Pregnancy Acne: Causes, Treatments, and More

Jeff Hautala
By Jeff Hautala, Co-Founder of Exposed Skincare

If you have pregnancy acne, you’re in good company: over 50% of people see increased acne at some point during their pregnancy. This is due, in large part, to the hormonal fluctuations that take place during pregnancy. Your body is creating a whole new cocktail of hormones in order to create a baby, and as we will discuss, acne is a strong possibility any time your hormones shift. Although pregnancy acne is caused by hormones and has its own name, it’s still acne, so most regular acne treatments work just as well on pregnancy acne. The one exception is systemic acne treatment. With most hormonal acne, we would recommend a hormonal treatment to cut the acne off at the source. But when you’re pregnant, you need those hormones to be doing all the crazy things they’re doing. Anything that alters your hormones could increase the risk of birth complications or defects, so we’ve included a list of medications you definitely should not take, along with a list of effective acne treatments you could try instead.

pregnancy acne
Pregnancy acne is just regular acne caused by the hormonal fluctuations involved in pregnancy.

Don’t Feel Bad If You Don’t Have Pregnancy Glow

Supposedly, women “glow” when they get pregnant; there’s just something about their skin that seems brighter somehow. Even though it sounds ridiculous and none of us really expect it to happen, it can be weirdly disappointing when, instead of glowing, we get acne. At a time when you’re under an immense amount of pressure to do things right, like eat the right things, sleep the right amount, go to the right checkups, getting acne can feel like a failure of sorts. We want to clarify: pregnancy acne is not a failure in any way. If you’re feeling guilty or confused or upset about your acne, just know that you’re doing fine. Acne during pregnancy is incredibly normal, and you aren’t doing anything wrong to cause it.

Then What Does Cause Pregnancy Acne?

Okay, you think, but then if it’s not me, then why is my acne back? I thought I left that behind in high school! Well, the reason you had more acne in high school and the reason you have acne again now are actually very similar: hormonal upheaval. In your teens, your sex hormones start playing a more prominent role in your body’s biology, and your testosterone and estrogen levels shift a lot. The same thing happens during pregnancy. All of your hormones will be increasing and decreasing at different times by different amounts, but when it comes to acne, there are two types of hormones to blame: sex hormones, and stress hormones.

The Link Between Stress and Acne

Stress hormones can cause acne because of our fight, flight, or freeze response. When we face emotional stress, like fears about bringing a life into the world, expanding your family, or going through childbirth, our bodies respond as though we are facing a physical threat and releases stress hormones like cortisol and adrenaline. These hormones prepare us for any incoming threat, and one way they do that is through inflammation.

Systemic inflammation, like that caused by a generic, stress-related inflammation response, leads to minor swelling throughout the whole body, including the skin. When the skin is inflamed, the pores constrict slightly and any oil, dead skin cells, or bacteria in that pore become trapped. This is the primary cause of all acne, from blackheads to cysts. During high-stress times, like pregnancy, you are prone to increased inflammation and thus, an increased possibility for acne.

Sex Hormones and Acne During Pregnancy

There are many hormones involved in anyone of any sex, but the two that are most related to acne are testosterone and estrogen. Although you may have heard that boys produce testosterone and girls produce estrogen, the truth is, everyone produces both. Most men produce more testosterone, most women produce more estrogen, and intersex folks can produce any combination of the two. No matter how much of either hormone you typically produce, neither one inherently causes acne. It’s when your own natural levels start to change that acne becomes a possibility.

How these hormones affect acne all depends on the ratio between testosterone and other, balancing hormones, like estrogen. If your body produces more testosterone than normal, you can see an increase in acne. If you start producing more estrogen, acne may start to disappear. However, if your normal estrogen levels drop, no matter what they are originally, you are likely to have more acne. This is because there’s less estrogen to balance out your normal levels of testosterone, whether they’re high or low. The ratio has changed, and it’s these changes that lead to acne.

During pregnancy, these hormones can shift in a multitude of ways. It’s important to remember that everyone is different, but generally, women see a rapid increase in estrogen during the first trimester which then plateaus in the second and third trimesters, and a slow but steady increase in testosterone throughout the pregnancy. The initial increase in estrogen can cause that “pregnancy glow” we talked about, but it can also cause acne or something known as “the mask of pregnancy,” which gives the skin a dark or grayish hue. Pregnancy acne is most likely to occur toward the end of the second trimester and throughout the third trimester, because estrogen levels are evening out as testosterone levels continue to rise.

pregnancy acne
Pregnancy acne usually starts at the end of the second trimester due to the increase in testosterone.

How Do These Shifts Lead to Acne?

Shifting hormones don’t just magically create blackheads and pimples. They contribute to one of the main causes of acne: oil production. Whenever testosterone increases (or estrogen decreases), the body produces more oil which can lead to blackheads, whiteheads, pimples, and even cysts.

Oil creates blackheads and whiteheads in much the same way because they are very similar. The only difference between a blackhead and a whitehead is whether or not the pore is closed. A whitehead forms when oil and dead skin cells get trapped in a closed pore, and a blackhead forms when a clogged pore is open. This is what gives blackheads their dark color. Contrary to popular belief, it is not dirt, but air that makes blackheads dark. Similar to how an apple turns brown if you cut it up and leave it on the counter for a while, the oil in an open pore gets oxidized by the air and turns brown in the pore. When we produce too much oil, it clogs pores more easily, leading to an increase in blackheads and whiteheads.

Oil can also lead to pimples and cysts, even though those types of acne are most commonly attributed to the third cause of acne: bacteria. P. acnes bacteria always live on the surface of our skin, and as long as they don’t grow to especially large numbers or get trapped in the pores due to inflammation, they typically don’t cause problems. They can even help reduce acne slightly because their main food source is the oil our skin produces. However, you see how this can become a problem during pregnancy, when our hormones are causing us to produce more oil. With more food, the bacteria can multiply very quickly and cause the minor infections that lead to pimples and cysts.

How to Treat Hormonal Acne Non-Hormonally

In most cases of hormonal acne, like puberty, menstruation, or menopause, dermatologists recommend a hormonal treatment that can prevent the creation of extra oil, rather than a topical treatment that simply tries to keep up with all the extra oil production. However, when you’re pregnant, your hormones are doing exactly what they’re supposed to be doing, and most hormonal acne treatments can cause serious problems. Instead, dermatologists recommend acne treatment products that reduce oil and exfoliate the skin to prevent clogged pores, and antibacterial products to kill the increased numbers of p. acnes bacteria.

Acne Treatment Products to Avoid While Pregnant

There are three products that a doctor should never prescribe you if you are pregnant: isotretinoin (commonly called Accutane), tazarotene, and spironolactone. All of these drugs have been proven to cause birth defects, and many doctors won’t even prescribe them to non-pregnant people without also prescribing birth control and having the patient sign a pledge to use two forms of birth control at all times.

Although these are the big three drugs that the American Academy of Dermatology says are a strict no-go, there are others you may want to be cautious about. Unfortunately, very few drug studies have been conducted on women, and even fewer have been conducted with pregnant women, so it is very difficult to ascertain the dangers of various medications during pregnancy. Because acne is not life-threatening and typically does not impair quality of life, many doctors may encourage you to err on the side of caution, but if your acne does present a serious problem for you, like anxiety or depression, you should definitely talk to your doctor about your options. Studies show that taking proper care of a pregnant mother almost always results in a healthier baby.

For instance, retinoids are often prescribed to reduce acne, especially severe or cystic acne. Isotretinoin and tazarotene are both retinoids, but they are incredibly strong ones. Milder retinoids like Differin have not been studies extensively in pregnant patients, and may be worth discussing with your doctor.

Another potential option for treating pregnancy acne is antibiotics. Although there are antibiotics deemed safe during pregnancy, like clindamycin, erythromycin, and amoxicillin, more and more research suggests that antibiotics are not overly effective in treating acne. Instead, we recommend benzoyl peroxide for killing p. acnes, salicylic acid for removing excess oil and exfoliating skin, and green tea extract for preventing inflammation.

The Best Treatment for Pregnancy Acne

The best treatment for pregnancy acne is a gentle skin care routine that you can do every single day. At times, being pregnant can feel like a full-time job, with all the extra vitamins to take and doctor’s visits to attend, so you want to be careful to use a skin care routine that won’t eat up too much of your time or energy. The Exposed Skin Care Basic Kit has only four products and three steps, and you can go through the whole process in less than five minutes each morning and night. Our products use the best ingredients for fighting acne while protecting your skin, including benzoyl peroxide, salicylic acid, and green tea extract.

Pregnancy acne is a pain, but taking on an intensive skin care regimen to get rid of it isn’t always feasible. Our Basic Kit is designed to be quick, easy, and effective.

Benzoyl Peroxide

Benzoyl peroxide is one of the most common acne treatment products right now because it can effectively kill 99% of p. acnes bacteria, making it a great treatment for pregnancy acne. Unlike antibiotics which try to kill bacteria by affecting their DNA or cell walls, benzoyl peroxide simply carries oxygen below the surface of the skin so it can come into contact with the bacteria. P. acnes are anaerobic, meaning they can’t survive long in the presence of oxygen. Regular application of a low-concentration benzoyl peroxide product (2.5%-5%) can effectively kill any extra p. acnes bacteria without irritating or damaging the skin.

Salicylic Acid

Benzoyl peroxide takes care of the extra bacteria that result from all the extra oil produced during pregnancy, but salicylic acid takes care of the extra oil itself. Salicylic acid is a gentle exfoliating agent, meaning it can help strip away excess oil without damaging the skin, as long as it’s used at a relatively low concentration, like 0.5%-2%. When used at higher concentration, salicylic acid products can strip away too much oil, leaving the skin exposed to irritants that can cause inflammation. Although it can be tempting to scrub away any and all oil that could be causing your acne, excessive scrubbing or harsh products are actually likely to make pregnancy acne worse.

Green Tea Extract

In order to prevent any irritation or inflammation that could result from these acne-fighting products, we have added green tea extract to our line of products. Green tea is widely known for its anti-inflammatory properties, even when simply drinking it, so we developed products that allow you to apply green tea extract directly to your skin. Because pregnancy is usually stressful and stress can often cause inflammation, green tea extract is an essential ingredient in your skin care routine if you have pregnancy acne.