During pregnancy, acne can both clear and get worse. In early pregnancy, acne often gets a bit worse but as pregnancy progresses, acne can often improve, possibly because of increased levels of oestrogen.
Treatment in pregnancy
Topical treatments that can be used in pregnancy include:
* Benzoyl peroxide
* Azelaic acid
Benzoyl peroxide
Benzoyl peroxide is a commonly used topical treatment for mild acne. It is safe for adults and children, and can be used in pregnancy.
Benzoyl peroxide has the following properties:
* Antiseptic i.e. it reduces the number of skin surface bacteria (but it does not cause bacterial resistance and in fact can reduce bacterial resistance if this has arisen from antibiotic therapy). It also reduces the number of yeasts on the skin surface.
* Oxidizing agent – this makes it keratolytic and comedolytic i.e. it reduces the number of comedones.
* Anti-inflammatory action.
Benzoyl peroxide is available as cream, gel, lotion and wash at concentrations of 2.5 %, 5 % and 10 %. It may
be combined with other topical or oral therapy. It is especially valuable in combination with topical or oral antibiotics as it may reduce the growth of antibiotic-resistant bacteria.
In New Zealand, products containing benzoyl peroxide are available without prescription. They include:
* Benoxyl™ 5%, 10% Lotion
* Benzac™ AC2.5%, 5%, 10% Gel; Wash 5%
* Brevoxyl™ 4% Cream
* Oxy™ 5 5% lotion, Oxy™ 10 10% Lotion
* PanOxyl™ 2.5%, 5%, 10% Gel, PanOxyl™ AQ 2.5%, 5%, 10% Gel
How to use benzoyl peroxide products
* Make sure the skin is clean and dry before applying
* Apply a thin smear to areas of skin affected by acne, initially every second night, then build up to once or twice daily as tolerated
* It can be used on the face as well as the trunk
* Be patient: acne responds very slowly to treatment. It may take several months to notice improvement
Problems with benzoyl peroxide products
* Dryness of the treated area can be expected and is usually mild. If the skin is visibly scaly, apply a light non-oily moisturizer.
* Skin irritation is rarely severe. Occasionally, irritation means that product must be discontinued.
Consider applying it less frequently.
* Contact dermatitis (red, dry, itchy skin) can be due to irritation or allergy. It can be treated with a topical steroid such as hydrocortisone cream (available at a NZ pharmacy without prescription).
* Bleaching of clothing. Make sure the benzoyl peroxide has completely dried before the treated skin touches clothes or bedding.
Azelaic acid
Azelaic acid is a natural material produced by a yeast that lives on normal skin, Malassezia furfur (also known as Pityrosporum ovale). In New Zealand, azelaic acid is available at a concentration of 20% as Skinoren™ Cream and Acne-Derm™ Medicated Lotion.
Azelaic acid is used as a topical treatment for mild to moderate acne, and may be combined with oral antibiotics or hormonal therapy. It is useful for both comedonal acne and inflammatory acne.
Azelaic acid is:
* Antibacterial – it reduces the growth of bacteria in the follicle (Proprionibacterium acnes and Staphylococcus epidermidis)
* Keratolytic & comedolytic – it returns to normal the disordered growth of the skin cells lining the follicle
* A scavenger of free radicals – i.e. it reduces inflammation.
Azelaic acid also helps reduce pigmentation, so it’s particularly useful for darker skinned patients whose acne spots leave persistent brown marks or who have melasma.
The cream should be applied to the area affected by acne initially daily, then if tolerated building up to a generous twice-daily application after thoroughly cleansing the skin.
Acne responds slowly to treatment. Some improvement should be seen after one month of using azelaic acid cream. Further improvement should occur with maximum results after six months’ continuous use. Treatment may be continued safely for months or years if the acne remains active.
Azelaic acid is nontoxic and is well tolerated by most subjects. However, those with very sensitive skin or who suffer from eczema, may find it irritating to apply, resulting in a mild irritant dermatitis.
Discontinue applying the cream and seek medical advice if you develop severe:
* Redness
* Scaling
* Itching
* Burning
Azelaic acid does not result in:
* Bacterial resistance to antibiotics
* Reduction in sebum production
* Photosensitivity (easy sunburn)
* Staining of skin or clothing
* Bleaching of normal skin or clothing
Although not registered in New Zealand for other skin disorders, azelaic acid cream may also be useful in the treatment of:
* Postinflammatory pigmentation
* Melasma
* Rosacea
* Lentigo maligna, a type of early melanoma. Azelaic acid is not recommended for most cases of this pre-cancerous lesion; where possible, surgery should be performed.
On the whole, it is preferable to avoid oral medicines in pregnancy in case they have an effect on the fetus.
However, oral erythromycin may be prescribed safely for severe acne.
The following medications must be avoided in pregnancy or if pregnancy is being contemplated:
* Tetracycline
* Oral isotretinoin
* Topical retinoids (tretinoin, isotretinoin and adapalene)
* Salicylic acid preparations
See also: Acne is Not Just for Teenagers
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