Treatment of Acne Vulgaris During Pregnancy and Lactation

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.

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.…”

Acne Protection: Measures & Miseries

“…Short contact therapy utilizing a 2-minute skin contact time with BP 9.8% emollient foam used once daily over a 2-week duration was highly effective in reducing the quantity of P acnes organisms on the back and provided comparable colony count reduction to "leave on" therapy using BP 5.3% emollient foam [182]. The FDA classifies benzoyl peroxide as pregnancy risk category C [186].…”

Acneiform Eruptions and Pregnancy

“…However, these anti androgenic treatments are not suggested to be used during pregnancy because of the risk of hypospadias and feminization of a male fetus [26]. Also, higher incidence of Down syndrome has been reported with use of OCPs in early pregnancy [27].…”