is believed that tetracycline causes dental discoloration and bone depression because it acts on the calcification process in development. The critical period for calcification begins at four months’ gestation and ends twelve months post-partum. Therefore, tetracyline should be avoided after the sixteenth week of gestation and throughout lactation.

The degree of dental staining appears to proportional to the dose of the medication (Egerman et al., 1992). Cohlan et al. (1961) also found that tetracycline caused long bone growth depression of 40% which normalized when the use of the medication was suspended.

Doxycycline and minocycline, two medications structurally-related to tetracycline, are also used to treat acne. These medications have not been as well-studied as tetracycline; it is, however, generally assumed that doxycycline and minocycline similarly affect the fetal calcification process. Therefore, these medications should also be avoided after the first trimester of pregnancy through the breastfeeding period.

Sodium Sulfacetamide (Sulfaset, Klaron, Novacet, Sebizon)

Sodium sulfacetamide is a topical anti-infective medication used to treat acne and seborrheic skin conditions. It belongs to the class of medications termed sulfonamides, and most reproductive studies examine sulfonamides as a class and in oral dosages, making it difficult to extrapolate the potential risk for a topical medication such as sulfacetamide.

The maternal use of sulfonamides near delivery can lead to newborn toxicity, resulting in anemia and jaundice and, theoretically, kernicterus, although this has yet to be documented in the literature. (Briggs, 1998). There have been two large retrospective studies of sulfonamide exposure, which involved 1445 and 3465 women exposed in the first trimester; neither study found an increased risk for malformations from the class in general (Heinonen et al., 1977; Briggs, 1998).

In contrast, other case controlled studies raised concerns about sulfonamide use in pregnancy. A 1971 case-control study by Nelson et al. determined the pregnancy exposures of 1369 patients, 468 of whom had babies with congenital malformations. They observed that significantly more mothers of the babies with birth defects took sulfonamides than the control mothers (Nelson et al., 1971). Saxon et al. (1975) looked retrospectively at 599 children born with oral clefts. The mothers of children with malformations in addition to the oral clefts were more likely to have taken sulfonamides than mothers of children with isolated oral clefts.

Because topical sulfacetamide has never been specifically studied to determine its potential teratogenic risk, one cannot definitively conclude that it does not cause birth defects. However, because it is topical and, for the most part, sulfonamides as a class do not appear to significantly increase the risk for birth defects, it is unlikely that topical sulfacetamide causes a significantly increased risk for malformations.

Breastfeeding while using sulfonamides is probably not a risk to a healthy infant. At most 1-2% of a maternal, oral dose of sulfonamides enters the breastmilk (Adair, 1938; Hac, 1939). However, sulfonamides can potentially cause anemia and jaundice in stressed, premature or hyperbilirubinemic infants. In addition, if an infant has G-6-PD deficiency breastfeeding should be avoided while taking sulfonamides , as sulfonamides act as oxidative stressors and can result in a hemolytic crisis.

Retinoids Isotretinoin (Accutane, Roaccutane)

Isotretinoin is an oral retinoid used to treat cystic acne. A known teratogen, this medication is contraindicated during pregnancy due to the characteristic malformations it causes. The pattern includes defects of the CNS, thymus, craniofacial and cardiovascular systems, as well as conotruncal malformations. Isotretinoin is thought to affect initial differentiation and migration of cephalic neural crest cells, and the critical period for this medication is 2-5 weeks post conception. Because the teratogenicity of Accutane is fairly well-known, we have chosen to focus upon other common acne medications in this review, rather than summarizing the literature about isotretinoin (for more details, see RISK/NEWSLETTER 3/96). Despite the half-life of approximately 1 day (manufacturer insert), due to the teratogenicity of this medication it is recommended that isotretinoin be discontinued at least one month prior to attempting pregnancy (Braun et al., 1984; Benke, 1984; Rosa, 1983; McBride, 1985; Rizzo et al., 1991).

Tretinoin (Avita cream, Retin A)

Tretinoin is a component of various topical acne creams. Because this medication is related to isotretinoin, there is concern that tretinoin could potentially have similar teratogenic effects on the fetus. Two case reports have described infants born to women using topical tretinoin during the first trimester of pregnancy. The infants had malformations that mimic the birth defects associated with isotretinoin (Camera et al., 1992; Lipson et al., 1993). In contrast, a prospective cohort study failed to find an association between birth defects and 215 women exposed to tretinoin in the first trimester (Jick et al., 1993). Shapiro et al. (1997) did not find a significant increase in number of livebirths, SAB’s, low birth weight, major malformations, duration of pregnancy, and cesarean sections in 94 women exposed to tretinoin versus controls.

A dose-response relationship potentially could play a role in the effects of tretinoin; it is of note that 5-31% of tretinoin is absorbed sytemically, depending on whether the skin is healthy or dermatitic. Although prospective studies have shown no increase in congenital anomalies, the case reports and biological plausibility of the anomalies raise concern about this medication. While such risks are likely to be low given the low topical absorption, health professionals should encourage women to weigh the risk and benefits of tretinoin during pregnancy.

Adapalene (Differin Gel)

Adapalene is a retinoid used in a topical gel form for the treatment of acne. As such, there are theoretical risks for retinoid embryopathy. However, the manufacturer reports that only trace amounts of adapalene are absorbed from the skin (trace is defined as less than 0.25 ng/ml). The manufacturer’s studies on pregnant rats and rabbits using doses 120-150 times the maximum human topical dose did not show an increased risk of adverse outcome or malformations. There has been one human case report of adapalene use during weeks 4-13 of pregnancy; the fetus had IUGR, anophthalmia and agenesis of the optic chiasm, and the pregnancy was aborted at 13 weeks (Autret et al., 1997). The anomalies seen in this pregnancy are not typical of those seen with other retinoid exposures. In addition, as with any case report, the malformations could be coincidental and unrelated to the adapalene. There have not been any other human studies or case reports to date. The overall risk of adapalene is undetermined because there have not been any human studies. However, because only trace amounts of the gel are absorbed into the skin, it is unlikely that doses large enough to induce malformations could reach a fetus.

Other medications

Azelaic Acid (Azelex)

Azelaic acid is a topical cream for acne. The manufacturer’s studies in animals do not show an increase in malformations at doses much higher than the maximum human dose. There have not been any human reproductive studies to date. While it is reassuring that animal studies do not show teratogenicity and that the fetal dose is small because the medication is topical, the risk of azelaic acid is undetermined because there have been no human studies.

Conclusions/Summary

In summary, acne medications present a range of risks during pregnancy. Because of its proven teratogenicity, it is well known that isotretinoin (Accutane) should not be taken during pregnancy. Additionally, tetracycline and its derivatives should not be used after 16 weeks gestation due to its effects on calcium-containing tissue, particularly teeth. The risks of other medications such as tretinoin are less certain, while some commonly used medications, like benzoyl peroxide, do not appear to pose a significant risk for malformations. Because of the widely known teratogenic effects of isotretinoin, many women are wary of acne medications in general during pregnancy. However, there are a wide variety of medications available for the treatment of acne, many of which pose a minimal risk if applied topically during pregnancy.

-babycenter.com says that BP & AHAs are OK:

Most pregnant women know that what they put (or don't put) in their bodies is important to the well-being of their growing baby, whether it's the right kind of protein, too much caffeine, or certain types of fish. But many pregnant women might not know that what they put on their bodies is just as important.

Most of us slather on oceans of lotions every day, but we don't think about what might be passing the skin barrier and being absorbed into our bodies. With a developing baby in your belly, this is a vital concern.

"Everything you eat, apply, or come into contact with may affect not only you but also your baby," says Sandra Marchese Johnson, a dermatologist with Johnson Dermatology in Fort Smith, Arkansas.

"Because some topical ingredients get absorbed into the bloodstream, there are some you want to avoid," adds Leslie Baumann, a professor of dermatology at the University of Miami and author of The Skin Type Solution (Bantam, 2006).

The more powerful and targeted products get, the more we need to be careful about what we have in our skin-care regimens during pregnancy. While most commonly used products are completely safe, there's a handful of ingredients considered potentially harmful to a growing baby. Below, see our guide to what to look for when shopping the beauty aisle.

If you plan to breastfeed, adds Johnson, continue following the guidelines noted below until you stop nursing.

Retinoids

These powerful substances, found in some antiaging moisturizers, are lauded for helping reduce wrinkles and improve skin tone. Retinoids are a type of vitamin A that speeds up cell division (quickening your skin's renewal) and prevent skin collagen from breaking down.

But retinoids are one of the skin-care ingredients that experts, including Baumann, recommend that expectant moms stay away from. Some studies have shown that high doses of vitamin A during pregnancy can be harmful to an unborn child. And oral retinoids, such as isotretinoin (Accutane, an acne treatment), are known to cause birth defects.

If you've been using a skin cream that contains a retinoid, don't panic. Retinoids have not been shown to cause problems in their topical form in pregnant women.

"There is no data to show these retinoids ingredients are harmful when used on the skin — doctors are just being extra cautious," explains Baumann.

On the label:

Differin (adapelene)

Retin-A, Renova (tretinoin)

Retinoic acid

Retinol

Retinyl linoleate

Retinyl palmitate

Tazorac and avage (Tazarotene)

Bottom line:

Best to avoid

Salicylic acid

This mild acid is used to treat certain skin disorders, including acne, and you can find it in a number of skin products, such as cleansers and toners. It can penetrate facial oils to get deep into pores and clean out dead skin cells. Salicylic acid is in the aspirin family, so it can also help reduce inflammation or redness. BHA, or beta hydroxy acid, is a form of salicylic acid and is used in some topical exfoliants to reverse signs of aging.

But salicylic acid is another no-no for pregnant women. High doses of the acid in its oral form have been shown in studies to cause birth defects and various pregnancy complications.

Again, doctors are being cautious by recommending that pregnant women avoid the topical use of salicylic acid. Small amounts applied to the skin — such as a salicylic acid-containing toner used once or twice a day — are considered safe, says Johnson.

But the concern is stronger about face and body peels containing salicylic acid. "This kind of 'soaking' in the ingredient is similar to taking one or more aspirin when pregnant," she explains.

"More product used equals more absorption into the bloodstream," adds Baumann. Always check with your doctor before having a peel treatment. Better yet, she advises, if you must have a peel, have it done professionally at your dermatologist's office. A dermatologist will know how to do it safely during pregnancy.

On the label:

Salicylic acid

Beta hydroxy acid

BHA

Bottom line:

Best to avoid

Note: Alpha hydroxy acids, sometimes listed as AHAs, glycolic acid, or lactic acid, are safe.

But if you prefer to avoid yet another doctor appointment, Baumann recommends using a facial wash that contains no more than 2 percent salicylic acid (look for the percentage on the product label). This small amount is considered safe.

If you want to be doubly sure, ask your obstetrician or midwife before use. As for what to avoid when it comes to treating acne, stay away from leave-on acne lotions, gels, and creams, as well as at-home peels, which can contain salicylic acid or retinoids, says Baumann. And, of course, steer clear of the oral form of the retinoid Accutane.

On the label:

Beta hydroxy acid

BHA

Differin (adapelene)

Retin-A, Renova (tretinoin)

Retinoic acid

Retinol

Retinyl linoleate

Retinyl palmitate

Salicylic acid

Tazorac and avage (Tazarotene)

Tretinoin

-laboroflove.com says BP is OK:

"Can Benzoyl Peroxide Be Used During Pregnancy?

During pregnancy, a woman’s body is going through a variety of radical changes. Many of these changes are due to the changes in hormone levels that occurs during pregnancy. Some of the side effects of these hormone levels may be relatively harmless, such as a change in sex drive. Other side effects can be severely annoying. Few are more annoying than acne. As hormone levels change, your skin may produce more oils. This, in turn, can lead to an outbreak of acne. If a woman is prone to acne or if she has a history of acne, she might find that pregnancy only serves to multiply her acne woes. In addition, acne during pregnancy may occur anywhere on her body, not just on her face.

Over-the-counter acne treatments are generally considered to be safe to use during pregnancy. Most of these treatments contain benzoyl peroxide. Benzoyl peroxide has been proven in clinical studies to be safe to use during pregnancy. There are a few anti-acne medications, such as Tetracycline, Salicylic Acid, Tretinon, and Isotrentinoin that either are known to be harmful during pregnancy or have not been fully tested as to their effects on pregnant women. Of course, you should always check with your health care provider before using any medications while pregnant, whether they are over-the-counter or prescription. There may be circumstances that are unique to you or to your pregnancy that may affect whether or not you should use them.

There are other things that you can do to help address the problem of acne during your pregnancy, that don’t require medications such as benzoyl peroxide. You should keep your skin clean by using an oil-free facial cleanser and avoiding soaps that contain oils or other irritating substances. You should avoid picking your pimples, which can cause bacteria to spread or create scars. You should also maintain a regular regimen of moderate exercise, which can increase the flow of blood to the skin and help your body to stay more toned and healthy. Finally, you should avoid stress. In addition to causing acne, stress can cause problems for both you and your unborn baby."

-from wynne, a moderator on acne.org: "Please realize that Dan's statement above is the final word from acne.org on the safety of any of the products during pregnancy. Please do not just consider what other posters say about the safety of ANY products in pregnancy. Please talk to your doctor.

Benzoyl peroxide is a category C medication. A category C medication means that no studies have been conducted in pregnant women (for obvious reasons as Dan states above.) A Category C medication has however caused effects in pregnant animal studies. Thus the medication should not be used unless the benefits far outweigh the risks, and THAT is a judgment reserved for the woman herself AND her doctor, not any of us. "

-From Jentalkin2u, a member of acne.org: "I researched this topic online because I'm currently trying to conceive. What I found was it's OK to use:

BP

AHA

Clendomycin

Erythromycin

Do NOT use:

BHA (salicylic acid)

Retinoid / Vitamin A products

"



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