Topical Acne Treatments

What are topical acne treatments?

Topical acne treatments are applied to the surface of your skin to reduce acne. These medications are available in lotions, creams, gels, liquids, washes, and pads. There are various types of active ingredients that can be found in topical acne treatments, including retinoids (tretinoin, adapalene, tazarotene), antibiotics (clindamycin, erythromycin), dapsone, salicylic acid, azelaic acid, benzoyl peroxide, and sodium sulfacetamide. Some of these medications are available over-the-counter and others are available only with a prescription from your doctor.

What are topical acne treatments used to treat?

Topical acne treatments are used to treat acne on your skin. Acne is a skin condition caused when hair follicles are blocked by oil or dead skin cells. These clogged follicles lead to the formation of pimples, whiteheads, or blackheads on the skin’s surface. They usually appear on the forehead, face, upper back, chest, and shoulders. Oil and dead skin cells can also encourage a type of bacteria, called Propionibacterium acnes, to grow on your skin. This type of bacteria can lead to the formation of inflammatory lesions on the skin.

How do topical acne treatments work?

Topical acne treatments reduce acne through different mechanisms, which may include killing bacteria on the skin’s surface, increasing the rate of skin turnover (the process by which dead skin cells shed off the surface and are replaced by new skin cells), decreasing the amount of oil produced by the skin, or lowering inflammation to prevent scarring. Each topical acne treatment will have a different mechanism depending on the active ingredient in the product.

If I am taking a topical acne treatment, can it harm my baby?

Topical acne products should never be used during pregnancy without first speaking with your doctor. The active ingredients in some topical acne products are known to cause birth defects and are contraindicated during pregnancy, meaning they should not be used at all. Most other types of topical acne treatments have very little data available in pregnancy, so the risks of these medications are largely unknown. Your doctor will help you decide if a topical acne treatment is medically necessary during pregnancy, and which medication will be safest for both you and your baby.

Topical retinoids (tazarotene, tretinoin, adapalene) should not be used during pregnancy. There have been several case reports of birth defects associated with the use of topical retinoids during pregnancy. While some studies have not found an increased risk of birth defects with the use of topical retinoids, the authors have concluded that these medications are not safe for use during pregnancy. Retinoids that are taken by mouth increase the risk of miscarriage and birth defects. Depending on how much of the drug is absorbed by your skin, these effects may also occur with topical retinoids.

Some birth defects have been reported with the use of salicylic acid during pregnancy in animal studies. There are some cases of topical salicylic acid being absorbed into the blood in large amounts, but this has not reported with acne products. Due to the harm showed in animal studies, the FDA warns that the risks of harm to your baby with the use of topical salicylic acid cannot be ruled out. However, some studies consider the risks to be relatively low if topical salicylic acid is restricted to local areas and for limited time periods.

Additional examples of FDA warnings for the use of some topical acne treatments during pregnancy include:

• Topical tazarotene should never be used during pregnancy or in women who are planning to become pregnant. This medication may cause harm to your baby. The risks to the baby are greater than the benefits to the expecting mom.
• Topical tretinoin and topical adapalene: The FDA recommends that topical tretinoin and topical adapalene should only be used during pregnancy if the benefit to the expecting mom outweighs the potential risks. However, many studies consider all topical retinoids, including tretinoin and adapalene, to be unsafe during pregnancy and recommend avoiding these medications. Several birth defects have been reported with the use of topical tretinoin.
• Topical benzoyl peroxide: Some topical benzoyl peroxide products are only recommended by the FDA for use during pregnancy if medically necessary and if the benefits to the expecting mom outweigh potential risks. Ask your doctor before using any over-the-counter topical benzoyl peroxide formulas during pregnancy.
• Topical erythromycin and clindamycin should only be used if medically necessary.
• Topical dapsone should not be used during pregnancy unless the benefits to the expecting mom outweigh the potential risk to the baby.
• Topical sodium sulfacetamide and sulfur should only be used during pregnancy if medically necessary.
• Topical azelaic acid should only be used during pregnancy if the benefits to the expecting mom outweigh the potential risk to the baby.
• Topical salicylic acid: The risks of harm to your baby with the use of topical salicylic acid cannot be ruled out. Topical salicylic acid should only be used during pregnancy if the benefits to the expecting mom outweigh the potential risks. Over-the-counter topical salicylic acid products should not be used during pregnancy without first speaking with your doctor.
• This list composes only a few of the many topical acne treatments that are available. There are many additional active ingredients that can be found in topical acne treatments. Any medication has the potential to cause birth defects or harm to your baby. Always consult your doctor before using any topical acne treatment during pregnancy.

Despite FDA warnings, some study authors consider topical benzoyl peroxide to be safe during pregnancy. Topical azelaic acid has been found to be a low risk drug by many studies. Topical clindamycin and erythromycin are considered safe for short-term use during pregnancy by some experts. Theoretically, if topical dapsone is used near delivery, it may cause a condition where your baby has high amounts of a substance called bilirubin in the blood. Therefore, it is recommended to discontinue topical dapsone one month before delivery.

Bottom line: Always ask your doctor before using any topical acne treatment during pregnancy. Topical retinoids should not be used during pregnancy because they may increase the risk of birth defects or harm to your baby. There is very little data on the safety of most topical acne treatments during pregnancy, and the risks of many of these medications cannot be ruled out.

If I am using a topical acne treatment and become pregnant, what should I do?

If you become pregnant while using a topical acne treatment, you should contact your doctor immediately. Some topical acne products should not be used during pregnancy and may cause birth defects. Your doctor will help you determine if the topical acne treatment that you are using should be discontinued, or if it is safe for you and your baby.

If I am taking a topical acne treatment, can I safely breastfeed my baby?

There is not enough information to determine if many topical acne treatments are safe while breastfeeding. Always ask your doctor before using any topical acne treatments before breastfeeding. The FDA recommends that some topical acne treatments should be discontinued prior to breastfeeding, or alternatively, that breastfeeding should be discontinued. Your doctor will determine if a topical acne treatment is medically necessary and which product is safest for you and your baby.

Examples of FDA warnings for the
use of some topical acne treatments while breastfeeding:

• Topical retinoids: It is unknown if topical retinoids (tazarotene, tretinoin, or adapalene) pass into breast milk. Caution should be used when using topical tretinoin and topical adapalene while breastfeeding. For topical tazarotene, it is recommended to weigh the benefits of breastfeeding against the medical need for the medication. Your doctor will determine if the benefits of these medications outweigh the potential risks to your baby.
• Topical clindamycin/benzoyl peroxide: It is recommended to either discontinue breastfeeding or discontinue topical clindamycin/benzoyl peroxide prior to breastfeeding.
• Topical erythromycin: It is unknown if topical erythromycin passes into breast milk. Caution should be used before using topical erythromycin while breastfeeding.
• Topical dapsone: It is unknown if topical dapsone passes into breast milk. It is recommended to either discontinue topical dapsone or discontinue breastfeeding.
• Topical sodium sulfacetamide: It is unknown if sodium sulfacetamide passes into breast milk. Caution should be used before using sodium sulfacetamide in breastfeeding moms.
• Topical clindamycin: It is unknown if topical clindamycin passes into breast milk. It is recommended to either discontinue topical clindamycin or discontinue breastfeeding.
• Topical azelaic acid: It is unknown if topical azelaic acid passes into breast milk. It is recommended to either discontinue topical azelaic acid or discontinue breastfeeding.
• Topical salicylic acid: Depending on the strength of the product, it is recommended to either discontinue the topical salicylic acid product or discontinue nursing. You should ask your doctor before using any over-the-counter topical salicylic acid products while breastfeeding.
• Others: This list contains only a few of the topical acne treatments that are available. There are many other active ingredients found in topical acne treatments. Never use any topical acne treatment while breastfeeding without first speaking with your doctor.

Despite FDA recommendations, some experts consider benzoyl peroxide to be a low risk drug and topical salicylic acid acne treatments to be safe while breastfeeding. In addition, experts recommend that topical tazarotene should not be applied to larger than 20% of the body surface while breastfeeding due to the potential for the medication to be absorbed. There is no safety data on the use of most topical acne treatments while breastfeeding. If your doctor determines that a topical acne treatment is medically necessary and safe to use while breastfeeding, always ensure that your baby does not come into contact with the treated areas. Wash your hands after using any topical acne treatment and before handling your baby. You should also not apply topical acne products to the nipple area.

Bottom line: Always ask your doctor before using any topical acne treatment while breastfeeding. Some of these medications are not recommended for use while breastfeeding. Your doctor will determine whether a topical acne treatment is medically necessary and which product is safest.

If I am taking a topical acne treatment, will it be more difficult to get pregnant?

There have been no studies on the effects of topical acne treatments on fertility.

It is important to note that some topical acne treatments require the use of effective contraception because they may cause birth defects. Contact your doctor before trying to get pregnant to determine if the topical acne treatment that you are using is safe.

If I am taking a topical acne treatment, what should I know?

Always ask your doctor before using any topical acne treatment during pregnancy or if you are planning to become pregnant. Topical retinoids should not be used during pregnancy and may cause harm to your baby. There is very little data on the safety of most topical acne treatments during pregnancy. Your doctor will determine if a topical acne treatment is medically necessary and which medication is safest for both you and your baby.

Always ask your doctor before using any topical acne treatment while breastfeeding. For most topical acne treatments, it is unknown if these medications pass into breast milk. If your doctor determines that a topical acne treatment is medically necessary, you should ensure that your baby does not come into contact with any areas where the medication was applied.

If I am taking any medication, what should I know?

This report provides a summary of available information about the use of topical acne treatments during pregnancy and breastfeeding. Content is from the product label unless otherwise indicated.

You may find Pregistry's expert report about acne here.  Additional information can also be found in the links below. 

Resources for topical acne treatments during pregnancy and breastfeeding:

For more information about topical acne treatments during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:

Mayo Clinic: Acne: Diagnosis & treatment

Mayo Clinic: Acne: Symptoms & causes