Pregnancy Acne: How to Diminish It?

Pregnancy is a period of risk for both the mother and child that requires constant vigilance . Therefore, certain compounds usually recommended for fighting acne, due to their high effectiveness, are discouraged during pregnancy. This is particularly the case for the following active ingredients.

• Retinoids.

  Oral retinoids, primarily used in acne treatment such as isotretinoin, are strictly contraindicated in pregnant women, because they are teratogenic. Indeed, this compound causes malformations in newborns in 20% of cases. Other retinoids often used topically, like retinol, are also discouraged during pregnancy, as they are also suspected to be teratogenic. Studies on this subject vary, but several cases of congenital malformations have been reported following the application of this type of compound during pregnancy.

• Benzoyl peroxide.

  This is a molecule well-known for its effectiveness in inhibiting the formation of comedones. However, its use as a first-line treatment is not recommended for pregnant women. This is a precautionary measure, as no study to date has shown a negative effect on fetal development or on the mother's health. Nevertheless, animal studies have shown that it has negative effects on their offspring.

  Given that the cited animal studies are relatively marginal, benzoyl peroxide is still prescribed today to pregnant women with severe acne or those on whom other treatments have shown no effect.

If you have acne during your pregnancy, it is recommended to consult a dermatologist or a healthcare professional, who can guide you towards suitable treatments.

• Antibiotics.

  In cases of acne during pregnancy, antibiotics can sometimes be prescribed to women. Applied topically or taken orally, they help combat the bacterial proliferation of Cutibacterium acnes and assist in restoring smooth skin. One of the most commonly used is erythromycin, which has anti-inflammatory and antibacterial properties. It is typically found in solutions of 2 to 4%.

  Erythromycin exerts a bacteriostatic activity by inhibiting the growth of bacteria responsible for acne. It penetrates bacterial cells and interferes with their reproductive mechanism, thereby reducing their number and impact on the skin. Regarding its anti-inflammatory action, erythromycin works by inhibiting the production of inflammatory mediators and reducing the activity of enzymes that trigger inflammation, such as cyclooxygenases (COX). The COX enzymes, particularly COX-2, are responsible for converting arachidonic acid into prostaglandins E2, molecules that cause inflammatory and painful effects.

• The zinc gluconate.

  This is an antibacterial, anti-inflammatory, and mattifying agent. It inhibits the growth of bacteria responsible for acne by interfering with their ability to divide and form new cells. Zinc gluconate can also reduce the adhesion of Cutibacterium acnes to hair follicles or sebaceous glands, thereby limiting its proliferation.

  Furthermore, it reduces the production of certain inflammatory mediators, such as pro-inflammatory cytokines, interleukins, and prostaglandins. Zinc gluconate can also modulate the activity of enzymes involved in inflammation like the 5-lipoxygenase (5-LOX). This latter is expressed by leukocytes and is responsible for the synthesis of leukotrienes, lipid mediators of inflammation.

  Finally, zinc gluconate inhibits the activity of 5-alpha-reductase, an enzyme involved in the synthesis of sebum by the sebaceous glands. The concentration of zinc gluconate used in creams or fluids targeting acne is generally between 0.5 and 2%.

• Theazelaic acid.

  This is a safe ingredient during pregnancy that does not involve any harmful side effects. Research has shown that it has an anti-bacterial action against Cutibacterium acnes. It is notably capable of inhibiting the growth of these bacteria and interfering with metabolic mechanisms essential to them, thereby reducing the bacterial load.

  Azelaic acid also has anti-inflammatory properties. Studies have shown that it inhibits the secretion of pro-inflammatory cytokines, such as interleukins IL-1β and IL-6, and the transcription factor TNF-α. Furthermore, azelaic acid promotes the regulation of kallikrein-5 in epidermal keratinocytes, which in turn, lower cathelicidins, thereby reducing inflammatory processes.

  Finally, this active ingredient promotes the natural exfoliation of the skin, which limits the accumulation of dead cells on the skin surface and thus the risk of pore obstruction. Azelaic acid is found in topical medicinal treatments for acne at concentrations generally ranging between 15 and 20%.

• Potentially, benzoyl peroxide.

  This molecule is well-known to those prone to acne. As described above, benzoyl peroxide is prescribed to pregnant women suffering from severe acne or when other treatments have not been effective. Benzoyl peroxide works by releasing active oxygen, an oxidant that will react with Cutibacterium acnes and disrupt its metabolism and its cell membranes. It also acts as a keratolytic which will limit the risk of skin pores being blocked by dead cells.

  Furthermore, benzoyl peroxide reduces inflammation by inhibiting the production of inflammatory mediators such as cytokines and prostaglandins. It can also modulate the activity of immune cells that play a key role in the body's inflammatory response, such as neutrophils and monocytes. All of this helps to alleviate the redness and pimples associated with acne.

  Typical topical treatments for acne containing benzoyl peroxide generally use concentrations between 2.5 and 10%. It's worth noting that some clinical studies have shown that concentrations of 2.5 and 5% are just as effective as a concentration of 10%, while reducing the risk of side effects, such as skin dryness.