Breakouts and Babies: How Acne Medications Can Affect Pregnancy

By Chris Colan, MS, OTIS Education Committee Member

As many women can tell you, pregnancy brings a lot of changes: not only in your life, but in your body. Women can experience morning sickness, swelling in the hands and feet, and (of course) weight gain. Because of the changes in hormones, women can also notice a difference in their skin, from the pregnancy glow to acne breakouts. Typically, women would use whatever treatment works best for them to fight acne. But in pregnancy, everything a woman does can affect her baby, so it's important to know what medications are safe to use during this special time.  Listed below are some common medications used to treat acne and the possible effects to pregnancy:

Isotretinoin (Accutane, Amnesteem®, Claravis, and Sotret) is taken by mouth to treat very serious cases of acne, and is usually only prescribed when other treatments have not worked. Isotretinoin is an artificial form of Vitamin A that is only available by prescription.  Studies have shown that taking even one pill of isotretinoin during pregnancy can cause birth defects in up to 35% of exposed pregnancies. Because this is considered to be a high risk, isotretinoin must be taken under the careful supervision of a doctor.

Women of reproductive age that decide to take isotretinoin are enrolled by their doctor into the iPLEDGE* program, which includes counseling about the risks associated with the drug in an unintended pregnancy. Women at risk for pregnancy must use two forms of effective birth control prior to starting the drug. Pregnancy tests are also done prior to taking isotretinoin. Women who are not considered at risk for pregnancy are not required to use birth control while taking isotretinoin. These include: 

• Those who have stopped having periods for 12 months in a row (menopause; confirmed by a doctor)
• Those who have had both ovaries or uterus taken out by surgery
• Those whose ovaries do not work and cannot get pregnant (confirmed by a doctor)
• Those who commit to not having any sexual contact with a male at any time forat least 1 month before, during, and 1 month after the last dose

If a woman gets pregnant while taking isotretinoin, she should stop taking the medicine immediately and call her doctor right away. In general, it is recommended that women of child-bearing age avoid isotretinoin and other Vitamin A-based medicines, such as Acitretin (sold as Soriatane) and high dose Vitamin A (more than 20,000 IU per day).**

Tretinoin (Atralin, Avita, Retin-A, Renova, Tretin-X) is acne treatment called a retinoid, and is related to Vitamin A. It is a topical medication (applied to the skin) and is available by prescription. Although tretinoin is related to Vitamin A (like isotretinoin), it is not thought to be as harmful to pregnancy. Tretinoin contains a much lower dose of the active medication, which means that when applied to the skin, the amount absorbed through the skin would be very small. One expert suggested that the amount that is absorbed is equivalent to 1/7 of the Vitamin A found in one prenatal vitamin. This means that less tretinoin makes it into the mother's blood and to the baby. If more tretinoin is used, the risk may theoretically be increased, so it is important to use this medication as directed. Because acne is considered to be a cosmetic problem, and due to the possible risks, it is usually recommended not to use this medication during pregnancy.

Tetracycline, doxycycline and minocycline are antibiotics used to treat acne and other conditions. These antibiotics are available by prescription and usually taken by mouth. Studies have not found an increased risk for birth defects when these antibiotics are used in the first trimester. However, use after 16 weeks is associated with discoloring of the teeth (permanent) and may temporarily slow down the growth of small bones.

So how are breakouts safely treated during pregnancy? Over-the-counter medications that contain benzoyl peroxide are considered safe for pregnant women to use. Skin treatments that contain salicylic acids, azelaic acids, and glycolic acids are thought to be unlikely to cause any risk to a pregnancy, because they are absorbed in small amounts through the skin. Before taking ANY medications or treatments during pregnancy, it is important to talk to a health care provider first.

Even women not planning on becoming pregnant aren't out of the woods yet almost half (about 50%) of all pregnancies are unplanned. Women who are sexually active should consider talking to their doctor about the effects medications can have on a pregnancy (planned or unplanned).

Have questions about exposures before, during, or after pregnancy? Contact the Organization of Teratology Information Specialists (OTIS) at 866-626-6847 or visit our website at otispregnancy.org.

*For more information on the iPLEDGE Program, visit www.ipledgeprogram.com

**Isotretinoin (Accutane) and Pregnancy. Retrieved from http://www.otispregnancy.org/files/isotretinoin.pdf

Chris Colan, MS, is a genetic counselor and a member of the OTIS Education Committee. OTIS is a North American non-profit dedicated to providing accurate evidence-based information about exposures during pregnancy and breastfeeding.