Is azelaic acid safe during pregnancy?

What does the evidence say about azelaic acid during pregnancy?

1. Azelaic acid is one of the acne ingredients ACOG considers fine to use during pregnancy, unlike prescription retinoids. 1
2. Doctors have recommended azelaic acid as a first-choice topical option for pregnant and breastfeeding patients for more than a decade. 2
3. Family medicine guidance names azelaic acid, alongside benzoyl peroxide, as a safe baseline choice for acne throughout pregnancy. 3
4. A 2024 dermatology review still lists azelaic acid as an acne option that's fine to continue during pregnancy, while retinoids stay on the avoid list. 4
5. A 2026 study that tracked millions of pregnancies used azelaic acid as part of its safe comparison group, and those babies didn't show a higher rate of major birth defects. 5

Is azelaic acid safe in each trimester?

• First trimester. Breakouts often show up early as hormones shift, and azelaic acid is a reasonable pick to start or keep using right now. It skips the retinoid-style concern that rules out so many other acne options. Mention any new skincare product at your first prenatal visit.
• Second trimester. Dark patches, sometimes called the mask of pregnancy, often get more noticeable now, and azelaic acid is one of the few active ingredients that can help fade that tone without a retinoid-level concern. Daily sunscreen still matters more than any single product for keeping your skin tone even.
• Third trimester. There's no known reason to stop azelaic acid this late in pregnancy, unlike some other skincare ingredients. Add it to the list of products you mention to your delivery team, mostly out of habit rather than any specific concern.