Can I use skinoren cream if I am pregnant? Is there intial breakout at the beginning of using the cream?

Skinoren cream is not approved for use in the U.S. However, it's a form of Azelaic Acid (20%), which in it's own right is considered a category B drug that doesn't pose risks during pregnancy. HOWEVER, with all of that being said, when adding anything into your regimen during pregnancy, it's always best to check with your OB/GYN! "This answer has been solicited without seeing this patient and cannot
be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."