This sheet is about exposure to over-the-counter (OTC) topical acne treatments in pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider.
What are over-the-counter (OTC) topical acne treatments?
Over-the-counter (OTC) refers to medication that can be bought without a prescription. OTC topical acne treatments are products that are put directly on the skin to treat acne. Topical acne treatments are available in lotion, gel, cream, or ointment form. There are many different topical acne treatments with different generic and brand names. Common active ingredients in OTC topical acne treatments include adapalene, azelaic acid, benzoyl peroxide, glycolic acid, and salicylic acid. Products can vary in how strong the active ingredient is and in how much of the medication is in the product.
This fact sheet focuses on OTC acne treatments. Prescription treatments might have higher amounts of the active ingredients than over-the-counter products. For information on prescription acne medication, MotherToBaby has some fact sheets available, and always feel free to contact a MotherToBaby specialist.
Clindamycin fact sheet link: https://mothertobaby.org/fact-sheets/clindamycin-pregnancy/.
Erythromycin fact sheet link: https://mothertobaby.org/fact-sheets/erythromycin/.
Isotretinoin fact sheet link: https://mothertobaby.org/fact-sheets/isotretinoin-accutane-pregnancy/.
Tetracycline fact sheet link: https://mothertobaby.org/fact-sheets/tetracycline-pregnancy/.
Topical tretinoin fact sheet link: https://mothertobaby.org/fact-sheets/tretinoin-retin-a-pregnancy/.
Are topical medications absorbed through the skin?
In general, the skin serves as a good barrier, so only a small amount of the acne medication is likely to be absorbed with topical exposure. However, more of the active ingredients can be absorbed into the person’s blood stream if the skin is broken or irritated and when it is used over a large area of the skin. The more times the medication is applied on the skin, more can be absorbed. The amount of the medication that can reach the developing baby by absorption through the skin is usually much lower than with medications taken by mouth.
Are there OTC topical acne treatments that may be used during pregnancy?
The American College of Obstetricians and Gynecologists (ACOG) has recommendations for the treatment of acne during pregnancy, and you can discuss them with your healthcare providers. In general, ACOG has suggested OTC topical products containing the following ingredients for use during pregnancy, if needed: benzoyl peroxide, azelaic acid, salicylic acid, or glycolic acid. In addition to those recommended by ACOG, there are many other ingredients found in OTC topical acne treatments. If you have any questions about your OTC topical acne treatment, please contact MotherToBaby.
Are there any topical acne medications that should be avoided during pregnancy?
It has generally been recommended to avoid the use of topical retinoid medications, such as tretinoin (Retin A®) and adapalene. This is because retinoids, when taken by mouth, are known to cause birth defects.
I use an OTC topical acne treatment. Can it make it harder for me to get pregnant?
It is not known if the use of OTC topical acne treatments can make it harder to get pregnant. However, since only small amounts are typically expected to be absorbed through the skin, use of OTC acne treatments is unlikely to affect fertility.
Does using an OTC topical acne treatments increase the chance of miscarriage?
Miscarriage is common and can occur in any pregnancy for many different reasons. Based on the data available, the use of OTC topical acne treatments is not expected to increase the chance for miscarriage since only a small amount of the active ingredients are expected to be absorbed with topical exposure.
Does using OTC topical acne treatments increase the chance of birth defects?
Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. While not well studied, OTC topical acne treatments have not been associated with an increased chance for birth defects. In many cases, only a small amount of the active ingredient is likely to be absorbed with topical exposure, which means little medication gets into the blood stream. Because only small amounts applied on the skin are absorbed into the body, it is not likely to increase the chance for birth defects or cause problems for the baby.
Does using OTC topical acne treatments in pregnancy increase the chance of other pregnancy-related problems?
When used as directed, OTC topical acne treatments are not expected to increase the chance for pregnancy complications, such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).
Does using OTC topical acne treatments in pregnancy affect future behavior or learning for the child?
Studies have not been done to see if using OTC topical acne treatments can cause behavior or learning issues for the child. However, because the active ingredient is not expected to reach the fetus in significant amounts when applied topically, an increased risk for long-term problems is not expected.
Breastfeeding while using OTC topical acne treatments:
Use of OTC topical acne treatments have not been well studied in people who are breastfeeding. However, since most topical treatments are poorly absorbed by the skin, little, if any, of the treatment is expected to pass into the breast milk. Make sure that the product is not placed on the breast area or in any area that may come in contact with your baby’s skin. Be sure to wash your hands well after applying the treatment. Be sure to talk to your healthcare provider about all your breastfeeding questions.
If a male uses OTC topical acne treatments, could it affect fertility or increase the chance of birth defects?
Studies have not been done to see if use of OTC topical acne treatment could affect male fertility (ability to get partner pregnant) or increase the chance of birth defects above the background risk. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.
Please click here for references.
OTIS/MotherToBaby encourages inclusive and person-centered language. While our name still contains a reference to mothers, we are updating our resources with more inclusive terms. Use of the term mother or maternal refers to a person who is pregnant. Use of the term father or paternal refers to a person who contributes sperm.
