Last week I asked on Instagram stories what your pregnancy skincare questions were, and man, you guys came up with some great ones! I’m going to share some of them here and answer them. This was a great learning exercise for myself too!
Safety of Products and Procedures
- Botox: Generally contraindicated during pregnancy and breastfeeding. There have been no studies done that knowingly inject pregnant and breastfeeding moms (obviously, for ethical reasons!) but I did find one study that surveyed physicians about patients they inadvertently injected while they were pregnant or breastfeeding. Of the 19 pregnancies in which the moms received Botox injections, one was terminated medically and another woman with a history of spontaneous abortion miscarried. The woman who had a miscarriage had received one series of injections for cervical dystonia and had received approximately 300 U of botox. The other 17 pregnancies went to full term without complications and none of the infants needed special postnatal care. Because Botox is not medically necessary, I would NOT suggest getting this done during pregnancy or breastfeeding. (Non pregnant women: if you’re interested in Botox, click here and here to learn more about my personal experience with it!)
- Retinoids: The theoretical risk of topical retinoid and retinol use during pregnancy is unknown. The amount of drug systemically absorbed is low, but in the literature, there are 4 published case reports of birth defects in the literature associated with retinoid use. Because of this, we STOP all retinoid and retinol use during pregnancy.
- Hydroquinone: This is a bleaching cream (see below) that we do not recommend using in pregnancy and breastfeeding.
- Vitamin C: safe and recommended to help lighten dark spots and prevent hyperpigmentation. Here is a primer on all you need to know about this power ingredient for both antiaging and brown spots.
- Sunscreen: safe and recommended! I chose physical blockers for this time. Lately I’ve been loving the Colorescience Sunforgettable in SPF 50 and the bare minerals complexion rescue gel with SPF.
- Glycolic acid / lactic acid / salicylic acid: Generally considered safe at the low concentrations that we use in skincare (<10%). There have been studies done in women who took salicylic acid (aspirin) orally during pregnancy and found no increase in bad outcomes such as malformations, preterm birth, or low birth weight. The higher concentrations used in professional offices for chemical peels are to be avoided, in case of systemic absorption.
- Topical erythromycin / clindamycin: Used in acne, these are generally considered safe for use in pregnancy.
- Sodium sulfacetamide wash: Great for acne and rosacea, this is generally considered safe for use in pregnancy. Obviously if you have a sulfur allergy, you cannot use this, pregnant or not.
Hyperpigmentation and Melasma
We get dark spots and melasma (brownish patches on our forehead, cheeks, chin, upper lip) during pregnancy because we get increased levels of MSH (melanocyte stimulating hormone), estrogen, and progesterone during pregnancy. Melasma is notoriously difficult to treat once it is present, so you need a two pronged approach: prevention and treatment. Here is an excellent article summarizing some of the treatments in more detail. This is one of the major problems we face during pregnancy, so make sure you have something targeting hyperpigmentation in your pregnancy skincare routine!
- Prevention: Sunscreen, broad spectrum, UVA/UVB blocking, SPF 30+, daily, and my pro-tip: find a sunscreen with IRON OXIDE! This is often used in tinted moisturizers and makeups, and it’s so important because it blocks visible light (for ex: blue light from laptop and cell phone screens). Make sure to check the ingredients of your sunscreens so they block UV radiation AND visible light, because new research coming out says that all of these types of light can worsen melasma and dark spots.
- Treatment: We’re limited in what we can use during pregnancy. During pregnancy, we can use exfoliants like glycolic acid or lactic acid, kojic acid, steroids, niacinamide, and more. AFTER you’re no longer pregnant or breastfeeding, Hydroquinone is the mainstay of therapy, which is a bleaching agent that blocks the production of melanin. Hydroquinone comes in 2-4% formulations, and at higher concentrations up to 10% are available through a dermatologist. More research is coming out about tranexamic acid as well; read here about oral and topical applications of this mediation usually used in the ob/gyn world to stop excessive bleeding.
Acne Treatment
Our treatment options are limited during pregnancy because we cannot use certain oral antibiotics or Accutane. There are topical options that are safe though. Finacea, or azelaic acid, topical clindamycin or erythromycin (topical antibiotics), benzoyl peroxide in 5% or less, salicylic acid in low concentrations (not the high percentages found in chemical peels), and light therapies are all options to treat acne safely in pregnancy. Aczone (topical dapsone, an antibiotic) is a relatively new treatment and safety of use in pregnancy has not been established yet.
Rosacea Treatment
Similarly, because we cannot use oral antibiotics like doxycycline, we rely more on topical therapies such as niacinamide and azelaic acid.
Protection from the sun is key, as we know that UV radiation flares rosacea. You also want to identify your triggers: is it caffeine, cold or warm weather, spicy food or hot food, embarrassment, physical activity, etc? Try to avoid triggers as much as possible.
Any other questions that you have? I’ll be covering a couple other of your questions in my next post!
Menardi says
Congratulations on your pregnancy! Hope you are looking forward to a new chapter as a family with a newborn. What do you think about stem cell creams such as Calecim? They seem to be really popular amongst aesthetic doctors now. https://calecimprofessional.com/calecimr-professional-multi-action-cream-50g-trial.html
Is this safe for pregnancy? How about lip balms containing epidermal growth factors?
Joyce says
Hi Menardi, that’s a good question. I hadn’t actually heard of Calecim before, so I took a closer look at it. Calecim makes a cream with extracts from Red Deer Umbilical Cord Lining Mesenchymal Stem Cell media. There is one study published in Journal of Drugs in Dermatology in 2019 which had 40 subjects put Calecim cream on one half of the face and a placebo cream on the other half of the face for 3 months, and assessed the efficacy safety and tolerability throughout. It had the following conclusion:
Results: Both sides of the face achieved significant improvement. Blinded investigator assessments did not detect any statistically significant differences between the two halves of the face in terms of efficacy, safety, or tolerability. Subject evaluations demonstrated superiority of the active treatment side. Conclusion: Red deer umbilical cord lining mesenchymal stem cell extract was effective in rejuvenating the aging face as demonstrated by investigator and subject measures.
It’s interesting to me that blinded investigator assessments (meaning the person assessing the outcome of the subjects didn’t know whether the patient received the Calicem cream or the placebo cream) didn’t find any significant differences with the Calicem cream; also interesting that BOTH sides of the face (treated and untreated) showed significant improvement. However, the patients themselves thought it was effective.
My take: I’m not convinced by this one study that this is a magical anti-aging cream based on the ingredients themselves. I’m not sure if it is safe in pregnancy as there is no ruling or pregnancy-safe information on the active ingredients.
Viva Glow says
Good news for the acne sufferers that they can continue with topical creams during pregnancy. Do you have any suggestions for preventing stretch marks and dark underarms during pregnancy?
Joyce says
Hi! Please see my post on stretch marks here. Dark underarms and pigment changes such as the linea nigra (the vertical line down the belly) are unavoidable, but the good news is that it may lighten once you deliver!
Michelle says
This is great info! I always look forward to your blog posts. Thank you Dr!
Maria says
This is an amazing read! Thank you so much. I feel like i know a bit more about my melasma. I found a product people raved on You Tube called JJ Labs Skincare Solutions for melasma. This product is their Skin Brightening & Anti Aging Serum the ingredients are Hyaluronic acid, tranexamic acid, alpha arbutin, licorice, vitamin C, Vitamin E, optiphen, potassium sorbate, citric acid, distilled water. My jaw hit the floor when i saw these ingredients! WOW! Basically, everything you need to fight melasma. That being said, I don’t see any ingredient here that would alarm me if used while pregnant. What are your thoughts?
Joyce says
I’ll have to look into this product – I am not familiar with it. The ingredient list certainly sounds good, but efficacy also depends on how the ingredients are formulated together and the formulation conditions.