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Is any acne treatment safe to use during pregnancy?.Safety of skin care products during pregnancy - PMC
The new PMC design is here! Learn more about navigating our updated article layout. The PMC legacy view will also be available for a limited time. Federal government websites often end in. The site is secure. Language: English French. Question Many of my female patients complain about acne, unwanted hair growth, and other skin problems that have only developed since they became pregnant.
Are products used for these types of benign skin conditions safe to use in pregnancy, as it is understandable that women want to look their best at this important time in their lives? Answer With the exception of hydroquinone, which has a relatively high systemic absorption rate, and tretinoin, for which the evidence is controversial, these products act locally and therefore produce minimal systemic levels.
Consequently, in most cases women can deal with these cosmetically unappealing skin conditions without compromising the safety of their unborn children. Women experience many physiologic changes during pregnancy, including increases in androgen levels. Topical treatment options for acne often include retinoids, antibacterials, and agents such as benzoyl peroxide and salicylic acid.
Other agents used to improve the appearance of skin, or used in skin maintenance, include the following: hydroquinone found in skin-lightening agents; avobenzone, octinoxate, and oxybenxone found in sunscreens; and dihydroxyacetone found in self-tanning agents. Common topical agents used for removing hair or reducing its appearance include salts of thioglycolic acid and sodium, calcium, and potassium hydroxide found in depilatory creams, or hydrogen peroxide found in hair-bleaching creams.
Table 1 2 — 14 presents absorption of topical agents. The amount of drug absorbed from the skin when using this product is very low; however, there are 4 published case reports of birth defects in the literature associated benzac ac wash resultados topical tretinoin use, which are consistent with retinoid embryopathy.
The role of the topical retinoids in these cases remains controversial, 15 — 18 as 2 prospective studies that examined use during the first trimester of pregnancy with 96 and women did not find an increased risk of major malformations or evidence of retinoid embryopathy. Clindamycin and erythromycin are used either alone or in combination with other agents as topical treatments of acne. A surveillance study examining oral or topical use of clindamycin reported no increased risk of malformations among women with use in the first trimester.
Topical salicylic acid is an ingredient in a number of cosmetic and acne products and systemic absorption varies. Glycolic acid is an alpha hydroxy acid found in many cosmetics used to treat acne. There have been several animal studies demonstrating adverse reproductive effects when glycolic acid was administered in high doses, much larger than those used in topical cosmetic products in humans. Hydroquinone is used clinically as a topical depigmenting agent for conditions such as chloasma and melasma, and it is used cosmetically as a skin-whitening agent.
However, because of substantial absorption compared with other products, it is best to minimize exposure until further studies can confirm safety. Dihydroxyacetone is a colour additive that is found in self-tanning products to produce an artificial tan. Colour develops following topical application owing to dihydroxyacetone binding to amino acids in the stratum corneum. When addressing issues of hair removal, or reducing the appearance of hair, various topical agents are available, such as depilatory and hair-bleaching creams.
Sodium, calcium, and potassium hydroxide, which are also found in depilatory creams, disassociate into sodium, calcium, potassium, and hydroxide ions. These ions are found abundantly in the body, and the amount of these chemicals found in consumer products that would come in contact with skin would be negligible, especially compared with the average daily dietary intake. In addition, although they might permeate the skin, the systemic absorption of these ions is minimal and therefore they do not increase serum levels and would not be considered a problem for use during pregnancy.
In an in vitro study involving human skin, hydrogen peroxide was detectable in the dermis only after the application of high hydrogen peroxide concentrations for several hours. However, because cosmetic products such as hair-bleaching creams contain low concentrations of hydrogen peroxide, it is unlikely that substantial amounts are absorbed after topical application. In addition, once absorbed, hydrogen peroxide is rapidly metabolized.
Apart from hydroquinone which is absorbed systemically in fairly substantial amounts and should be used very sparingly and topical retinoids owing to the troubling case reportsskin care products are not expected to increase the risk of malformations or other adverse effects on the developing fetus. Consequently, pregnant women can look their best without compromising the health of their unborn children. Ms Einarson continues to be a member of the Motherisk team as a consultant.
Do you have questions about the effects of drugs, chemicals, radiation, or infections in women who are pregnant or breastfeeding?
We invite you to submit them to the Motherisk Program by fax at ; they will be addressed in future Motherisk Updates. Can Fam Physician. Copyright and License information Disclaimer. Abstract Question Many of my female patients complain about acne, unwanted hair growth, and other skin problems that have only developed since they became pregnant.
Table 1 Absorption of products following topical use. Small amounts of the metabolite benzoate are absorbed and easily eliminated 23 Tretinoin Endogenous vitamin A levels remained unchanged after repeated applications of 0.
Open in a separate window. Topical retinoids The amount of drug absorbed from the skin when using this product is very low; however, there are 4 published case reports of birth defects in the literature associated with topical tretinoin use, which are consistent with retinoid embryopathy. Topical antibacterials Clindamycin and erythromycin are used either alone or in combination with other agents as topical treatments of acne.
Salicylic acid Topical salicylic acid is an ingredient in a number of cosmetic and acne products and systemic absorption varies. Glycolic acid Glycolic acid is an alpha hydroxy acid found in many cosmetics used to treat acne. Skin-lightening agents Hydroquinone is used clinically as a topical depigmenting agent for conditions such as chloasma and melasma, and it is used cosmetically as a skin-whitening agent.
Self-tanning agents Dihydroxyacetone is a colour additive that is found in self-tanning products to produce an artificial tan. Topical hair removal and bleaching agents When addressing issues of hair removal, or reducing the appearance of hair, various topical agents are available, such as depilatory and hair-bleaching creams.
Conclusion Apart from hydroquinone which is absorbed systemically in fairly substantial amounts and should be used very sparingly and topical retinoids owing to the troubling case reportsskin care products are not expected to increase the risk of malformations or other adverse effects on the developing fetus. Footnotes Competing interests None declared. References 1. Maternal serum androgens in human pregnancy: early increases within the cycle of conception.
Hum Reprod. Benzoyl peroxide: percutaneous penetration and metabolic disposition. J Am Acad Dermatol. Morsches B, Holzmann H. Van Hoogdalem EJ. Transdermal absorption of topical anti-acne agents in man; review of clinical pharmacokinetic data. J Eur Acad Dermatol Venereol. Transdermal absorption of clindamycin and tretinoin from topically applied anti-acne formulations in man. Biopharm Drug Dispos. External erythromycin therapy of acne [article in German] Z Hautkr.
Cosmetic Ingredient Review Expert Panel Safety assessment of salicylic acid, butyloctyl salicylate, calcium salicylate, C alkyl salicylate, capryloyl salicylic acid, hexyldodecyl salicylate, isocetyl salicylate, isodecyl salicylate, magnesium salicylate, MEA-salicylate, ethylhexyl salicylate, potassium salicylate, methyl salicylate, myristyl salicylate, sodium salicylate, TEA-salicylate, and tridecyl salicylate.
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