Pregnancy triggers significant hormonal shifts, and for many women, this translates into clearer, calmer skin. Rising oestrogen levels, combined with a degree of natural immune modulation, often reduce inflammation in the skin. As a result, conditions such as acne, eczema, and psoriasis may temporarily improve.
However, the so-called “pregnancy glow” is not universal.
In some women, particularly during the first trimester, rapid hormonal fluctuations can instead stimulate oil production and trigger breakouts. Understanding why pregnancy acne occurs, and which pregnancy safe skincare actives can be used to treat it is essential. Dr Derrick Phillips, a consultant dermatologist and acne specialist in London, breaks down what you need ot know about pregnancy acne in this video and article.
Why Does Pregnancy Acne Happen?
Although estrogen levels increase during pregnancy and can reduce sebum production, progesterone and androgen activity may also rise. In some individuals, this stimulates oil glands, increases pore congestion, and leads to inflammatory acne lesions.
At the same time, pregnancy skin can become more reactive and sensitive. This means aggressive acne treatments are not only unsafe in certain cases, but often poorly tolerated.
The goal during pregnancy is not maximal strength, but controlled, barrier-supportive treatment options using ingredients with established safety profiles.
4 Pregnancy-Safe Skincare Actives for Acne
When treating pregnancy acne, dermatologists focus on ingredients that are effective, yet low risk. According to Dr Derrick Phillips, several topical actives can be safely incorporated when used appropriately.
Niacinamide
Niacinamide (vitamin B3) is one of the most versatile and well-tolerated skincare ingredients available. It reduces inflammation, helps regulate sebum production, and strengthens the skin barrier. Because pregnancy can make skin more sensitive, barrier support becomes particularly important.
Niacinamide also improves post-inflammatory hyperpigmentation — an important benefit, as hormonal changes during pregnancy can increase the likelihood of pigmentation issues after breakouts.
It is gentle enough for daily use and suitable for most skin types, including sensitive or reactive skin.
Benzoyl Peroxide (Up to 5%)
Benzoyl peroxide is a widely used topical treatment for inflammatory acne. It works by reducing Cutibacterium acnes, the bacteria associated with acne, while also helping to clear blocked pores and reduce inflammation.
In lower concentrations, typically up to 5%, topical benzoyl peroxide is generally considered acceptable during pregnancy. Only a small amount is absorbed through the skin and it is rapidly metabolised into benzoic acid, which is then excreted from the body.
It can be particularly helpful for treating inflamed papules and pustules that often occur with hormonal acne during pregnancy. Many patients benefit from using it as a short-contact treatment, such as a wash or targeted spot treatment, which can reduce irritation while still helping to control breakouts.
As pregnancy can make skin more reactive, benzoyl peroxide is best introduced gradually and used alongside a gentle moisturiser to maintain the skin barrier.
Azelaic Acid
Azelaic acid is often considered one of the most useful pregnancy-safe treatments for acne. It has antimicrobial, anti-inflammatory, and comedolytic properties, meaning it reduces bacteria, calms redness, and helps prevent clogged pores.
It is especially valuable for women experiencing both acne and pigmentation concerns during pregnancy. In addition to reducing active lesions, it can lighten post-inflammatory hyperpigmentation and help manage melasma.
Because it is generally well tolerated and not systemically absorbed in significant amounts, it is widely regarded as a safe and effective option during pregnancy.
Salicylic Acid Under 2%
Salicylic acid is a beta hydroxy acid that penetrates into pores and helps dissolve excess oil and debris. While high-strength peels and oral salicylates are not recommended during pregnancy, low-concentration topical salicylic acid under 2% is generally considered acceptable when used in moderation.
This makes it useful for mild comedonal acne, blackheads, and occasional breakouts. The key is avoiding excessive application or large surface area use. Cleansers or targeted spot treatments are preferable to full-face high-strength products.
As with all active ingredients in pregnancy, use should be guided by a healthcare professional.
Skincare Actives to Avoid During Pregnancy
Certain acne treatments are contraindicated during pregnancy due to known or potential risks to the developing fetus. Oral retinoids, such as isotretinoin, are known to be harmful in pregnancy and must be strictly avoided because of their strong association with serious birth defects.
Topical retinoids, including tretinoin and adapalene, are also generally discontinued during pregnancy as a precaution. Although only small amounts are absorbed through the skin, there is still potential for the ingredient to enter the bloodstream. For this reason, most dermatologists advise avoiding them during pregnancy.
Tetracycline antibiotics, which are sometimes prescribed for acne, are also not considered safe during pregnancy. These medications can affect fetal bone and tooth development and should therefore be avoided.
There is also currently insufficient safety data to recommend newer retinoid alternatives such as bakuchiol during pregnancy. While it is sometimes marketed as a “natural retinol alternative”, robust evidence confirming its safety in pregnancy is lacking, so it is generally best avoided.
If you are already under the care of a consultant dermatologist, it is important to review your current skincare or treatment regimen as soon as pregnancy is confirmed.
Building a Safe Acne Skincare Routine During Pregnancy
The foundation of managing pregnancy acne is gentle, consistent skincare. A cleanser containing pregnancy-safe actives can help control breakouts while still being kind to the skin barrier. Ingredients such as niacinamide or low-strength salicylic acid (up to 2%) can help regulate oil production and keep pores clear. Examples include the Cetaphil Gentle Clear Clarifying Cream Cleanser or the CeraVe Blemish Control Cleanser.
Lightweight, non-comedogenic moisturisers support hydration without clogging pores. Active ingredients should be introduced gradually and used in a balanced way to minimise irritation.
Sunscreen remains essential. Hormonal changes during pregnancy increase the risk of pigmentation, and UV exposure can worsen both post-acne marks and melasma.
Above all, avoid over-treating the skin. During pregnancy, skin can become more sensitive and reactive, so a simple, consistent routine is often more effective than layering multiple active products.
Dr Derrick Phillips shares his advice on gentler skincare routines in this Pop Sugar article.