The Real Reasons Pregnancy Acne Happens—and What Actually Works to Treat It

• Pregnancy acne is common, affecting up to 42 percent of pregnant women due to hormonal fluctuations that increase oil production and inflammation.
• Safe treatments include azelaic acid, gentle AHAs, sulfur, zinc, and pimple patches. Retinoids, hydroquinone, spironolactone, and Accutane must be avoided.
• Prevention and recovery take time, but a gentle routine, noncomedogenic products, and expert guidance can help. And know that breakouts often improve after hormones stabilize postpartum.

I vividly remember the day I found out I was pregnant with my daughter. I was beaming from ear to ear, excited to finally become a mom. I expected the weight gain, stretch marks, swollen ankles and feet, and morning sickness, but I never thought my skin would erupt with cystic acne that made me want to hide under the covers. Where was my pregnancy glow? Unfortunately, it never paid me a visit.

My pregnancy acne was far worse than the acne I experienced as a teenager and even the adult acne of my late 20s and early 30s, which was pretty bad. Clusters of deep, painful, super-inflamed, monster-sized bumps seemed to pop up overnight, taking up residence on the lower third of my face for weeks on end before slowly shrinking down, only for the cycle to repeat itself. No matter what I used to try and calm my skin, it continued to break out for nine months straight, eventually leaving my face and chest with hard-to-get-rid-of post-inflammatory hyperpigmentation.

I know I’m not the only pregnant woman to experience acne with a vengeance like that. 42 percent of pregnant women experience pregnancy acne, and it's largely due to fluctuating hormones and changes to the immune system. But unlike treating regular acne, which can be cleared up with things like prescription retinoids, lasers, and oral meds like spironolactone, getting rid of pregnancy acne can be tricky since fewer treatment options can be safely used. That's why I created this handy guide for managing acne when you're pregnancy. Keep reading for the best tips, ingredients, and insight from experts.

Hormones are to blame here. Dermatologist Aegean H. Chan, MD, FAAD, explains that levels of the hormone progesterone rise sharply to support the pregnancy while simultaneously stimulating the sebaceous glands, leading to increased oil production and a thickening of the lining of hair follicles, which can trap bacteria and debris within the pores and cause acne.

During pregnancy, changes in the immune system make it easier for bacteria to proliferate and inflammation can run rampant, says board-certified dermatologist Brendan Camp, MD. In other words, it’s so much easier for skin to break out during pregnancy, be it on the face, shoulders, chest, neck, back, or butt.

Dermatologist Gervaise Gerstner, MD, says that most acne occurs during the first trimester since this is when human chorionic gonadotropin (hCG), progesterone, and estrogen levels fluctuate. By the time the third trimester rolls around, some women notice fewer breakouts as hormone levels plateau and the skin adjusts. But that isn’t a hard and fast rule, and Dr. Chan says that acne can persist throughout pregnancy, especially in women who have a history of hormonally driven breakouts. “On the flipside, there are women who notice clearer skin while expecting, which is likely due to shifts in their immune balance and estrogen levels,” she adds.

As far as the old wives’ tale that breakouts mean you’re having a girl, that isn’t exactly true. Pregnancy acne that develops is often related to hormonal changes, which Dr. Camp says can occur no matter the sex of the unborn baby.

There are plenty of acne treatments that are safe to use while pregnant, and a handful that are completely off-limits. “I always tell patients to avoid hydroquinone and vitamin A in all forms,” Dr. Gerstner says. Oral isotretinoin (Accutane) and topical retinoids and retinols can potentially cause birth defects and therefore must be avoided while pregnant. Another holy grail acne medication to steer clear of? Spironolactone. “It’s also contraindicated during pregnancy because it works by interfering with certain hormone signals,” Dr. Camp explains.

When it comes to treating pregnancy acne, it's best to stick to ingredients like tea tree oil, azelaic and lactic acids, sulfur, zinc, and low-concentration glycolic acids, all of which are safe to use during pregnancy. “Azelaic acid is my go-to for pregnancy acne because it fights inflammation and bacteria, is gentle on the skin, and is one of the safest options we have,” Dr. Chan says. “It’s also anti-inflammatory and has mild comedolytic effects, so it can also help with post-inflammatory hyperpigmentation.” She likes pairing it with gentle alpha hydroxy acids (AHAs), such as lactic acid and mandelic acid, and polyhydroxy acids (PHAs), which have larger molecule sizes, so there’s less systemic absorption.

When pimples turn up, resist the urge to pop them. Picking and popping them only makes things worse, leading to increased swelling, infection, scarring, and post-inflammatory hyperpigmentation.

And since skin is more vascular and sensitive during pregnancy, small blemishes can morph into large, angry ones when manipulated. Instead, reach for gentle exfoliating pads, sulfur-based spot treatments, and pimple patches, which draw out fluid and help flatten pimples. At-home masks powered by sulfur and kaolin clay can help control excess oil while clarifying pores too.

Shop these pregnancy-safe acne treatments:

Face Reality Sulfur Spot Treatment

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Hero Cosmetics Mighty Patch The Original

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$22 $13 at Dermstore$22 $13 at GOOP

YSE Beauty Your Favorite Ex Exfoliating Pads

$75 at Sephora

The Ordinary Salicylic Acid 2% Masque

$14 at Amazon

$14 at Nordstrom$14 at Ulta Beauty

For deep, painful cysts, cortisone injections can help too. “Professional in-office treatments like a GLO2 Facial and HydraFacials, as well as a low-strength chemical peel, can also help with breakouts,” Dr. Gerstner adds. For more persistent, severe acne, low-risk medications can be prescribed under a dermatologist’s watch. “Topical antibiotics, such as clindamycin, are commonly prescribed acne medications during pregnancy,” says Dr. Camp.

Preventing pregnancy acne is hard, but it isn’t impossible. While you can’t control fluctuating hormones, you can follow a simple yet effective skincare routine that includes gentle cleansers, noncomedogenic moisturizers, and lightweight sunscreen. Changing your pillowcases weekly, regularly washing your makeup brushes, and avoiding pore-clogging hair products around the hairline can also make a difference, Dr. Chan says.

Pimples and acne don’t always instantaneously disappear once you give birth. “For some women, pregnancy-induced acne improves a few months after delivery as hormones stabilize, but for others, acne can persist or even worsen postpartum,” says Dr. Chan. “Hormone levels don’t reset overnight, and estrogen and progesterone continue to fluctuate as the body recovers.” Plus, she adds that breastfeeding can cause lower estrogen levels for longer, which can prolong oil production and breakouts.

If post-partum acne is a problem, the buffet of treatment options opens up, but still needs to be viewed cautiously if breastfeeding. Dr. Gerstner recommends checking in with a dermatologist after delivery but letting the body settle for about six weeks before starting a new regimen. “Be patient with your skin and body,” she says. “Remember, it takes nine months for the body to grow a baby and another nine months (sometimes longer) to get the skin, hair, and body back to a steady state.”

• Aegean H. Chan, MD, FAAD, is a dual board-certified dermatologist and dermatopathologist based in California.
• Brendan Camp, MD, is a board-certified dermatologist in New York.
• Gervaise Gerstner, MD, is a board-certified dermatologist in New York and brand partner at VirginSkin.

Elise Minton Tabin is an award-winning beauty journalist, editor, and expert with 20 years of experience. A prolific content creator and trendspotter, Elise always knows what’s new, what works, and who’s the best to go to for treatments and procedures.

Elise Tabin

Contributing Beauty Writer

Elise Minton Tabin is an award-winning beauty journalist, editor, and expert with 20 years of experience. She started her career in public relations before shifting to editorial. Elise rose the ranks at NewBeauty magazine from an editorial assistant to Executive Beauty Editor, overseeing and reporting on all things beauty, plastic surgery, anti-aging, health, and wellness. A prolific content creator and trendspotter, Elise always knows what’s new, what works, and who’s the best to go to for treatments and procedures. She contributes to media outlets including InStyle, NewBeauty, The Zoe Report, Byrdie, Beauty Independent, The Aesthetic Guide, Bazaar, and more.