Pregnancy acne: causes and a safe skincare routine

By trimester

Weeks 1–13

1st trimester

Rising hormones early in pregnancy often trigger new breakouts, so the first trimester is a common time for acne to start or get worse. Stop any tretinoin, adapalene, or oral acne medication now, since this is when your baby's major organs are forming, and ask your provider about azelaic acid or benzoyl peroxide instead.

Weeks 14–27

2nd trimester

Oil production often stays elevated, so breakouts can continue through the second trimester. Azelaic acid, benzoyl peroxide, and salicylic acid remain reasonable go-to options, and a provider-prescribed antibiotic like erythromycin or clindamycin is sometimes added for more stubborn spots.

Weeks 28–birth

3rd trimester

Hormone shifts near the end of pregnancy can bring another round of breakouts, especially along the jawline. Keep skipping tetracycline-class antibiotics and spironolactone, stick with your gentle topical routine, and ask your provider about postpartum options if hormonal acne keeps coming back.

What does the evidence show for pregnancy acne?

• Benzoyl peroxide, azelaic acid, salicylic acid, and glycolic acid are the over-the-counter ingredients considered safer choices for acne during pregnancy, since only a small amount absorbs through the skin. 1
• Topical retinoids like tretinoin (Retin-A) and adapalene are best skipped during pregnancy, even though they are common acne prescriptions, because the oral form of these medications is known to cause birth defects. 1
• Isotretinoin (Accutane) is one of the highest-risk medications to take during pregnancy: it causes birth defects in more than a third of exposed babies and raises miscarriage risk as high as 40%, so it must be stopped right away if you become pregnant while taking it. 2
• Spironolactone, a hormone-blocking pill sometimes prescribed for hormonal or jawline acne, is not well studied in pregnancy, and animal research suggests it could affect a male baby's development, so most clinicians pause it once pregnancy begins or is being planned. 3
• Beyond isotretinoin, a broader group of acne medications is generally set aside during pregnancy, including tetracycline-class antibiotics, co-trimoxazole, and fluoroquinolones, while topical erythromycin and clindamycin join benzoyl peroxide and azelaic acid as additional first-line options. 4
• Fulminant nodular cystic acne, a severe and sudden presentation, is sometimes managed with a short course of oral prednisolone after the first trimester rather than topical care alone. 5
• In pregnant patients with skin of color, post-inflammatory hyperpigmentation, keloids, and severe scarring are common consequences of acne, which is why early, active management is considered important for this group. 6

When should I call my provider about pregnancy acne?

Most pregnancy acne is a cosmetic concern that can wait for a routine visit, but a sudden, severe, deep, or painful nodular and cystic breakout (fulminant acne) is worth prompt attention rather than watchful waiting, since this pattern sometimes calls for a short course of oral steroids under a provider's care after the first trimester. Early, active management matters more for anyone with deeper skin tones, since post-inflammatory dark marks, keloids, and lasting scarring are more common in that group when severe acne goes unaddressed. Bring any new or rapidly worsening breakout to your healthcare provider or dermatologist rather than waiting to see if it clears on its own. When in doubt, call your obstetric team the same day. Early input almost always beats waiting, and the on-call line exists exactly for this.