During pregnancy elevated hormone levels can bring a variety of skin changes, including acne. Acne can be treated by a dermatologist in non-pregnant women through prescription drugs such as Accutane, Retin-A, and Tetracycline. However, use of these drugs is discouraged by pregnant women or women trying to conceive and should be thoroughly discussed with your health care provider and dermatologist.
What are these drugs?
Accutane:Accutane is a prescription medication that is taken orally to treat acne. The generic name for Accutane is isotretinoin.
Retin-A: Retin-A is a prescription cream that is applied to the skin to treat acne. The generic name for Retin-A is tretinoin.
Tetracycline: Tetracycline is an antibiotic taken orally to treat acne and respiratory infections.
What are the precautions?
Accutane: (Category X): According to the Organization of Teratology Information Services (OTIS), approximately 25-35% of infants born to women exposed to Accutane during the first trimester of pregnancy showed a pattern of birth defects. This pattern includes craniofacial defects, heart defects, and central nervous system defects. There also is an increased risk of miscarriage and infant death associated with use of Accutane during pregnancy.
Retin-A (Category C): According to OTIS, less than 10% of Retin-A passes into the mother’s blood stream and less than that reaches the baby. Even with these findings, Retin-A still carries warnings of use by women who are pregnant or contemplating pregnancy. In this case it is best to discuss treatment with your dermatologist and other health care provider.
Tetracycline: (Category D) According to OTIS, tetracycline appears to cause some inhibition of bone growth and discoloration of teeth in a fetus. Therefore, taking tetracycline should also be discussed with your dermatologist and other health care provider.
When is it safe to use these drugs?
Accutane:It is safe to use Accutane when you are not pregnant and have discussed certain guidelines with your health care provider.
- If you are in your childbearing years you must use two forms of birth control, beginning one month prior to starting Accutane through one month after stopping Accutane. If you are breastfeeding you should not take Accutane
- You must be counseled about the possible ways that your chosen birth control may fail.
- You must have a negative pregnancy test one week prior to taking Accutane.
- You must start Accutane on the 2nd or 3rd day after the next normal menstrual period.
Retin-A: Since not many studies have been done on Retin-A, it is best to avoid during pregnancy and follow the same guidelines as Accutane while consulting with your health care provider.
Tetracycline: Tetracycline should not be used during pregnancy unless recommended by your health care provider. The American Academy of Pediatrics has approved tetracycline safe for use during breastfeeding.
What about over-the-counter acne medicated creams and astringents?
When choosing over-the-counter medicated acne cleansers and treatments, it is advised that you consult with your health care provider first. There are products that contain benzoyl peroxide, which have been recommended safe for pregnant women to use. However, there are over-the-counter medications that you may want to avoid such as products containing salicylic acids. Always consult your health care provider before taking ANY medications during pregnancy, whether prescription or over-the-counter.
Compiled using information from the following sources:
Organization of Teratology Information Services, http://otispregnancy.org/
March of Dimes, http://www.marchofdimes.com/
Drugs in Pregnancy and Lactation Fifth Ed. Briggs, Gerald G., et al, pp.1011-1015 and 1044-1045
American Pregnancy Association, http://www.americanpregnancy.org