Acne treatment during pregnancy

Ekaterina Glagoleva, dermatocosmetologist, scientific editor of the portal about aesthetic medicine 1 nep . ru (Russia)

Judging by the numerous forums where the topic of acne and pregnancy is discussed, there is a problem, but it is proposed to solve it after the birth of the baby, so as not to cause harm. But what about those patients who suffered from acne even before pregnancy, and now the disease has only worsened? Wait? Remember that beauty is temporary, but health is eternal? What if the disease progresses? The answer lies on the surface: it is necessary to look for the safest methods of therapy, but the situation cannot be left without control.

About acne regardless of pregnancy

If we are talking about true acne, and not about a transient change in hormonal reception, which is manifested by several mild elements of rashes on the face, then we must act accordingly.

Let's remember the classical definitions.

Acne (acne vulgaris) is a chronic recurrent skin disease, mainly of young people, which is the result of overproduction of sebum and blockage of hyperplastic sebaceous glands with subsequent inflammation.

It has now been established that four main mechanisms are involved in the formation of acne:

• hyperproduction of secretions by the sebaceous glands;
• follicular hyperkeratosis;
• bacterial activity ( Propionibacterium acnes );
• inflammation.

Propionibacterium acnes is considered the main infectious agent in the pathogenesis of acne. It is important to note that this microorganism is a normal representative of the skin microflora, the mouths of hair follicles and sebaceous glands, which does not always cause the formation of acne and the development of inflammation. P. acnes , in the process of life, break down sebum and produce biochemical substances that have strong inflammatory properties when they come into contact with surrounding tissues. Damage to the epithelium causes the development of inflammation in the lesion, which leads to the formation of pustules and microabscesses. Accordingly, the points of acne therapy are:

• regulation (normalization) of sebum secretion;
• limitation and relief of the inflammatory process;
• fight against follicular hyperkeratosis;
• stabilization of the activity of bacteria that cause acne (P. acnes).

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There are proven protocols for the treatment of acne, but not all drugs can be used during pregnancy. Of course, we remember that pregnancy is not a disease, but this delicate and very important condition of the female body imposes a number of restrictions in the choice of medications and dermatocosmetological methods of correction.

Treatment options for acne during pregnancy

Which of the usual set of products can be taken into “pregnant care” for skin with acne, which is better to avoid, and which myths are really harmful? Let's analyze everything in order.

Daily skin cleansing

For some incredible reason, almost all pregnant women are recommended to wash their faces with baby soap - a dangerous misconception that leads to skin dehydration and increased sebum production in an attempt to protect the damaged hydrolipidic mantle of the skin.

To cleanse the skin during pregnancy, especially if it is more prone to acne, it is better to use micellar solutions, which are available both in pharmacy ranges and in professional skin care lines. Fatty acid micelles are highly active and remove surface contaminants. Some of the micellar solutions perform more specific functions, such as moisturizing, sebum regulation, minimizing itching and burning (if we are talking about symptoms typical of sensitive skin).

Deep skin cleansing

Very often, patients with acne use a large number of scrubs containing loofah particles, synthetic granules, particles of nut shells and seeds. Excessive enthusiasm for polishing compounds is quite understandable: the feeling of “cleanliness and freshness” of the face is immediate after the procedure. But excessive exfoliation leads to compensatory hypersecretion of sebum, increasing the main clinical manifestations.

An alternative is to use soft cream products with enzymes, traditionally bromelain and papain are among them. The modern interpretation is bacterial peelings that selectively destroy keratinocytes and successfully fight follicular hyperkeratosis. Improvement in sebum production will not occur instantly: to normalize the hyperproduction of sebum, several cycles of skin cell renewal will be required, so you need to be patient... and absorbent mattifying wipes.

Choosing a basic care cream

Many skin care lines have products designed for problem skin. Often these creams contain astringent plant antibacterial extracts, small amounts of salicylic acid and are supposed to have a local anti-inflammatory effect. It sounds attractive, of course, but the downside of regular use of such products is skin dehydration. Dehydrated skin is less resistant to environmental aggression and is more easily involved in inflammatory processes.

The alternative is adequate hydration. It is necessary to choose a moisturizing external product with a medium lipid content, without additional active molecules. The purpose of the cream in this case is to restore the barrier properties of the skin. Classic squalene, used along with adapalene and benzoyl peroxide, provides significant improvements in the first three weeks of use in patients with acne, indicating the restoration of the skin's own barrier properties and the ability to limit inflammation using the skin's immune autoresources.

Dermatological correction

In cases where the patient received active external therapy before pregnancy, it can be extremely difficult (even psychologically) to give up medications, and sometimes it is not even necessary. But it is important to remember that retinoids and their derivatives are strictly prohibited.

The drug of choice for acne in pregnant women can be considered a gel with azelaic acid (for example, Skinoren-gel).

Erythromycin and azelaic acid are classified as pregnancy category B by the FDA. No negative effects on the fetus were detected in the experiments. But the authors of the work conducted in the Department of Dermatology of the University of California (San Francisco) came to the conclusion that azelaic acid is a drug of the first rank in terms of safety in the treatment of acne in pregnant women, but the use of such antimicrobial and anti-inflammatory agents as salicylic and glycolic acid.

This confirmation of safety is extremely important for the possibility of using surface chemical pilins based on combined acids in the treatment of acne in pregnant women. In our clinical practice, we successfully use drugs based on lactic and salicylic acids to limit inflammation and combat follicular hyperkeratosis during pregnancy.

There is also no final clarity regarding the safety of using topical benzoyl peroxide in the treatment of pregnant patients with acne.

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Summarizing the analysis of scientific research and our own clinical experience, we can say that:

• therapy for acne in pregnant women must be timely, meet safety requirements and act on key links in pathogenesis;
• Today, the most studied and effective remedy is azelaic acid;
• in professional dermatocosmetological procedures, the drugs of choice are superficial chemical peels based on salicylic, lactic and glycolic acids;
• the use of topical benzoyl peroxide during pregnancy is permitted, but the choice of drug should be based on the severity of the disease;
• Using moisturizers with antioxidant properties in home care has been clinically proven to improve acne.

First published: Les Nouvelles Esthetiques Ukraine, No. 1 (83), 2014, pp. 76-80