I’ve written previously about pregnancy skincare, but another popular topic is breastfeeding skincare. I just did an Instagram live (watch the recording here) with Elvie last week, and I wanted to write down some of the key takeaways here regarding these topics. If you want to read the primary literature, please see the 2014 Dr. Murase et al JAAD paper located here for pregnancy (See Figure 1) and here for lactation or the Bozzo paper on skin care products here.
One general note: The gold standard in research is to do a randomized controlled trial, where one group is randomized to use a certain treatment and another group does not use that ingredient and you observe the outcomes. However, as you can imagine, this would be wildly unethical to test ingredients on pregnant or breastfeeding women to see what happens to their babies. A lot of what we do in this case is look backwards (retrospective studies) and see if we can correlate usage of certain ingredients during pregnancy or lactation with outcomes in babies. There can be many confounding factors that muddy the waters using this method; how do we know if an outcome is due solely to the ingredient vs. anything else the women may have been exposed to during that time? Authors try to control for these outside factors but it’s not always 100%. This is all to say that ingredients are not so black and white; it depends on the quality of the studies and the level of evidence we have for different products.
Breastfeeding
Good news: most topical skincare ingredients are not majorly absorbed into the bloodstream and are therefore safe to use while breastfeeding. In general, most topical skincare is safe to use, but you do not want to apply the products directly on the nipple or breast or anywhere where the baby can ingest it.
Rogaine is safe to use, with only 1.4% of it absorbed systemically. Cosmetic treatments such as Botox and hydroquinone are generally not recommended for usage during breastfeeding due to potential exposure to the baby. There was a case report of a mom who was actually hospitalized for systemic botulism resulting in paralysis, and even though botulinum toxin was present in her blood, it was not in her breastmilk, and her baby was able to breastfeed throughout the mom’s hospital stay. However, to be safe, because this is not a medically necessary exposure, we recommend to avoid it.
Retinoid and retinol use while nursing is a personal decision, as there have not been any studies done looking specifically at topical retinoid/retinol use during lactation. According to the major dermatology journal article looking at safety of ingredients, tretinoin is deemed “moderately safe” and “unlikely absorbed in significant quantities.” Tazorac, which is a high strength retinoid, should not be used Please talk to your doctor about your personal decision about whether or not to use this while nursing.
The jury is also still out regarding sunscreen. Chemical sunscreen filters such as oxybenzone have been found in human milk, though studies have not demonstrated this to be toxic. For me personally, I choose to use mineral sunscreens while pregnant and breastfeeding, because there are so many great options and I don’t need to think about any potential side effects.
Oral medications are different. Spironolactone for hormonal acne may cause suppression of milk, and Accutane is a definite no no.
Any questions for me?
Katey says
Hello! Thank you for your informative article. You mention a major dermatology journal article looking at safety of ingredients, that said tha tretinoin is deemed “moderately safe” and “unlikely absorbed in significant quantities.” Can i ask which journal this is? Do you have a link? Thanks so much
Joyce says
Absolutely! Please find the linkhere