Is There a Safe Solution for Acne During Pregnancy?

My road to finding perfect skin has been a bumpy one. Red, swollen, and bumpy. At age 13, I got it – as in I had it, hated it, but understood it. It was puberty, after all, and I was already frizzy-haired, overweight, and six inches taller than all of the boys in my class.

What was one more self-esteem crusher? But now, at age 34, as spots of grey freckle my roots, I am having trouble reconciling with the spots of red freckling the slowly decreasing smooth space between my budding wrinkles. How am I still breaking out?!

Sure, there are a million quick fixes, and I have tried them ALL to varying success. So why am I complaining? Well, number one: They are just that. Quick fixes. And number two: Things started to get tricky about 8 months ago when my husband and I decided that we wanted to start thinking about having a baby.

And since I am COMPLETELY neurotic, I decided that even though we weren’t going to start actually “negotiating” the project for several months, I wanted anything that could hurt that little one OUT of its future, albeit, temporary home. Very quickly, my acne came back – with a vengeance, super ready to shine after years of being suppressed.

I mean, I kinda had goddess-like skin while on the birth control pill – along with raised cholesterol, blood pressure, yeast infections, and hair loss. (And I can’t be on THAT when I’m pregnant. Clearly.) And antibiotics did the trick temporarily – along with their companion gift of nausea and loose stools. And so, I thought I would go to some magic “Preparing for Pregnancy” store and purchase a great, safe product to help me with my plight.

However, I discovered two things:

1. A perfectly healthy product doesn’t exist and
2. If it did, no one would be able to agree upon whether it was safe or not.

I was able to make sense of the U.S. FDA’s categories of drugs during pregnancy:

Category A – NO RISK

Category B – BASICALLY NO RISK

Category C – POSSIBLE RISK BUT BENEFITS COULD BE WARRANTED

Category D – YES, THERE’S RISK BUT BENEFITS COULD BE WARRANTED

Category X – NO WAY

Let’s start with the biggest NOs and move up the list…

• Accutane (also known as Isotretinoin) – Category X- According to OTIS (Organization of Teratology Information Specialists):

“The risk for having a miscarriage may be as high as 40% when a woman takes isotretinoin in early pregnancy… Isotretinoin causes a pattern of birth defects in more than 35% of infants whose mothers take the drug during pregnancy… Many of the exposed children will have moderate to severe mental retardation.”

• Tazorac (tazarotene) – Category X – According to EMedTV:

“When Tazorac was given to pregnant animals, it caused a wide range of serious birth defects, such as spina bifida, hydrocephalus, and heart problems. Other problems, such as low fetal weight, miscarriages, and developmental delays, were also seen.”

• Tetracycline -Category D – According to OTIS:

“If you take tetracycline after the fourth month of pregnancy, there is a risk for discoloration (graying) of the ‘baby’ teeth… Tetracycline appears to affect the calcification (hardening) of the bones and teeth, and it also appears to cause reduced growth of some bones while the baby is being exposed to the medication.”

• Retin-A (Tretinoin, the retinoid family) – Category C – According to OTIS, since it is used topically, only “low amounts of tretinoin pass through the skin into the mother’s bloodstream and even less reaches the baby.” And several studies looking for a link between pregnant mothers’ tretinoin use and birth defects in their babies have come up negative.

However, “there have been four reports of babies born with birth defects after their mothers used tretinoin during pregnancy… the birth defects in those four cases are like the defects seen in babies whose mothers took isotretinoin during pregnancy.” Conclusion? Forget it – better safe than sorry.

Retinoids or Retinols (Vitamin A) are not only found in prescriptions from your dermatologist. Look at the ingredients in your facial washes, lotions, and eye creams purchased over-the-counter as well.

• Differin (Adapelene) – Category C – in the same family of drugs (retinoids) as Retin-A.

• Salicylic Acid, Benzoyl Peroxide – Category C – My current dermatologist says no. My esthetician says yes. My OB/GYN says they’re okay in small doses and concentrations. Others say they’re okay after the first trimester, though aspirin (a form of oral salicylic acid) is not recommended. My friend says no way. In other words, the jury’s out on these two.

What we do know is that, when used topically, a small amount of both salicylic acid and benzoyl peroxide can be absorbed systemically, but there are no studies looking at either in pregnancy. If you are going the safe route, also check all over-the-counter products. Chances are if the product is specifically made to treate acne, it’s got either salicylic acid or benzoyl peroxide in it. And just because you shop at a “healthy” store doesn’t mean you’re off the hook. In the more natural products, salicylic acid may be listed as Willow Bark.

• Topical Erythromycin, Clindamycin, Azelaic Acid (Category B) – My current dermatologist says yes. The other derm in that office says to be as pure as possible. My dad, a doctor, says no. I have yet to talk to my OB about any of the three. But the general consensus is that these are all safe to use during pregnancy.

However, I was never quite happy with a B in school, and my worry, perfectionism, and neuroticism are kicking in. What is in the A category??

Everything I have read on Glycolic Acid says it is safe, and my dermatologist even sold a glycolic acid wash to me. So, Category A? I can’t find that listed anywhere. I am starting to believe that an article in The New York Times said it best:

“Products are categorized by toxicity levels: those in pregnancy category A like folic acid have no evidence of risk, but none of them quell blemishes.”

Well, certainly topical herbs that I buy at the health food store are Category A+, safe for all. Right?

Wrong. The U.S. FDA does not categorize herbs and supplements the way it does other drugs. According to the American Pregnancy Association, one can go to the Natural Medicines Database to find out information regarding the safety of natural medicines throughout one’s pregnancy. Each natural medicine is placed into one of the following categories:

• Likely Safe
• Possible Safe
• Possibly Unsafe
• Likely Unsafe
• Unsafe
• Insufficient Evidence

I went to check it out, but it costs to join and search their database. So I did a little sleuthing elsewhere. Some herbs seem safe to use topically but are not recommended orally while pregnant. And regarding most topical herbal supplements that I have heard/read help acne – from tea tree oil to camphor to sulfur to arnica montana to witch hazel – the research seems contradictory at best, inconclusive or non-existent.

Feeling that pregnant glow? Keep your complexion free from acne during pregnancy by eating well, relieving stress, and promoting a healthy liver to clarify your skin!

So what is a hormonal, broken-out “mommy-to-be”…to do? Well, once my frustration subsided after having not discovered the safest product with which to curb my acne, I turned my focus away from what more I could do and take to what I was already doing. And I came up with the following list of improvements:

1. Clean Up My Diet

I have discovered that when my digestion is off, my acne is ON. For example, my skin seems to break out more when I eat nuts. And as The Body Ecology Diet suggests, nuts are tough to digest, especially when our inner ecosystems are compromised. So I’ve cut those out for now.

I’ve also found that my overall digestion is better while drinking Probiotic Liquids and taking a probiotic supplement.

I am loading up on vegetables of every color, healthy fats, and organic, low-mercury fish, and organic, hormone-free poultry. And, of course, no gluten, no refined sugar, and caffeine only from green tea.

2. De-Stress – i.e. Daily Meditation

Our lives reflect what we create in our minds. So if I want a smooth, calm complexion, I must think smooth, calm thoughts. I aim to meditate for 20 minutes a day. “Who has 20 extra minutes?” I know, but taking time to sit still each day is perhaps the kindest thing I can do for myself – as a reminder that I am indeed a human being and not a human doing.

3. Sleep Better (and More)

No falling asleep with the television on – in fact, we took it out of our bedroom. (Nothing like the scary news to rock you to sleep!) And I’ve been aiming for 7 to 9 hours a night. “But I don’t have time to sleep!” But, oh, how much time is wasted when I don’t! PLUS good sleep equals good skin; in Chinese medicine, the liver cleanses between 1am-3am, and if you eat too late or go to sleep too late, the liver will not complete all of its house cleaning.

4. Improve Cleansing Regime

All makeup comes off each night no matter how late it is and how tired I am. I am washing my face in the morning and night followed by a 30 SPF UVA/UVB sunscreen in the morning and a moisturizer at bedtime. Take care, however, that your sunscreen does NOT contain the ingredients Oxybenzone or Retinyl Palmitate. According to the Environmental Working Group (EWG), the ingredient Oxybenzone:

“Can trigger allergic reactions, is a potential hormone disruptor, and penetrates the skin in relatively large amounts. Some experts caution that it should not be used on children.”

My dermatologist told me to avoid it too. EWG’s website also points to a study recently done by the FDA on another very common sunscreen ingredient, Retinyl Palmitate:

“Recently available data from an FDA study indicates that a form of vitamin A, retinyl palmitate, when applied to the skin in the presence of sunlight, may speed the development of skin tumors and lesions (NTP 2009). This evidence is troubling because the sunscreen industry adds vitamin A to 41% of all sunscreens.”

The Environmental Working Group (EWG) says that, at present, mineral sunscreens (i.e. zinc or titanium) are our best and safest best as far as products are concerned. But the very best things to do are: cover up, get in the shade, and avoid peak hours when the sun is directly overhead.

5. Clean Out the Liver and the Colon

Making sure the major elimination channels are open is key. I first use LivAmend to move what has built up in the liver. Then colonics will even be more effective. ALL the colon hydrotherapists I’ve spoken to agree to AVOID colonics early in pregnancy, although a few said later in pregnancy may be ok.

Who knows? Maybe this acne has been a blessing of sorts. An internal alarm system telling, alerting me that there is something it doesn’t like going on internally.

So, I am going to wash my face twice a day, calm down, sleep well, and make sure my diet is clean.

And when I do have a little bun in the oven… if my acne gets worse? Well, I can look at it as a reminder that I need to take extra special care of myself. And I kinda predict that the little bumps on my face will soon be forgotten, as the object of my attention – and affection – will be one, great big bump.

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