It is quite normal to experience skin changes in pregnancy with some women having oily skin problems while others dealing with extremely dry skin. In some women, the pregnancy hormones contribute to make the skin soft and silky, giving them the rosy “pregnancy glow” while others may be unlucky enough to develop multiple skin problems such as itchy skin with pimples and acne (acne vulgaris) .
Acne during pregnancy usually occurs on the face (cheeks, chin, forehead); however, they may also affect other skin areas such as the back, chest, neck and even the scalp . The high hormone levels can even lead to painful cystic acne in some cases.
Is Acne a Sign of Pregnancy?
It is one of the less common early pregnancy symptoms as some women may experience a noticeable acne outbreak during the 4th or 5th week of pregnancy , even before they notice a missed period. However, acne may appear anytime in the first, second and third trimesters .
Acne during pregnancy: boy or girl?
According to old wives’ tales, having acne during pregnancy means you are carrying a girl as a girl fetus was said to steal away the mother’s beauty.
Why does pregnancy cause acne?
The exact factors and mechanisms leading to the outbreak are still not clear. However, high levels of the pregnancy hormone androgen are known to be one of the responsible factors . The functions of this hormone include boosting sebum production and prompting the sebaceous glands in the skin to get bigger. The extra sebum (an oily substance) combines with the dead skin cells lining your hair follicles to clog your skin pores. This oily environment is ideal for bacteria to grow and multiply rapidly, eventually leading to skin inflammation and eruptions .
In most cases, the hormone levels peak in the first trimester. So, women who do not have acne in early pregnancy are less likely to have them in the later stages . Those diagnosed with polycystic ovarian syndrome (PCOS) are sometimes more likely to experience acne outbreaks while pregnant.
How to prevent acne while pregnant?
There is often no way to prevent acne during pregnancy as it is not possible to control the hormonal changes that lead to the problem. However, taking the following precautions might help to check the outbreak:
- Using a mild, soap-free face wash or cleanser to clean your face twice daily, rinsing thoroughly around your jaw and hairline (as the pores are most likely to get clogged in these areas) 
- Patting your skin dry after each wash as rubbing with towels or washcloths can irritate the facial skin, leading to the problem
- Using oil-free moisturizers, face wash and makeup
- Using an oil-free sunscreen lotion (SPF 15 at the least) whenever going out during daytime  (avoiding the sun is even more vital in case of cystic acne)
- Wearing hats and full-sleeve clothes to avoid exposing your skin to direct sunlight
- Washing your hair regularly (especially if you have oily hair)
- Washing and cleaning your towels, pillowcases and hats regularly
- Drinking lots of water to flush out any harmful toxins and keep the skin hydrated
- Following a diet containing plenty of fresh fruits and vegetables rich in vitamins A, E and B complex (especially B6) as well as zinc and fiber 
- Avoiding oily, greasy foods and fast foods
- Getting lots of sleep and practicing some relaxation techniques to avoid fatigue and stress
How to get rid of pregnancy acne?
Acne in pregnancy is a normal skin condition that gradually goes away on its own after delivery . Although it is impossible to get rid of them overnight, there are many safe natural treatment options and medications to control and improve the symptom:
Home remedies for acne
- Applying a small amount of tea tree oil on the affected area 
- Squeezing some fresh lemon juice and applying it on the acne with a clean cotton ball is one of the fastest ways of getting rid of pregnancy acne 
- Regular application of papaya juice helps cure the problem
- Adding some powdered nutmeg to half a cup of boiled milk and applying on the acne with a cotton ball
- Rubbing a clove of garlic can help as garlic contains several medicinal components that are beneficial for skin 
- Making a smooth paste of tomato and cucumber and applying it on the affected areas for 5 to 10 minutes
- Mixing some cinnamon powder to a tablespoon of honey and applying the mixture on the face, leaving it on for around 30 minutes before rinsing off with warm water 
- Fruits with yellow flesh, such as orange and mango, can be used for making a pulp and applying on the acne – it is one of the best acne treatments during pregnancy
- Applying some toothpaste is a traditional way of clearing up acne, even cystic acne 
- Mixing one part apple cider vinegar with three parts of distilled water for making your own toner. The naturally occurring enzymes in apple cider vinegar contain alpha hydroxy acids that help to get rid of dead skin cells, balance the skin pH and reduce acne as well as acne scars . ACV is considered one of the best natural ways to get rid of cystic acne .
- Regularly applying coconut oil to clear up pregnancy acne as it has anti-bacterial and anti-fungal properties 
- Application of aloe vera gel is another traditional safe acne treatment
- Jojoba oil is considered safe for external use in pregnancy 
- The homemade baking soda-water mask is considered safe for pregnant women as its application is external; however, it is recommended to consult your doctor before opting for this remedy due to lack of study regarding its risks during this time 
- Applying argan oil on the affected areas 
- Applying a mixture of castor oil and olive oil
Natural acne treatments like witch hazel  and evening primrose oil  are considered unsafe for pregnant women.
Safe acne medications to use during pregnancy
Certain topical prescription medications are considered safe during pregnancy as they are not absorbed in your body, thus cannot harm your baby . These include:
- Clindamycin (e.g. Cleocin T, Clindagel)
- Azelaic acid (Finacea, Azelex)
- Erythromycin (Erygel) 
Cephalexin (Keflex) is another prescription drug that belongs to pregnancy category B, meaning this drug is not likely to harm the baby when taken under medical guidance .
Over-the-counter anti-acne solutions and lotions containing sulfur, glycolic acid and benzoyl peroxide are also considered safe  as only 5% of the creams are absorbed by your skin . Therefore, they have minimal chances of harming your baby. However, it is recommended to consult your doctor before using any such products as other components in them might be potentially harmful for pregnant women .
Are regular acne treatments and products safe during pregnancy?
Hormone therapy: Includes anti-androgens like spironolactone and flutamide as well as estrogen that can lead to various birth defects .
Oral tetracycyclines (minocycline, doxycycline, tetracycline): Can affect bone growth and cause permanent teeth discoloration .
Topical retinoids: There is a lack of research regarding the potential dangers of using acne fighting products such as Retin-A (tretinoin), Differin (adapalene) and Tazorac (tazarotene) . Although low amounts of the products are absorbed by the skin, they still carry considerable risk of birth defects .
Accutane (Pregnancy Category X): Also known as isotretinoin, it has been shown to increase the chances of life threatening congenital anomalies including heart defects, central nervous system defects and craniofacial defects by 25% to 35% . It is also associated with increased risk of miscarriage .
Other acne treatments such as antibiotic medicines, inorganic compounds (e.g. milk of magnesia) , laser or light therapy and chemical peels are also not recommended for pregnant women unless prescribed by doctors.
Acne ICD-0 and ICD-10 Codes
The ICD-9 code for acne is 706.1  while the ICD-10 code used for indicating it is L70.0 .
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