Skip to main content
Log in

Treatment of Acne Vulgaris During Pregnancy and Lactation

  • Therapy in Practice
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

Acne vulgaris is a common problem encountered by pregnant and lactating women. Unfortunately, in clinical practice, treatment is often not optimized as a result of the lack of safety data and unified recommendations on the use of the various anti-acne therapies. In this narrative review, current data on their safety is summarized. We recommend the use of topical medications as first-line treatment for acne vulgaris in pregnant and lactating women. These include antibiotics (erythromycin, clindamycin, metronidazole and dapsone), benzoyl peroxide, azelaic acid and salicylic acid. Oral agents and/or light-based therapy may be considered as second-line treatment. The former consists of oral macrolides (erythromycin and azithromycin), cephalexin or zinc compounds. Blue–violet or red light phototherapy may be used as monotherapy or in addition to topical and/or oral therapies. Hormonal therapy, antibiotics consisting of tetracyclines, co-trimoxazole and fluoroquinolones, and both oral and topical retinoids should be avoided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kamangar F, Shinkai K. Acne in the adult female patient: a practical approach. Int J Dermatol. 2012;51(10):1162–74.

    Article  PubMed  Google Scholar 

  2. Mays RM, Gordon RA, Wilson JM, et al. New antibiotic therapies for acne and rosacea. Dermatol Ther. 2012;25(1):23–37.

    Article  PubMed  Google Scholar 

  3. Feneran AN, Kaufman WS, Dabade TS, et al. Retinoid plus antimicrobial combination treatments for acne. Clin Cosmet Investig Dermatol. 2011;4:79–92.

    PubMed  CAS  Google Scholar 

  4. Bozzo P, Chua-Gocheco A, Einarson A. Safety of skin care products during pregnancy. Can Fam Phys. 2011;57(6):665–7.

    Google Scholar 

  5. Fried RG, Wechsler A. Psychological problems in the acne patient. Dermatol Ther. 2006;19(4):237–40.

    Article  PubMed  Google Scholar 

  6. Wong JW, Heller MM, Murase JE. Caution advised in interpretation of US FDA risk classification for dermatological medications during pregnancy. Dermatol Online J. 2012;18(10):15.

    PubMed  Google Scholar 

  7. Hale T. Medications and mothers’ milk. 14th ed. Amarillo: Hale Publishing; 2010.

    Google Scholar 

  8. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776.

    Google Scholar 

  9. LactMed: A New NLM Database on Drugs and Lactation. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT.

  10. Hale EK, Pomeranz MK. Dermatologic agents during pregnancy and lactation: an update and clinical review. Int J Dermatol. 2002;41(4):197–203.

    Article  PubMed  Google Scholar 

  11. Rozex [package insert]. Watford: Galderma; 2012.

  12. ACZONE (dapsone) gel [package insert]. Irvine: Allergan, Inc.; 2013.

  13. Tuffanelli DL. Successful pregnancy in a patient with dermatitis herpetiformis treated with low dose dapsone. Arch Dermatol. 1982;118(11):876.

    Article  PubMed  CAS  Google Scholar 

  14. Sanders SW, Zone JJ, Foltz RL, et al. Hemolytic anemia induced by dapsone transmitted through breast milk. Ann Intern Med. 1982;96(4):465–6.

    Article  PubMed  CAS  Google Scholar 

  15. Webster GF. Is topical dapsone safe in glucose-6-phosphate dehydrogenase-deficient and sulfonamide-allergic patients? J Drugs Dermatol. 2010;9(5):532–6.

    PubMed  Google Scholar 

  16. Jung JY, Kwon HH, Yeom KB, et al. Clinical and histological evaluation of 1% nadifloxacin cream in the treatment of acne vulgaris in Korean patients. Int J Dermatol. 2011;50(3):350–7.

    Article  PubMed  Google Scholar 

  17. Selcen D, Seidman S, Nigro MA. Otocerebral anomalies associated with topical tretinoin use. Brain Dev. 2000;22(4):218–20.

    Article  PubMed  CAS  Google Scholar 

  18. Autret E, Berjot M, Jonville-Béra AP, et al. Anophthalmia and agenesis of optic chiasma associated with adapalene gel in early pregnancy. Lancet. 1997;350(9074):339.

    Article  PubMed  CAS  Google Scholar 

  19. Loureiro KD, Kao KK, Jones KL, et al. Minor malformations characteristic of the retinoic acid embryopathy and other birth outcomes in children of women exposed to topical tretinoin during early pregnancy. Am J Med Genet A. 2005;136(2):117–21.

    PubMed  Google Scholar 

  20. Panchaud A, Csajka C, Merlob P, et al. Pregnancy outcome following exposure to topical retinoids: a multicentre prospective study. J Clin Pharmacol. 2012;52(12):1844–51.

    Article  PubMed  CAS  Google Scholar 

  21. Leachman SA, Reed BR. The use of dermatologic drugs in pregnancy and lactation. Dermatol Clin. 2006;24:167–97.

    Article  PubMed  CAS  Google Scholar 

  22. Akhavan A, Bershad S. Topical acne drugs: review of clinical properties, systemic exposure, and safety. Am J Clin Dermatol. 2003;4:473–92.

    Article  PubMed  Google Scholar 

  23. Trivedi NA. A meta-analysis of low-dose aspirin for prevention of preeclampsia. J Postgrad Med. 2011;57(2):91–5.

    Article  PubMed  CAS  Google Scholar 

  24. The WHO Working Group, Bennet PN (ed). Drugs and human lactation. Oxford: Elsevier; 1988. p. 325–6.

  25. Källén BA, Otterblad Olausson P, Danielsson BR. Is erythromycin therapy teratogenic in humans? Reprod Toxicol. 2005;20(2):209–14.

    Article  PubMed  Google Scholar 

  26. McCormack WM, George H, Donner A, et al. Hepatotoxicity of erythromycin estolate during pregnancy. Antimicrob Agents Chemother. 1977;12(5):630–5.

    Article  PubMed  CAS  Google Scholar 

  27. Hayashi N, Kawashima M. Efficacy of oral antibiotics on acne vulgaris and their effects on quality of life: a multicenter randomized controlled trial using minocycline, roxithromycin and faropenem. J Dermatol. 2011;38(2):111–9.

    Article  PubMed  CAS  Google Scholar 

  28. Czeizel AE, Rockenbauer M, Olsen J, et al. A case–control teratological study of spiramycin, roxithromycin, oleandomycin and josamycin. Acta Obstet Gynecol Scand. 2000;79(3):234–7.

    Article  PubMed  CAS  Google Scholar 

  29. Sorensen HT, Skriver MV, Pedersen L, et al. Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. Scand J Infect Dis. 2003;35:104–6.

    Article  PubMed  CAS  Google Scholar 

  30. Harmon T, Burkhart G, Applebaum H. Transfer of probenecid and cephalexin into breast milk. Ann Pharmacother. 2006;40(5):986–9.

    Article  Google Scholar 

  31. Fenner JA, Wiss K, Levin NA. Oral cephalexin for acne vulgaris: clinical experience with 93 patients. Pediatr Dermatol. 2008;25(2):179–83.

    Article  PubMed  Google Scholar 

  32. Rothman KF, Pochi PE. Use of oral and topical agents for acne in pregnancy. J Am Acad Dermatol. 1988;19(3):431–42.

    Article  PubMed  CAS  Google Scholar 

  33. Wenk RE, Gebhardt FC, Bhagavan BS, et al. Tetracycline-associated fatty liver of pregnancy, including possible pregnancy risk after chronic dermatologic use of tetracycline. J Reprod Med. 1981;26(3):135–41.

    PubMed  CAS  Google Scholar 

  34. Spencer JP, Gonzalez LS 3rd, Barnhart DJ. Medications in the breast-feeding mother. Am Fam Phys. 2001;64(1):119–26.

    CAS  Google Scholar 

  35. Ho JM, Juurlink DN. Considerations when prescribing trimethoprim-sulfamethoxazole. CMAJ. 2011;183(16):1851–8.

    PubMed  Google Scholar 

  36. Katsambas A, Dessinioti C. New and emerging treatments in dermatology: acne. Dermatol Ther. 2008;21(2):86–95 (Review).

    Google Scholar 

  37. Briggs GG, Freeman RK, Yaffe SJ, eds. Drugs in pregnancy and lactation. 5th ed. Baltimore: Williams & Wilkins; 1998.

  38. Harmon T, Burkhart G, Applebaum H. Perforated pseudomembranous colitis in the breast-fed infant. Pediatr Surg. 1992;27(6):744–6.

    Article  CAS  Google Scholar 

  39. Dréno B, Blouin E. Acne, pregnant women and zinc salts: a literature review. Ann Dermatol Venereol. 2008;135(1):27–33.

    Article  PubMed  Google Scholar 

  40. Martínez-Frías ML, Bermejo E, Rodríguez-Pinilla E, et al. Periconceptional exposure to contraceptive pills and risk for Down syndrome. J Perinatol. 2001;21(5):288–92.

    Article  PubMed  Google Scholar 

  41. Tankeyoon M, Dusitain N, Chalapati S, et al. Effects of hormonal contraceptives on milk volume and infant growth. WHO Special Programme of Research, Development and Research Training in Human Reproduction. Task force on oral contraceptives. Contraception. 1984;30:505–22.

    Article  PubMed  CAS  Google Scholar 

  42. Maloney ME, Stone SP. Isotretinoin and iPledge: a view of results. J Am Acad Dermatol. 2011;65(2):418–9.

    Article  PubMed  Google Scholar 

  43. Ross EV. Optical treatments for acne. Dermatol Ther. 2005;18(3):253–66.

    Article  PubMed  Google Scholar 

  44. McDonagh AF, Lightner DA. ‘Like a shrivelled blood orange’—bilirubin, jaundice, and phototherapy. Pediatrics. 1985;75(3):443–55.

    PubMed  CAS  Google Scholar 

  45. Yang YG, Zou XB, Zhao H, et al. Photodynamic therapy of condyloma acuminata in pregnant women. Chin Med J (Engl). 2012;125(16):2925–8.

    Google Scholar 

  46. Lehmann HP, Robinson KA, Andrews JS, et al. Acne therapy: a methodological review. J Am Acad Dermatol. 2002;47:231–40.

    Article  PubMed  Google Scholar 

  47. Archer CB, Cohen SN, Baron SE. Guidance on the diagnosis and clinical management of acne. Clin Exp Dermatol. 2012;37(Suppl 1):1–6.

    Article  PubMed  Google Scholar 

  48. Strauss JS, Krowchuk DP, Leyden JJ, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007;56(4):651–63.

    Article  PubMed  Google Scholar 

  49. Graupe K, Cunliffe WJ, Gollnick HP, et al. Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports. Cutis. 1996;57(1 Suppl):20–35.

    PubMed  CAS  Google Scholar 

  50. Dreno B, Moyse D, Alirezai M, et al. Multicenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus minocycline hydrochloride in the treatment of inflammatory acne vulgaris. Dermatology. 2001;203(2):135–40.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to H. L. Tey.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kong, Y.L., Tey, H.L. Treatment of Acne Vulgaris During Pregnancy and Lactation. Drugs 73, 779–787 (2013). https://doi.org/10.1007/s40265-013-0060-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40265-013-0060-0

Keywords

Navigation