Experiencing breakouts or acne is a common symptom that can occur in early pregnancy. A sudden appearance of blemishes can be one of the earliest signs that the body is undergoing significant change, often appearing around the same time as other first-trimester symptoms like breast tenderness or fatigue. This skin change is directly linked to the rapid hormonal shifts that begin almost immediately after conception to support the developing baby. While some people experience the fabled “pregnancy glow,” around 40% of pregnant individuals will deal with acne at some point during their term. The severity of the acne can vary widely, from mild blemishes to more inflamed spots appearing on the face, chest, or back.
The Hormonal Basis for Pregnancy Acne
The primary driver behind early pregnancy breakouts is the surge in hormones, particularly progesterone, which is essential for maintaining the pregnancy. Progesterone’s increase causes the sebaceous glands in the skin to ramp up their production of sebum. This increase in oil production typically begins in the first trimester, often around the six-week mark.
The excess sebum creates an environment where pores are more easily clogged with oil and dead skin cells. This blockage, combined with acne-causing bacteria, results in the formation of whiteheads, blackheads, and inflamed pimples. Androgens, which also rise during pregnancy, further contribute to stimulating the oil glands, exacerbating the problem.
Safe Strategies for Managing Breakouts
Managing acne during pregnancy requires a cautious approach, as many common treatments are not safe for a developing fetus. The first step is a gentle, consistent skincare routine, involving washing the face twice a day with a mild cleanser and avoiding aggressive scrubbing or picking at blemishes. It is recommended to consult with an obstetrician or dermatologist before starting any new product to ensure it is safe for pregnancy.
Several topical ingredients are safe and effective for treating pregnancy acne:
- Azelaic acid is often a preferred treatment because it fights inflammation and bacteria while remaining gentle on the skin.
- Alpha hydroxy acids (AHAs), such as glycolic acid and lactic acid, are safe in low concentrations and help exfoliate the skin to keep pores clear.
- Over-the-counter products containing low concentrations of benzoyl peroxide (less than 2%) are typically permitted for topical spot treatment.
- Salicylic acid (less than 2%) is also permitted for topical spot treatment, but high-dose chemical peels should be avoided.
It is necessary to avoid certain high-risk ingredients that are common in non-pregnancy acne and anti-aging products. All forms of retinoids, including topical retinols, tretinoin, and oral isotretinoin, are known to pose a risk of birth defects and must be discontinued. Oral antibiotics like tetracyclines (doxycycline and minocycline) and hormonal therapies like spironolactone are also not safe for use during pregnancy.
The Typical Timeline for Skin Changes
Pregnancy-related acne typically begins in the first trimester, often between six and eight weeks, coinciding with the initial surge of hormones. Breakouts are most noticeable during these early weeks due to the dramatic shift in oil production. The skin often stabilizes or improves during the second trimester as hormone levels reach a more steady state.
However, the skin changes can persist for some individuals, and acne may continue throughout the entire nine months of pregnancy. If the acne does not improve in the second trimester, it may sometimes worsen again in the third trimester as androgen hormone levels can peak later on. Ultimately, the symptoms resolve completely after delivery, as the body’s hormones return to pre-pregnancy levels.