Pregnancy acne: advice from Dr. Aoun

The appearance of blemishes during pregnancy can be explained by various biological mechanisms. Hormonal changes influence sebum production and the balance of the pilosebaceous follicle, promoting pore blockage and inflammation.

Acne is linked to an imbalance in the pilosebaceous follicle, i.e. the structure formed by a hair and the gland that produces sebum, the oily substance naturally secreted by the skin to protect it and keep it supple. During pregnancy, hormonal changes are significant. The sebaceous glands are particularly sensitive to androgens, so-called "male" hormones that women also produce naturally, particularly in the adrenal glands. These hormones stimulate sebum production. When produced in excess, the skin becomes oilier and pores can become clogged more easily.

At the same time, a phenomenon called keratinization may occur. This involves a thickening of the cells lining the hair follicle canal. When these cells accumulate, they can block the pore. This blockage creates an environment conducive to the development of certain bacteria naturally present on the skin, notably Cutibacterium acnes. Their proliferation can trigger an inflammatory reaction, causing the appearance of blackheads, comedones, and pimples that may or may not be inflammatory.

During pregnancy, hormonal changes can increase sebum production and promote these mechanisms. Blemishes can therefore appear as early as the first trimester, sometimes after stopping hormonal contraception. They can also occur later, particularly in the third trimester, depending on the individual's skin sensitivity to hormonal changes.

Treating acne during pregnancy requires special precautions, as many commonly used treatments are contraindicated due to risks to the fetus. Before using any medication or dermatological product, it is recommended to check its compatibility with pregnancy, in particular via the CRAT (Reference Center on Teratogenic Agents) website or with a healthcare professional.

However, there are several approaches that can help to safely reduce blemishes:

1. Cleanse the skin gently and regularly: cleansing morning and evening helps remove excess sebum, impurities, and makeup residue that can clog pores. Choose a gentle cleanser without irritating agents, and avoid harsh scrubs or excessive rubbing, which can increase inflammation.

2. Choose simple, well-tolerated skincare products: During pregnancy, the skin can become more reactive. It is best to use skincare products formulated for sensitive skin, without potentially irritating or occlusive ingredients. Opt for non-comedogenic products to limit pore blockage. Certain oils or very rich textures can promote blemishes: coconut oil, for example, is often not recommended for use on the face.

3. Moisturise the skin without clogging pores: Even when acne is present, the skin needs moisture. A light, non-comedogenic cream helps maintain skin comfort and preserve the balance of the skin's protective barrier. Good overall hydration, by drinking enough water, also contributes to the proper functioning of the body.

4. Limit factors that promote inflammation: A varied diet rich in fruits, vegetables and antioxidant nutrients can help support skin balance. Avoid popping or scratching pimples as much as possible, as this increases the risk of scarring and prolonged inflammation. Moderate sun exposure can sometimes temporarily dry out lesions, but appropriate sun protection is still essential to prevent pigmentation marks.

5. Use certain active ingredients that are compatible with pregnancy: When blemishes are more pronounced, certain treatments may be considered under medical supervision. Dermatological options generally considered safe include benzoyl peroxide, used locally on inflammatory lesions, and erythromycin, which can be prescribed for topical application or, in some cases, for oral use. Zinc supplementation may also be recommended from the second trimester onwards, depending on the needs and recommendations of the healthcare professional.

Certain topical active ingredients are also frequently well tolerated during pregnancy. This is particularly the case with azelaic acid, which is useful for reducing inflammation and minimiing the marks left by pimples, and glycolic acid, which is used in low concentrations to promote skin renewal.

However, other substances are generally not recommended, particularly retinoids and high concentrations of salicylic acid.

6. Consult a doctor if the lesions persist or worsen: as every pregnancy is different, skin reactions can vary. If the acne becomes severe, painful or does not improve despite the measures taken, a dermatologist will be able to offer appropriate and safe treatment.

Hormonal changes during pregnancy can throw your skin out of balance for several months. Fortunately, there are things you can do to slow down the appearance of blemishes and help your skin recover after giving birth.

During pregnancy, the skin often becomes more reactive and sensitive. The use of natural skincare products therefore requires special attention so as not to upset this fragile balance. Before adopting a new ingredient, always test it on the inside of your elbow to check for tolerance. Choose simple formulas that are suitable for combination to oily skin or acne-prone skin. To moisturize without clogging pores, opt for light, non-comedogenic textures. As certain natural active ingredients are not recommended during pregnancy, always check the precautions for use for each product. Finally, if blemishes persist or become painful, seeking medical advice is still the best option for getting appropriate advice.