Breaking out during pregnancy is extremely common. Nearly half of pregnant women develop acne at some point during their pregnancy, with breakouts most likely to appear or worsen in the second and third trimesters. The same hormonal shifts that support your baby’s development also ramp up oil production in your skin, making pimples an expected (if unwelcome) side effect.
Why Pregnancy Triggers Breakouts
Your body produces higher levels of androgens during pregnancy, hormones that stimulate the oil glands in your skin. When those glands go into overdrive, excess oil mixes with dead skin cells and clogs pores, creating the perfect setup for acne. This process is driven by the broader hormonal, metabolic, and immune system changes that pregnancy demands.
The timing matters. Androgen levels climb as pregnancy progresses, which is why breakouts tend to intensify during the second and third trimesters rather than appearing right away. Women who had acne-prone skin before pregnancy are more likely to see flare-ups, but plenty of women who’ve never dealt with acne find themselves breaking out for the first time.
What You Can Safely Use
Not all acne treatments are safe during pregnancy, so it helps to know what’s on the approved list. The American College of Obstetricians and Gynecologists identifies these over-the-counter ingredients as acceptable to use while pregnant:
- Topical benzoyl peroxide: kills acne-causing bacteria. The NHS confirms that the small amount absorbed through your skin should not cause problems for your baby.
- Topical salicylic acid: helps unclog pores. Generally considered safe when used in limited amounts for a limited time.
- Azelaic acid: reduces inflammation and bacteria on the skin.
- Glycolic acid: a gentle exfoliant that helps with cell turnover.
For daily care, wash your face twice a day with a mild cleanser and lukewarm water. If your hair tends to be oily, shampoo daily and keep hair off your face. Use oil-free cosmetics, and resist the urge to pick or squeeze breakouts, which increases your risk of scarring.
If over-the-counter options aren’t enough, your provider may consider a prescription topical or oral antibiotic. Some antibiotics have a well-established safety profile in pregnancy and can help manage more stubborn breakouts.
Treatments to Avoid Completely
One category of acne treatment is absolutely off-limits during pregnancy: retinoids, which are vitamin A derivatives. This includes both prescription oral forms and topical versions. Oral isotretinoin (commonly known by the former brand name Accutane) carries a 35% risk of birth defects when taken beyond the 15th day after conception, with overall malformation rates in exposed pregnancies ranging from 5% to 20%.
The potential damage is severe. Retinoid exposure during pregnancy can cause malformations of the skull and face, heart defects, central nervous system abnormalities, hearing loss, cleft palate, and in some cases missing eyes. The risk and severity depend on the timing of exposure, but no safe window exists. If you’re currently using any retinoid product and discover you’re pregnant, stop immediately and contact your provider.
When a Rash Isn’t Just Acne
Regular acne during pregnancy looks the same as it does outside of pregnancy: whiteheads, blackheads, red pimples, or deeper painful bumps, mostly on the face, jawline, and sometimes the chest or back. But pregnancy also brings its own set of unique skin conditions that can look different from typical breakouts.
Intensely itchy patches with small raised bumps could signal atopic eruption of pregnancy, the most common pregnancy-specific skin condition. Hive-like bumps that start in the stretch marks on your abdomen (but spare the belly button area) may be polymorphic eruption of pregnancy. A condition called pemphigoid gestationis produces intensely itchy lesions that develop into blisters, starting on the abdomen and spreading to the thighs, palms, and soles. Severe itching with no visible rash at all can point to intrahepatic cholestasis, a liver-related condition that requires monitoring.
The key distinction: regular pregnancy acne is not intensely itchy, does not blister, and does not produce a widespread rash across your torso and limbs. If your skin symptoms go beyond typical pimples, it’s worth getting checked to rule out these pregnancy-specific conditions.
How Long Breakouts Last After Delivery
For most women, pregnancy acne improves after delivery as hormone levels gradually return to their pre-pregnancy baseline. This process takes several weeks, so don’t expect your skin to clear up overnight. Some women notice their skin starts improving within a few weeks postpartum, while others deal with lingering breakouts for longer.
Breastfeeding can extend the timeline. Hormonal fluctuations continue while you’re nursing, and some women experience new or worsening breakouts after they stop breastfeeding or when their menstrual cycle returns. Once your hormones fully stabilize, the acne typically resolves on its own. At that point, the full range of acne treatments, including retinoids, becomes available again if needed.