Can I continue topical or oral acne treatments while I am pregnant? How long should I wait before I get pregnant?

It is learnt that acne is at its worst when women are at the height of their child-bearing potential, hence it is very important to let our doctor know all of the medications (including over-the-counter acne medications) that we are using to treat our acne if we become pregnant.

In fact, the FDA's (i.e. short for Food and Drug Administration) has divided drugs into five categories, i.e. ranging from completely safe to absolutely forbidden in pregnancy. And to qualify for a particular category, a drug must pass (or fail) certain scientific tests in either animals or humans, or both tests. We may want to refer to the FDA’s standards for each category as shown below:

Category A - Generally considered safe

• Controlled studies show no risk in first trimester
• No evidence of second- or third-trimester risk
• Risk of fetal harm remote

Category B - Caution advised

• Animal studies show no risk or adverse fetal effects. No controlled human first-trimester studies are available
• No evidence of second- or third-trimester fetal risk
• Fetal harm possible but not likely

Category C - Weigh risk/benefit

• Animal studies show adverse fetal effect. No controlled human and animal studies are available

Category D - Weigh risk/benefit

• Positive evidence of human fetal risk
• Maternal benefit may outweigh fetal risk in serious or life-threatening situations

Category X – Contraindicated

• Positive evidence of serious fetal abnormalities in animals, humans or both
• Fetal risk clearly outweighs any maternal benefit

We may notice that except for category "A" and "X", these ratings do require a judgment call, for example, harm to the baby is never a certainty, and that some drugs such as epilepsy medications, may be so crucial to the mother's safety as to make taking them the least risky choice.

If a drug is rated "X," avoid it at all costs if we even think we're pregnant. However, if it falls into the "B" or "C" categories, we should check with our doctor before discontinuing it as the risks may be low enough while its benefits is sufficient to make its continued use the wisest course.

Generally, topical BP (i.e. benzoyl peroxide, an antiseptic commonly used topically to treat acne as it does not induce bacterial resistance) and topical erythromycin (i.e. an antibiotic commonly used to treat skin infections) can be used during pregnancy although BP is in the pregnancy category C. It is leant that Azelaic acid (i.e. a natural material produced by a yeast that is used as a topical treatment for mild to moderate acne) which is rated in pregnancy category B, is approved for use by pregnant women in some countries. However, topical retinoids (i.e. products that are generally in the vitamin A family) are not recommended for use in pregnant women.

On the other hand, pregnant women who have severe acne or acne that leaves significant scars, oral tetracyclines, including doxycycline and minocycline, should be avoided at all costs because they are harmful to the developing fetus. Also oral trimethoprim is not recommended. Generally, erythromycin is considered the safest choice, followed by topical azelaic acid. It is advisable to review with our obstetrician before any medication for acne is used, who may tell us to hold off on certain acne treatments until after the first trimester of our pregnancy.

Points for reference:

1. It is advisable not to use retinoids during pregnancy though it is okay to stop using the retinoid once we think we may be pregnant.
   
   
2. Acne medications such as oral isotretinoin (e.g. Accutane, Sotret and others) must not under any circumstances be taken during pregnancy. Women who are taking oral isotretinoin must discontinue the drug at least 4 weeks before even trying to get pregnant. Therefore, it is very important for women who plan to take isotretinoin to have adequate contraception to ensure that they will not get pregnant either during the acne treatment or for 4 weeks after.
   
   Due to the serious side effects of it, the makers of oral isotretinoin has instituted programs called System to Monitor Accutane-related Teratogenicity (S.M.A.R.T.) or variations of it to help ensure that women do not get pregnant while taking this medication or for at least 1 month after. What follows are some of the birth defects that are associated with oral isotretinoin:
   
   Brain abnormalities/deformities
   Cleft palate
   Deafness
   Ear abnormalities/deformities
   Heart abnormalities/deformities
   Hormonal abnormalities
   Skull abnormalities/deformities