Yes, you can use azelaic acid while pregnant. It is one of a small number of topical skin treatments considered compatible with pregnancy. The American College of Obstetricians and Gynecologists (ACOG) includes azelaic acid on its list of over-the-counter ingredients that can be used during pregnancy, alongside benzoyl peroxide, topical salicylic acid, and glycolic acid.
Why Azelaic Acid Is Considered Safe
Azelaic acid carries an FDA pregnancy category B rating, which means animal studies have shown no risk to the fetus, though large controlled studies in pregnant humans are limited. What makes this ingredient particularly reassuring is how little of it actually enters your bloodstream. When you apply azelaic acid to your skin, only about 3 to 8 percent is absorbed systemically. For a 20% cream, that figure is less than 4 percent.
Azelaic acid is also a naturally occurring substance. Your body already produces it, and it’s found in common foods like wheat, barley, and rye. So even the small amount that does reach your bloodstream isn’t introducing something foreign to your system. Animal studies using doses far higher than what a topical product delivers found no harmful effects on fetuses or newborns. And in a clinical study comparing acne treatments in pregnant women, azelaic acid caused no side effects that required stopping treatment.
What It Treats During Pregnancy
Pregnancy triggers a range of skin changes driven by hormonal shifts, and azelaic acid happens to address several of them. For acne, it works by slowing the growth of acne-causing bacteria on the skin, reducing inflammation, and helping unclog pores. A study comparing three topical acne treatments in pregnant women found azelaic acid was the most effective for mild to moderate breakouts, with higher patient satisfaction than the alternatives.
The other major use is melasma, sometimes called “the mask of pregnancy.” Up to 70% of pregnant women develop these dark patches on the face. Azelaic acid helps by interfering with excess pigment production in the skin. A meta-analysis of six studies found that azelaic acid actually outperformed hydroquinone (the standard melasma treatment, which is not recommended during pregnancy) in reducing melasma severity scores. This makes azelaic acid one of the few effective options for pregnancy-related hyperpigmentation.
Practical Tips for Using It Safely
While azelaic acid is generally considered low-risk, some dermatology guidelines recommend a cautious approach: apply it to small areas of skin rather than large surfaces, and some experts suggest avoiding use during the first trimester when possible. These are precautionary recommendations rather than responses to known risks, since no adverse events have been reported.
Both prescription-strength formulations (15% gel and 20% cream) and lower-concentration over-the-counter products are available. The research on pregnancy safety hasn’t identified meaningful differences between concentrations, since systemic absorption remains low across the board. If you’re using a prescription product, your provider likely already factored pregnancy into that recommendation. For over-the-counter products, the same low-absorption profile applies.
Common side effects are limited to the skin itself: mild burning, stinging, or dryness at the application site. These aren’t pregnancy-specific and tend to improve as your skin adjusts.
Using Azelaic Acid While Breastfeeding
Azelaic acid is also considered low-risk during breastfeeding. Because so little is absorbed into the bloodstream, and because azelaic acid already appears naturally in breast milk, topical use isn’t expected to change what your baby is exposed to in any meaningful way. The main practical precaution: don’t apply it to your breast or nipple area, and make sure your baby’s skin doesn’t come into direct contact with treated areas. If you’re using a product on your face for acne or melasma, this is straightforward.
Ingredients to Avoid Instead
The reason azelaic acid comes up so often in pregnancy skin care discussions is that many of the go-to treatments for acne and hyperpigmentation are off the table. Retinoids (tretinoin, adapalene, tazarotene) are contraindicated during pregnancy. Hydroquinone, the most common melasma treatment, is not recommended due to its higher absorption rate. Oral acne medications like isotretinoin are known to cause birth defects.
That leaves a short list of pregnancy-compatible options. According to ACOG, your safest over-the-counter choices are azelaic acid, benzoyl peroxide, topical salicylic acid, and glycolic acid. Of these, azelaic acid is the most versatile because it addresses both acne and hyperpigmentation, while the others primarily target breakouts alone.