Topical products and pregnancy

Many physiologic changes occur during pregnancy, including fluctuations in hormone levels, leading to skin conditions such as acne or melasma.

Common topical treatment options for acne and pigmentation include retinoids, antibiotics, benzoyl peroxide, salicylic acid or hydroquinone.

RETINOL AND RETINOIDS

Retinol and retinoids are part of the Vitamin A family. These agents have been used for decades, mainly for cosmetic purposes, in topical products for reducing the appearance of wrinkles, enhancing skin tone and texture, and treating skin conditions such as acne or rosacea.

The amount absorbed from the topical application of retinoids is very low; however, there are reported cases of birth defects associated with topical retinoid use. Therefore, topical retinoids use in pregnancy remains controversial (1-4). Consequently, it is best to avoid oral use or topical application of retinoids such as tretinoin, retinol, isotretinoin or derivates during pregnancy or breastfeeding.

ANTIBACTERIALS

Topical antibiotics clindamycin and erythromycin are used alone or in combination with other agents for treating mild to moderate acne. According to several studies, these two antibiotics have not been associated with adverse outcomes or increased risk of malformations when used in pregnancy (5-8). However, as these are prescription-only medicines, we recommend consulting with your doctor to find out if these are suitable for you.

BENZOYL PEROXIDE

Benzoyl peroxide is a topical product with antiseptic properties used to treat mild to moderate acne. When benzoyl peroxide is applied topically, a small amount is absorbed through the skin (9, 10). No studies on using this preparation in pregnant patients have been published. Although using this product during pregnancy would not be expected to cause adverse effects on a pregnant woman and her child (11), we strongly recommend you consult your doctor before using it topically.

SALICYLIC ACID

Salicylic acid is a beta-hydroxy acid and a key ingredient in many cosmetic and acne products, and systemic absorption varies (12). According to numerous studies on the use of acetylsalicylic acid during pregnancy, there was no increase in the risk of major malformations, preterm birth, or low birth weight (13). The role of topical salicylic acid remains controversial; therefore, it is best to seek advice from your doctor before use.

GLYCOLIC ACID

Glycolic acid is an alpha-hydroxy acid derived from sugar cane and a key ingredient in many cosmetic products. Unfortunately, there are no studies investigating the use of glycolic acid in pregnancy in humans; therefore, it is advised to avoid using this ingredient in pregnancy and while breastfeeding or to seek your doctor’s approval before topical use (14).

Professional treatments such as chemical peels or other treatments containing high concentrations of glycolic acid, lactic acid, or other acids should be avoided during pregnancy.

SKIN LIGHTENING AGENTS

Hydroquinone is used clinically as a topical lightening agent to reduce pigmentation in conditions such as chloasma, melasma, and post-inflammatory hyperpigmentation or to pre-treat the skin before chemical peels or laser treatments (16). It has been estimated that approximately 40% of hydroquinone is systemically absorbed following topical application (15). Although a small study on pregnant women involving hydroquinone use did not report a rise in complications (17) due to increased absorption compared with other products, it is best to avoid it in pregnancy until further studies confirm safety.

CONCLUSION

Numerous skin care products are not expected to increase the risk of malformations or other adverse effects on the developing foetus. However, we strongly recommend consulting your doctor before starting any skin care regimen during pregnancy or breastfeeding.

 

 

REFERENCES

1. Lipson AH, Collins F, Webster WS. Multiple congenital defects associated with maternal use of topical tretinoin. Lancet 1993;341(8856):1352-3.
2. Jick SS, Terris BZ, Jick H. First-trimester topical tretinoin and congenital disorders. Lancet 1993;341(8854):1181-2.
3. Navarre-Belhassen C, Blanchet P, Hillaire-Buys D, Sarda P, Blayac J-P. Multiple congenital malformations associated with topical tretinoin. Ann Pharmacother 1998;32(4):505-6.
4. Selcen D, Seidman S, Nigro MA. Otocerebral anomalies associated with topical tretinoin use. Brain Dev 2000;22(4):218-20.
5. Briggs GG, Freeman RK, Ya_ e SJ. Drugs in pregnancy and lactation. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008. p. 384.
6. Ugwumadu A, Manyonda I, Reid F, Hay P. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial. Lancet 2003;361(9362):983-8.
7. McCormack WM, Rosner B, Lee YH, Munoz A, et al.: Effect on birth weight of erythromycin treatment of pregnant women. Obstet Gynecol 69:202-207, 1987.
8. Heinonen OP, Slone D, Shapiro S. Birth defects and drugs in pregnancy. Littleton, Mass: Publishing Sciences Group; 1977. p. 297-313.
9. Nacht S, Yeung D, Beasley JN Jr, Anjo MD, Maibach HI. Benzoyl peroxide: percutaneous penetration and metabolic disposition. J Am Acad Dermatol 1981;4(1):31-7.
10. Morsches B, Holzmann H. Studies on the percutaneous absorption of benzoyl peroxide. Arzneimittelforschung 1982;32(3):298-300.
11. Rothman KF, Pochi PE. Use of oral and topical agents for acne in pregnancy. J Am Acad Dermatol 1988;19(3):431-42.
12. Cosmetic Ingredient Review Expert Panel. Safety assessment of salicylic acid, butyloctyl salicylate, calcium salicylate, C12-15alkyl salicylate,capryloyl salicylic acid, hexyldodecyl salicylate, isocetyl salicylate, isodecyl salicylate, magnesium salicylate, MEA-salicylate, ethylhexyl salicylate, potassium salicylate, methyl salicylate, myristyl salicylate, sodium salicylate, TEA salicylate, and Tridecyl salicylate. Int J Toxicol 2003; 22(3):1-108.
13. James AH, Brancazio LR, Price T. Aspirin and reproductive outcomes. Obstet Gynecol Surv 2008;63(1):49-57.
14. Anderson FA. Final Report On the Safety Assessment of Glycolic Acid, Ammonium, Calcium, Potassium, and Sodium Glycolates, Methyl, Ethyl, Propyl, and Butyl Glycolates, and Lactic Acid, Ammonium, Calcium, Potassium, Sodium, and Tea-Lactates, Methyl, Ethyl, Isopropyl, and Butyl Lactates, and Lauryl, Myristyl, and Cetyl Lactates Inter J Tox. 1998; 17(supp 1): 1-241.
15. Wester RC, Melendres J, Hui X, Cox R, Serranzana S, Zhai H, Quan D and Maibach HI. Human in vivo and in vitro hydroquinone topical bioavailabiltiy, metabolism and disposition. J Toxicol Environ Health Part A. 1998; 54(4):301-17.
16. Ngan, V. & Coulson, I. Hydroquinone (2021). URL: https://dermnetnz.org/topics/hydroquinone (12 Sept 2022).
17. Mahé A, Perret JL, Ly F, Fall F, Rault JP, Dumont A. The cosmetic use of skin lightening products during pregnancy in Dakar, Senegal: a common and potentially hazardous practice. Trans R Soc Trop Med Hyg 2007;101(2):183-7. Epub 2006 Oct 4.