Treatment of Acne in Pregnancy

Abstract

Acne vulgaris is a common disease of the pilosebaceous unit and affects adolescents and adults. Because high-quality guidelines regarding treatment of acne in pregnancy are scarce, management of this condition can be challenging. We describe the safety profile of common therapies and outline approaches based on available evidence. Topical azelaic acid or benzoyl peroxide can be recommended as baseline therapy. A combination of topical erythromycin or clindamycin with benzoyl peroxide is recommended for inflammatory acne. Oral erythromycin or cephalexin is generally considered safe for moderate to severe inflammatory acne when used for a few weeks. A short course of oral prednisolone may be useful for treating fulminant nodular cystic acne after the first trimester. In general, topical and oral antibiotics should not be used as monotherapy, but combined with topical benzoyl peroxide to decrease bacterial resistance. Oral retinoids are teratogenic and absolutely contraindicated for women who are pregnant or considering pregnancy. Although some complementary therapies including micronutrients and nonpharmacologic treatments seem to be well tolerated, limited data exist regarding their safety and efficacy, and they are not currently recommended during pregnancy. The risk-to-benefit ratio, efficacy, acceptability, and costs are considerations when choosing a treatment for acne in pregnancy. (J Am Board Fam Med 2016;29:254 -262.)

A randomized controlled open label comparative clinical study of cephalexin versus doxycycline in patients with acne vulgaris in a hospital based population of South India

“…39 Although, pregnant ladies were not involved in our study, previous literatures suggest that Cephalexin can be a safer option in such patients, whenever an oral antibiotic is to be administered. [40][41][42][43] Safety wise both the drugs were comparable during the study period of eight months. The total incidence of treatment-related adverse events turned out to be slightly higher among the Cephalexin users than Doxycycline (6.81% versus 6.25%, p= 0.912), which was nevertheless statistically insignificant.…”

Dermatologic conditions in patients of color who are pregnant

“…Moderate-to severe inflammatory acne can be managed with oral amoxicillin or medications with cephalosporin such as cefadroxil or cephalexin. With regard to fulminant nodular cystic acne, a course of oral prednisolone that lasts no longer than a month may be appropriate after the first trimester (Chien et al 2016). Patient education is important to prevent the excoriation of acne lesions, harsh skin regimen, and cultural skin and hair care practices by the patient that can either worsen acne or cause PIH or scarring (Taylor et al 2002).…”

Acneiform Eruptions and Pregnancy

“…In the majority, pregnancy has a beneficial effect on the activity of acne, and often improves in the first trimester. This is suggested to be related with the sebosuppressive effect of estrogens [5]. In a small number of cases, there is a flare-up of acne requiring active intervention, especially if scarring is a threat.…”

“…The course of acne in pregnancy is unpredictable and severity shows variations [4,5]. In the majority, pregnancy has a beneficial effect on the activity of acne, and often improves in the first trimester.…”