Several over-the-counter acne treatments are considered safe during pregnancy, including benzoyl peroxide, azelaic acid, topical salicylic acid, and glycolic acid. These are the four topical ingredients specifically listed by the American College of Obstetricians and Gynecologists (ACOG) as acceptable for use during pregnancy. A few prescription options also exist, while some of the most common acne medications are strictly off-limits.
Safe Over-the-Counter Options
The reason these four ingredients get the green light comes down to how little of each one actually enters your bloodstream when applied to the skin.
Benzoyl peroxide is one of the most widely available acne-fighting ingredients. It kills acne-causing bacteria on the skin’s surface. Very little is absorbed systemically, making it a practical first choice for mild to moderate breakouts during pregnancy. It’s available in concentrations from 2.5% to 10%, and lower strengths tend to be less drying.
Azelaic acid is a particularly versatile option. It fights bacteria, unclogs pores, and reduces inflammation all at once. It also helps with dark spots, which can be a bonus since pregnancy often triggers hyperpigmentation. Systemic absorption is low: the 20% cream formulation results in roughly 3% absorption, while the 15% gel absorbs around 8%. Animal studies found no harmful effects on fetuses even at high doses. Controlled human studies during pregnancy are still lacking, but no adverse events have been reported. It carries a Category B safety rating from the FDA, meaning animal studies show no risk and it’s generally considered the preferred pregnancy acne treatment. That said, some experts recommend using it on smaller areas of skin and avoiding it in the first trimester as a precaution.
Topical salicylic acid is found in many face washes, toners, and spot treatments. When applied to intact skin at the low concentrations typical in acne products (usually 0.5% to 2%), absorption through the skin is minimal to undetectable. No studies have been done specifically on topical use during pregnancy, but the very small amounts that reach the bloodstream make it unlikely to pose any risk. The concern with salicylic acid relates to high-dose oral forms (like aspirin), not the small amounts in a face wash or toner.
Glycolic acid is an alpha-hydroxy acid that works by exfoliating the outer layer of skin, helping to keep pores clear. ACOG includes it on its safe list for pregnancy. It’s commonly found in cleansers, toners, and peels at concentrations ranging from about 5% to 10% in at-home products.
Prescription Treatments That Are Safe
Topical clindamycin is an antibiotic your provider may prescribe for inflammatory acne (the red, swollen kind) during pregnancy. When applied to the skin, only very small amounts pass through into the bloodstream, meaning a pregnancy would be exposed to a minimal dose. It’s often combined with benzoyl peroxide for better results and to prevent bacterial resistance.
For more severe or stubborn acne that doesn’t respond to topical treatments, light and laser therapies are an option worth discussing with your dermatologist. Narrowband ultraviolet B phototherapy, photodynamic therapy, and certain laser treatments are generally considered safe during pregnancy. These procedures have no known ability to cause birth defects, and systemic absorption is minimal. Safe use of light therapy for pregnancy acne has been documented in clinical case reports, though large-scale studies in pregnant patients are limited.
Treatments You Must Avoid
Some of the most effective acne medications outside of pregnancy become genuinely dangerous during it. This isn’t a gray area, so it’s worth knowing exactly what to steer clear of.
Isotretinoin (originally sold as Accutane) is the most dangerous acne medication for a developing baby. It causes severe birth defects including skull and facial abnormalities, heart defects, brain malformations, and intellectual disabilities. The risks are so serious that anyone who can become pregnant must take two forms of contraception simultaneously and pass a monthly pregnancy test to receive a prescription. If you’re currently taking isotretinoin and discover you’re pregnant, stop immediately and contact your provider.
Topical retinoids like tretinoin (Retin-A) and adapalene (Differin) belong to the same vitamin A family as isotretinoin. While the amount absorbed through the skin is much lower than an oral dose, experts recommend avoiding them entirely during pregnancy. This includes retinol, the over-the-counter form found in many anti-aging serums and moisturizers. Check your existing skincare products for retinol, retinaldehyde, or any ingredient with “retin” in the name.
Oral tetracyclines, a class of antibiotics commonly prescribed for acne (including doxycycline and minocycline), can discolor a baby’s developing teeth if taken after the fourth month of pregnancy and may affect bone growth for as long as the medication is used.
Hormonal therapies like spironolactone, sometimes used for hormonal acne in non-pregnant patients, are not recommended during pregnancy because they can interfere with fetal development and cause birth defects.
Building a Pregnancy-Safe Routine
A practical approach for mild to moderate pregnancy acne is to start with a benzoyl peroxide cleanser or spot treatment and add azelaic acid for broader coverage. If breakouts are primarily blackheads and clogged pores, a salicylic acid wash or glycolic acid toner can help keep things clear. You can use these ingredients in combination, but introducing them one at a time helps you identify what’s working and avoid over-drying your skin, which pregnancy can already make more sensitive.
If over-the-counter options aren’t enough after several weeks, a prescription for topical clindamycin is a reasonable next step. For truly resistant or severe cystic acne, light therapy offers a non-medication alternative. Keep in mind that pregnancy acne often improves on its own as hormone levels stabilize, particularly after the first trimester.
One important step that’s easy to overlook: go through your current products and remove anything containing retinoids or retinol before you start adding new ones. Many popular serums, night creams, and even some foundations contain retinol as an anti-aging ingredient, and switching those out matters just as much as choosing the right acne treatment.