I Am Pregnant. What Can I Use As an Alternative to Retin A or Differin for my Acne?

My main issue is with skin texture and acne. I get comedones (white heads) and build up on my skin, which causes further breakouts. Most over the counter cleansers and exfoliants haven't helped much. My skin is very sensitive, but prior to getting pregnant, I used Differin cream 0.1%.

Doctor Answers 3

Options Llimited During Pregnancy

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This answer would be much different if you were a dermatologist's wife. ( Any dermatologist who chances upon this response would know what I mean.)

 It is very difficult to treat acne during pregnancy. I would avoid  all topical or oral medications during the first trimester with the exception of azelaic acid ( Azelex, Finacea) or products containing sulfur ( not sulfa, but chemical symbol S, that gives that rotten egg smell). In the second and third trimester, topical Clindomycin ( Claripel, Evoclin) is probably OK , as is Benzoyl Peroxide washes ( Brevoxyl, Triaz foaming pads). 

  Oral medications would depend on the degree of acne. If it is severe, then certain antibiotics are permissible. It is my feeling that if  a woman has large cysts, laden with bacteria and exudate, this material possibly rolling around in the system would not be healthy for the baby. I would therefore prescribe Cephalexin ( Keflex)  or Cefdinir (Omnicef). I would not recommend Erythromycin. There have been reports of heart defects and pyloric stenosis occurring in babies exposed to this drug in utero. 

   Excuse me at this point if I go into a semi-rant. A few days ago, I read some comments by Arnold Klein, M.D., the prominent Beverly Hills dermatologist. He bemoaned the fact that usually , when he writes to a magazine such as Allure, Cosmo, Glamour etc., his letter is ignored. In a strange way I felt a bit vindicated since I have had the same thing happen to me. Both of us are not talking about opinions but facts, that any but the most complacent journalist, can easily look up. 
   For instance, New Beauty quoted a colleague as saying Erythromycin would be recommended for acne during pregnancy. True, this may have an FDA Category B rating, like the two drugs mentioned above. Also, true, that this was regarded as a safe drug in utero when I was a resident ( 30 year ago!!). However, three recent papers have detailed major  problems regarding heart defects, arrythmias, and pyloric stenosis. In Europe, Erythromycin is on the do not give during pregnancy list. I enclosed these articles in my later-to-be-neglected letter to New Beauty. 

    Dr. Klein feels that his letters are ignored so as not to offend the advertisers of these magazines. Perhaps, the editors also do not want to pique the physicians who readily supply them with good quotes. Whatever.  However, it seems to me that their primary duty should be to their readers who have placed their trust in their expertise. If you make a mistake correct it don't pretend it never happened.

Virginia Beach Dermatologist

Safe acne treatment in pregnancy

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The retinoids are not recommended in pregnancy, however there are other things that can be used.  Benzoyl peroxide and topical erythromycin can be used, as can salicylic acid and azelic acid, and they can be combined for greater effect.  Also there are physical modalities that are safe and helpful such as microdermabrasion, glycolic acid peels and Intense Pulse Light treatments.

Stephen Mandy, MD
Miami Dermatologic Surgeon
4.3 out of 5 stars 6 reviews

Treating acne during pregnancy

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Azeleic acid (Azelex and Finacea) are pregnancy category B meaning they are generally considered safe during pregnancy. Extractions (acne surgery or facials) should also be fine. Retinoids (which includes the Differin you werre using) and oral antibiotics should be avoided. As for most other topical acne medicines, most labels advise against their use during pregnancy although there is little evidence that they are unsafe. Pregnancy is a temporary state. Be conservative. Discuss your options with a board-certified dermatollgist.

Dina D. Strachan, MD
New York Dermatologist

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.