Skin care dos and don'ts when pregnant or breastfeeding

As soon as you find out you’re expecting, your whole world changes – and that may include your skin care routine. Rest assured, most over-the-counter, or OTC, skin care products are safe for pregnant or nursing women, but there are a few ingredients that can be harmful. Below, Carly Jennings, MD, OB-GYN, and Matthew Stephany, MD, dermatologist, explain what is safe and what you should avoid.

Skin changes during pregnancy

When you become pregnant, progesterone and estrogen, the hormones that are part of your normal menstrual cycle, rise drastically. Progesterone helps the uterus, or womb, grow and keeps it from having contractions. Estrogen maintains the uterine lining, regulates other key hormones and triggers the development of the baby’s organs. Simultaneously, a new hormone called human chorionic gonadotropin, which is only present during pregnancy, also rises. This surge in hormones can cause a variety of skin changes. Ironically, some women’s skin becomes clearer, while most experience at least one less favorable or worsening skin issue.

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The most common skin changes during pregnancy are:

• Acne
• Darkening skin or melasma, also known as “pregnancy mask”
• Dry skin
• Dermatoses or itchy, red patches around stretch marks

Skin care products to avoid when pregnant or nursing

The Food and Drug Administration requires cosmetic products to be “safe” based on their specific uses and labeling, but products don’t necessarily need FDA approval to be sold. This makes it difficult to know which skin care products and treatments are truly safe. Generally, most experts err on the side of caution for pregnant or nursing women, especially when it comes to the following:

1. Retinoids – Some topical anti-aging skin care products use retinoids to help reverse acne and reduce fine lines. They do this by helping surface-level skin cells to exfoliate faster and by boosting collagen production to rejuvenate skin. While the amount of retinoids absorbed by topical products is likely low, they have been linked to birth defects and should be avoided when pregnant or nursing.
2. Isotretinoin – Isotretinoin, another form of retinoids, is commonly sold under the brand name Accutane and used to treat severe acne. Prescription retinoids like isotretinoin have been widely documented for posing a risk of severe congenital irregularities, with about 30-60% of children showing neurocognitive conditions with exposure in utero.
3. Spironolactone – Another common acne treatment, spironolactone, is considered a potassium-sparing diuretic. It is designed to prevent low potassium levels from occurring, unlike traditional diuretics. However, it’s not recommended during pregnancy due to potential risks to the fetus. There’s also limited data on the effects while breastfeeding, so it’s best to consult your doctor before using.
4. Hydroquinone – Hydroquinone is a topical medication designed to reduce hyperpigmentation or melasma. Since the body can absorb a significant amount of hydroquinone compared with other ingredients (35% to 45%), it’s best to limit exposure during pregnancy. However, it is approved for women who are breastfeeding.
5. Benzoyl peroxide – While benzoyl peroxide, an ingredient used to treat acne, is classified as a “C” risk medication, meaning it’s probably safe, the benefits don’t outweigh the risks. Therefore, it’s best to avoid it when you’re pregnant. However, it’s generally safe to use on your face and back while nursing – just don’t place it on your breasts.
6. High-dose salicylic acid – Salicylic acid is commonly used to treat acne, but a 2013 study concluded that products with high doses of salicylic acid, such as peels or oral medications, can be harmful during pregnancy. That said, lower-dose topical products that contain 2% or less salicylic acid have been reported safe by the American College of Obstetricians and Gynecologists.
7. Laser treatments – While they aren’t safe for pregnant women, laser treatments can be used to treat melasma in breastfeeding women. Your doctor may recommend them individually or with topical treatments to help minimize dark spots.

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Depending on the severity of your skin condition, your doctor may recommend a safer alternative.

Safe skin care alternatives for pregnant or nursing women

Safer alternatives to help manage your skin concerns may include:

1. Sunscreen – Sun protection is the number one thing you can do for long-term skin health. But how you safely protect your skin when pregnant or nursing is the big question. The verdict is still out on the safety of sunscreen chemicals like oxybenzone, so it’s best to opt for mineral-based ones that include zinc oxide or titanium dioxide. Both are “generally recognized as safe and effective” by the FDA.
2. Glycolic acid – Glycolic acid and similar ones, such as azelaic acid, help reduce fine lines, brighten skin and reduce hyperpigmentation. While glycolic acid isn’t recommended in large quantities during pregnancy, it’s likely safe in the small amounts commonly found in OTC beauty products – and it’s generally safe to use while nursing.
3. Topical antibiotics – Depending on the severity of your acne, your doctor may recommend certain topical antibiotics, such as clindamycin. However, they work best in conjunction with benzoyl peroxide, which is not recommended during pregnancy. Using topical antibiotics for an extended period – with or without benzoyl peroxide – can also make your acne more resistant to long-term treatment.

It’s not easy to give up your beloved skin-care regimen, but you’ll likely do anything to protect your baby. This includes avoiding products that could be harmful when you’re pregnant or nursing. Additionally, some ingredients aren’t intended to be used together and may cause adverse reactions, such as redness or irritation. Therefore, it’s best to consult your doctor before combining products or trying anything new, even if you’re not pregnant or breastfeeding. For questions about specific products or to schedule an appointment, call 800.922.0000.

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