Answer: There are many changes that take place in the female body during pregnancy and these changes can have both positive and negative effects on acne symptoms.
Many women experience dramatic changes in their acne both during and after pregnancy. Hormones that control the natural processes of menstruation and pregnancy have wide-ranging effects throughout the body. Onset of acne or a worsening of acne symptoms is very common during pregnancy. At the same time, a smaller percentage of women report an improvement in their acne symptoms during pregnancy.
Pregnancy and Hormones
Hormones can play a major role in the development of acne symptoms. Pregnancy causes large changes in hormone balance. During pregnancy, women produce increasing amounts of the female hormones progesterone and estrogen. In addition, blood sugar levels rise to provide additional energy to the growing fetus. These blood sugar changes also affect hormone balance. The fetus itself and the placenta produce additional hormones.
Sex Hormones and Acne
The fundamental regulators of pregnancy are the sex hormones. These sex hormones include both female hormones (progesterone and estrogen) and male hormones (testosterone and other androgens). Both sets of hormones cause major physiological and metabolic changes in the body. During pregnancy, levels of all of these hormones tend to rise. Increasing levels of progesterone and estrogen help to stabilize the uterus, direct nutrients to the placenta and facilitate growth of the fetus.
The role of male sex hormones (androgens) in the process of pregnancy is less well understood. What is known is that androgen levels increase throughout pregnancy and spike in the third trimester. Androgen hormones tends to stimulate proliferation of the sebaceous glands and the production of sebum, both of which can worsen acne symptoms. Elevated levels of androgens are strongly correlated with increased frequency and severity of acne symptoms. Signs of elevated androgen levels in women include increased body and facial hair growth (hirsutism), hair thinning (on the head) and masculinization of features (in severe cases).
The Role of Post-Pregnancy Sex Hormones
Research indicates that pregnancy can induce long-lasting changes in a woman’s hormonal balance. This can include elevated levels of both male and female sex hormones. Many women report experiencing problems with acne that began with a pregnancy and continued long after the birth of their child.
Lasting acne symptoms that began during pregnancy could be the result of semi-permanent changes in sex hormone levels. It could also be a result of continuing infection with acne causing bacteria that began during pregnancy. For women who are not pregnant, there are several medications available to modulate hormone levels and to treat acne directly. These include androgen inhibitors, which can block the effect of elevated androgen levels.
Common Changes in the Skin during Pregnancy
In most cases, pregnancy induces noticeable changes in the appearance of the skin, especially in facial skin. People often refer to a “glow” in the skin of pregnant women. These changes result from vascular (blood vessel) dilation and proliferation which results in increased blood flow to the skin. Another very common change is hyper-pigmentation, which occurs in approximately 90% of women. Approximately 50% of women experience pregnancy induced melasma, which is increased pigmentation of patches of skin, primarily found on the nose, cheeks and upper lip. Some of these effects subside after completion of pregnancy, but some remain permanently.
Acne Medications and Pregnancy
Pregnant women have limited acne treatment options, compared to men or non-pregnant women. Because pregnancy is such a delicate process, it is essential that pregnant women maintain a healthy diet and limit their exposure to substances that may effect the development of the fetus. Some acne medications, like Retinoids (eg. Isotretinoin, Accutane) are highly toxic to the fetus and even small amounts of these drugs can cause birth defects or death of the fetus. Other medications like Tetracyclines (eg. Doxycycline, Minocycline) or Androgen Inhibitors (eg. Spironolactone, Cyproterone) can disrupt normal fetal development.
Allergic reactions to medications can also be dangerous to the fetus. Even homeopathic treatments, such as Herbal and Mineral supplements (eg. Zinc, Copper), can be dangerous to a developing embryo. It is important to thoroughly discuss any medication or homeopathic treatment with your physician or Ob/Gyn before beginning treatment.
Acne Treatment Options for Pregnant Women
In general, topical treatments are significantly safer for pregnant women than oral medications. Most Topical Antibiotics and Topical Naturopathic Treatments do not enter the body in concentrations high enough to risk harm to the developing fetus. Light and Laser Treatments, such as Blue Light Phototherapy, are also generally safe for use by pregnant women.
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Acne and Pregnancy. O’Connell, et al. 2000.
Maternal serum androgens in human pregnancy: early increases within the cycle of conception. Castracane, et al. 1998.
Treatment of acne in pregnancy. Chien, et al. 2016.
Inflammatory facial acne during uncomplicated pregnancy and post‐partum in adult women: a preliminary hospital‐based prospective observational study of 35 cases from Taiwan. Yang, et al. 2016.
Acne in pregnant women: a French survey. Dreno, et al. 2014.
Dermatologic therapy in pregnancy. Tyler, 2015.
Sex hormones and acne. Ju, et al. 2017.
An overview of pregnancy dermatoses. McNulty-Brown, et al. 2016.
Inflammatory and glandular skin disease in pregnancy. Yang, et al. 2016.
Acne and rosacea in pregnancy. Bechstein, et al. 2017.