Dr Ian Webster
Dr Ian Webster

A Dermatologist’s Guide to Skincare in Pregnancy

This is a tricky subject to write about as very few clinical trials are conducted for skincare ingredients while a woman is pregnant. Therefore, we have to rely on anecdotal evidence on the use of certain skincare ingredients in pregnancy.

When a major pharmaceutical company produces a new skincare product, the package insert will often state the following: ‘The safety and efficacy of this product in pregnancy and lactation has not been established’. In other words, they are playing it safe by saying that their new skincare product has not been proven to be safe in pregnancy.

Hormonal changes occur during the pregnancy and many skin conditions such as acne, rosacea, pigmentation, and unwanted hair growth takes place which obviously may be very frustrating for the pregnant woman. Below is a guide to the treatment of the above skin conditions during pregnancy. I have thoroughly researched all the products and ingredients recommended which are generally considered safe to use during pregnancy.

Skincare Products To Avoid During Pregnancy

Prescription medications such as Isotretinoin and oral tetracycline antibiotics should definitely not be prescribed during pregnancy.

Topical hydroquinone and topical retinoids in the form of Tretinoin, Adapalene, Isotretinoin, and Retinol should also not be used during pregnancy or lactation.

Acne

With the hormonal changes in pregnancy, it is common for women to get acne breakouts, and often this may lead to post-inflammatory hyperpigmentation especially in people with a darker skin tone.

Depending upon the person’s skin type, I would recommend a gentle cleanser appropriate for the person’s skin. Many anti-acne cleansers may contain a low concentration of Salicylic Acid between 1% – 2% but as the cleanser is a wash-off product, this concentration of Salicylic Acid is generally considered to be safe to use in pregnancy. I would, however, avoid harsh toners and scrubs as any irritation of the skin is more likely to lead to post-inflammatory hyperpigmentation.

If Salicylic Acid (2%) is not used as a wash-off product, then it should only be used as a spot treatment only, as well as the frequency of applications should be considered.

Azelaic Acid and Niacinamide are generally considered safe to use during pregnancy. Azelaic Acid is an especially useful ingredient as it helps for blackheads, whiteheads have anti-inflammatory properties, and also helps to lighten pigmentation. Azelaic Acid is found in milk as well as wheat, rye, and barley. I wouldn’t recommend using anything with over 20% Azelaic Acid in it applied topically.

Benzoyl Peroxide has anti-bacterial and anti-inflammatory properties and should be used as a spot treatment to more inflamed red pustules caused by the acne breakout, no more than twice a day. Benzoyl Peroxide that is applied to the skin is metabolized to benzoic acid which is a food additive. I wouldn’t recommend using more than 5% Benzoyl Peroxide applied topically as a spot treatment.

What is very important is to use the appropriate mineral, high factor, broad-spectrum sunscreen to prevent post-inflammatory hyperpigmentation as well as melasma. This is a vital part of protecting your skin during pregnancy.

An excellent treatment for acne in pregnant and lactating women is the Acleara/Theraclear Acne Clearing System. This novel in-clinic laser-like device uses Intense Pulsed Light which has an anti-inflammatory action and a gentle vacuum therapy that extracts blackheads and whiteheads. A number of treatments are required and it is a very safe and useful treatment for mild to more severe forms of acne. Depending on your medical plan, treatments can be claimed from your medical aid. This treatment is available at various laser clinics throughout South Africa: www.dermalaser.co.za

A skin routine for Acne-prone skin in pregnancy:

Cleanser: Dr Barbara Sturm Darker Skin Tones Foam Cleanser

Day moisturiser: Lamelle Clarity Corrective AM

Night moisturiser: Huxley Fresh and More Cream

Spot Treatment: pHformula SPOT ON Blemish Active 

Add ons: La Roche-Posay Serozinc

Hyperpigmentation / Melasma

People with a darker skin tone are more likely to develop chloasma/melasma during pregnancy so it is vital that they use a mineral, high factor, broad-spectrum sunscreen which is appropriate for their skin type.

Topically applied ingredients that are generally considered safe to use in pregnancy that would also help to lighten and control pigmentation would include:

Recent research has shown that a small percentage of the more older generation chemical sun filters such as Oxybenzone is absorbed into the bloodstream – these chemical sunscreens have been used for many years in pregnant women without any apparent side effects. However, the American Federal Drug Administration has requested further studies to be performed in this regard.

Therefore, to play it safe during pregnancy, I would recommend using sunscreen with mineral filters such as Zinc Oxide and Titanium Dioxide. However, these can be more expensive, especially if used over a large area of the body.

MINERAL SUNSCREENS

Face: Colorescience Total Protection Face Shield SPF 50 or SkinCeuticals Physical Fusion UV Defense SPF 50

Face & Body: Obagi Physical Defense SPF 40

A skincare routine for Hyperpigmentation/Melasma skin in pregnancy:

Cleanser: Dr Barbara Sturm Darker Skin Tones Enzyme Cleanser

Serum: Huxley Brightly Ever After Essence

Day Cream: Dr Barbara Sturm Brightening Face Cream

Night moisturiser: pHformula VITA B3 Cream

Add on: ISDIN UV Mineral Brush SPF 50+

Anti-Ageing

Anti-ageing products that contain antioxidants such as Vitamin C, Vitamin E as well as Poly-hydroxy Acids are generally considered safe during pregnancy. Pure Vitamin C should not be in a concentration higher than 10% whilst PHA shouldn’t be more than 15% applied topically.

A skincare routine for Ageing skin in pregnancy:

Cleanser: Exuviance Gentle Cleansing Crème

Serum: Dr Barbara Sturm The Good C Vitamin C Serum

Day moisturiser: Huxley Anti-Gravity Cream

Night moisturiser: Dr Barbara Sturm Super Anti-Aging Face Cream

Add ons: mesoestetic energy C eye contour

Rosacea / Perioral Dermatitis

With the hormonal changes as well as increased blood volume during pregnancy, many women will experience more flushing and blushing and therefore there may be a flare of rosacea as well as peri-oral dermatitis. For a flare of rosacea or peri-oral dermatitis, you need to use a very gentle cream cleanser and no harsh toners or scrubs. Ingredients that are soothing to the skin and that are generally considered safe during pregnancy would include Hyaluronic Acid, Niacinamide, Vitamin E, and Polyhydroxy Acids (PHAs) such as Gluconolactone.

A skin routine for Rosacea-prone skin in pregnancy:

Cleanser: Dr Barbara Sturm Foam Cleanser

Serum: SkinCeuticals Phyto Corrective Serum

Day moisturiser: NeoStrata Bionic Face Cream

Night moisturiser: mesoestetic couperend maintenance cream

Add ons: Bioderma Sensibio H2O Cleanser 

Products That Produce A Glow

For some women, the increase of blood supply to the skin and hormones can give them a natural healthy glow in pregnancy but this is not always the case. For those who are seeking a natural glow in pregnancy, there are some products that can help you to achieve a healthy, radiant glow.

A skin routine for THAT glow during pregnancy:

Cleanser: mesoestetic brightening foam

Serum: Dr Barbara Sturm Hyaluronic Serum

AM/PM moisturiser: Huxley Glow Awakening Cream

Add on: PCA Skin Sheer Tint Broad Spectrum SPF 45

Hair Growth

Again, with hormonal changes in pregnancy, women will often experience increased hair growth on the face and body. I would be cautious about waxing or using depilatory creams on the face or body during pregnancy as these can cause post-inflammatory hyperpigmentation.

Safer options during pregnancy would be shaving or threading. Threading is an ancient technique of removing facial hair that is thought to have first originated in India and then spreading across the Middle East. In recent years, it has become increasingly popular in Western countries and is a quick and effective way of removing hair in smaller areas of the body and on the face. Threading should be done by a skin therapist trained in this art.

There are no studies that evaluate the safety of laser hair removal during pregnancy.

Self-Tanning Products

Many women turn to self-tanning products during pregnancy to avoid the risk of pigmentation. Dihydroxyacetone (DHA) found in self-tanning lotions and creams are generally considered safe during pregnancy and lactation. However, pregnant women should avoid going into a tan spraying booth where the DHA is sprayed onto the skin as there is a small risk of inhaling the DHA and this could possibly be harmful to the unborn fetus.

If you have any queries about products to use during pregnancy it is best to discuss them with your personal physician or obstetrician.

References:

JAAD.org/article/S0190-9622(13)00961-4/March 2014

Can Fam Physician, 2011 June; 57 (6); 665-667

Posted in LEARN / DERMATOLOGIST FAQS on November 12th, 2020.

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