Acne vulgaris occurring during pregnancy or lactation requires a modified approach to therapy. The clinical priority is to manage the condition effectively while avoiding agents that carry meaningful risk to the fetus or nursing infant.
In patients who are pregnant or lactating, the spectrum of acceptable treatments narrows considerably. Systemic exposure to topical agents — even at low levels — and the potential for harm to the developing fetus or nursing infant are central to agent selection. Certain widely used acne therapies are not appropriate in this population.
DOI: 10.1016/j.jaad.2023.12.017
In patients who are pregnant, the risk of fetal harm from topical azelaic acid, BP, erythromycin, and clindamycin are not expected based on limited expected systemic absorption.
In patients who are pregnant or lactating, tetracycline-class antibiotics should be avoided due to potential for permanent teeth discoloration and bone growth inhibition in the fetus or nursing infant.
No human studies have established causal relationships between the use of topical retinoids with birth defects; nevertheless, topical therapies other than topical retinoids are preferred during pregnancy.
Salicylic acid can be used in pregnancy if the area of exposure and duration of therapy is limited; use for large areas or under occlusion are not recommended due to the potential for systemic absorption.
Topical minocycline is not recommended during pregnancy or lactation.
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