Pregnancy is such an incredible and exciting event in life, but many women will admit that it can have some challenging moments, both physically and emotionally. For some, “pregnancy glow” can quickly become overshadowed by hormonal acne. Most women know that they will have to sacrifice some aspects of their life, but, often, do not know that it might include their skin. In fact, almost half of expecting women are affected by hormonal acne in the first trimester.

There is quite a bit of hormonally-driven change that takes place in those nine months and skin can respond with some unexpected issues, as well. “Acne during pregnancy can be mild, moderate, or even severe and it can occur at any time during the pregnancy. It may come and go or it may last the entire pregnancy,” says Andrea Cambio, a dermatologist in Cape Coral, Florida. The good news is, it is only temporary.

Causes and Triggers
During pregnancy, hormone levels are elevated. Hormones called androgens become present and are then converted into estrogen and progesterone, which can cause the glands to produce an excess of sebum, causing congestion, inflammation, and breakouts.
Individuals who were acne-prone as adolescents and those prone to breakouts during their menstrual periods have a greater likelihood to experience breakouts in the first and second trimester.
Dehydration can also contribute to worsening complexion during pregnancy, so staying hydrated can be a simple, yet helpful, strategy in minimizing breakouts. Besides, drinking an adequate amount of water daily is beneficial for both the mind and body.

Treatment
For those expecting, a monthly facial is highly beneficial. If one’s lifestyle does not call for a monthly commitment, then getting a facial every other month is an option. Skin care should be part of everyone’s wellness program, just like exercise and diet. Even though treatment options may be limited, a monthly facial should be used for that much needed personal time. This is especially important as a mom or expecting mom. In addition, facials promote relaxation and happiness and can be that feel-good needed for overall mental health. Facials should not be treated as a “splurge” item, but treated as deliberate self-care. But, of course, great skin is a pretty nice bonus!
“While not everyone begins a skin care regimen for beauty reasons, the very act of looking out for skin, no matter the purpose, is comforting and soothing by nature,” says Rena Jogi, a dermatologist and affiliated physician with Memorial Hermann Memorial City Medical Center in Houston. “When you do a skin care routine, you’re usually alone in your bathroom or somewhere quiet and it’s just you and the mirror.” “There’s something slightly meditative about just sitting there and taking that 10 minutes just for you.”
Seeing an aesthetician regularly can help keep clients on track with a homecare routine and help guide them through their pregnancy as skin care needs change. Pregnant clients should only use products that contain ingredients that are safe to use during pregnancy. If acne is not an issue during pregnancy, then products that target sensitive skin are typically a good option.

Ingredients
The following are some ingredients that are regarded as safe when treating acne during pregnancy.

• Azelaic Acid: A potent, multifunctional compound found in wheat, rye, barley, and sunflowers, belonging to the family of dicarboxylic acids. Azelaic acid is one of the most valuable and versatile keratolytic, comedolytic, antimicrobial, anti-inflammatory, and pigment-brightening actives capable of improving multiple imperfections related to hyperpigmentation, acne, rosacea, aging, and sensitive skin. From a pregnancy stand point, it helps refine, clarify, calm the skin, and brighten dark spots from pregnancy-induced melasma.
• Glycolic Acid: Often regarded as the most powerful and aggressive alpha hydroxy acid, this sugar cane-derived fruit acid seems to be the go-to by skin care professionals and consumers. Its popularity may be from its ability to penetrate quickly and efficiently due to its small molecular size, breaking up the lipid and protein bonds between the cells and speeding up their exfoliation and turnover rate. It is effective for aiding in the removal of dead, polluted, dehydrated, and pigmented cells, speeding up cell turnover and encouraging healthier, younger cells to emerge.
• Lactic Acid: Derived from milk or sugar fermentation, it works more on the surface level due to larger molecular structure, ensuring a gentler approach on the skin than glycolic acid, making it more suitable for pregnant women worried about using acids for skin treatments. It helps reduce surface cell buildup while infusing plumping moisture into the skin’s surface, helping those who suffer from dry, dull skin, restoring smoothness to skin and softening the appearance of fine lines.
• Clay: Clay masks have become a staple in homecare routines and are a great treatment solution for acne prone skin. Formulas that contain bentonite clay have antimicrobial and anti-inflammatory properties and absorb excess oil and surface cells. Kaolin clay is another option that works well to help purify skin and draw out impurities from deep within pores.
• Charcoal: Continuing to be a trend in the skin care industry – and for good reason – charcoal acts as a biological magnet that draws out pore-clogging impurities and environmental toxins from congested pores. Drawing out these impurities helps minimize the look of large pores, fine lines, and wrinkles, leaving skin looking pure, fresh, moisturized, and radiant.
• Vitamin C: Vitamin C is a powerhouse ingredient that can target a multitude of issues from environmental damage to different forms of pigmentation to lack of firmness. This powerful antioxidant can also do wonders for one of the more annoying side effects of hormonal acne, brown spots.
• Lilac Stem Cells (Syringa Vulgaris): These purifying and brightening sebo-regulators are produced through directed plant cell culture methods designed to increase lilac’s content of verbascoside, a potent biosugar with multiple benefits on imbalanced complexion. These powerful plant extracts reduce both the number and the surface of irritated and discolored spots caused by inflammatory blemishes. They visibly reduce oiliness, shine, and cell buildup, improving the elimination of dead cells, diminishing breakouts, and promoting brighter, clearer-looking skin. Lilac stem cells exhibit strong anti-tyrosinase activity, limiting the melanin production stimulated by inflammation. Therefore, the intensity of dark spots caused by inflammatory blemishes are reduced. It also limits the bacterial breeding ground by decreasing hyperkeratosis and the bacteria’s system for binding to cells. This potent, yet gentle, ingredient works to reveal a smoother, blemishfree surface.

Ingredients to Avoid
The following ingredients should not be used in a skin care routine because of the risk they pose to the baby.

• Found in Retin-A and Accutane, retinoids are prescription acne and antiaging medications. They may be listed on ingredient labels as retinoic acid, retinyl palmitate, retinaldehyde, adapalene, tretinoin, tazarotene, and isotretinoin. There is an increased risk of birth defects for developing babies if retinoids are used. If using retinoids when pregnant, clients should stop taking them immediately.
• Tetracyclines are antibiotics that should be avoided during pregnancy. Medications include doxycycline and minocycline. They are used to treat a number of infections. There are many side effects, one of which is poor tooth development on children eight years old and under. Studies have shown that it may be harmful to the baby during pregnancy.
• Hydroquinone is only available by prescription and is a skin-lightening agent used to treat conditions such as chloasma and melasma. While brighter skin is high on wish lists for both men and women, treatments of this nature need to stop during pregnancy and breastfeeding.
• Hydroquinone is a pregnancy category “C” ingredient, meaning the ingredient has been proven to cause birth defects in animals, but not conclusively in humans. The effect on animals includes stillbirth, deformities, and lower than average birth weight. Despite the potential threat to animals and humans, many skin bleaching products are marketed toward pregnant women to treat melasma. The risk surely outweighs any benefit.
• Salicylic acid is a beta hydroxy acid and is commonly used in acne-prone or oily skin care products. Salicylic acid is a keratolytic BHA that is derived from willow bark and can penetrate into pore lining, reduce sebum buildup, and exfoliate inside the pore, as well as on the surface of skin. It makes for a great spot treatment for breakouts because it gets deep into pores, purifies them, and helps reduce redness. However, salicylic acid should not be used during pregnancy because it may cause complications for the baby.

Establishing a Homecare Routine
Caring for skin during pregnancy does not need to be difficult. In fact, it should not be difficult if the individual is already on an existing routine. Professionals should encourage pregnant clients to see them regularly, not only for a service, but for help in setting up and maintaining a healthy homecare routine. Product selections should be based on the client’s lifestyle and skin condition, which will most likely change in those nine months, so continue to monitor the homecare routine and adjust when needed.
Here are some ways to setup healthy homecare habits for expecting clients. Keep the homecare routine simple and build a foundation if they do not have one. Start with the basics: a cleanser, toner, and moisturizer and, then, sunscreen for the daytime. These are the core products that everyone should be using and clients can build from there with corrective serums, masks, and exfoliants. Depending on the client, a morning and evening routine can be suggested. While the morning routine can be kept simple using the previously mentioned basics, the evening routine is a good place to incorporate an exfoliant and mask (only two to three times a week), avoiding any product that may be too abrasive or cause irritation to the skin.

Some additional tips that may help include:

• Washing gently with an ultra-mild, soap-free, sulfate-free cleanser twice a day.
• Avoiding irritating the skin and exacerbating problematic skin. Clients should not use a washcloth to clean their face.
• Using a lightweight, non-fragrant moisturizer that provides all day hydration.
• Refraining from squeezing, rubbing, or popping pimples, as it can lead to worsening the problem and possible scarring.
• Washing off makeup before bedtime, as well as looking for products that are water-based rather than oil-based.

Understanding the causes of pregnancy acne, as well as best practices for treating it, such as ingredients to look for and to avoid, will help professionals in reducing their clients’ skin-related worries during this exciting and, sometimes, stressful time in their lives.

Ashley Stowers is a national educator and account executive for YG Laboratories and CelleClé Skincare. In addition to her role in sales, she provides hands-on support in all aspects of education and product knowledge training, protocol development, and effective business merchandising. With over 15 years of experience in sales and education, holding positions as an aesthetics instructor and skin care therapist, Stowers possesses a very broad and unique understanding of the professional world and skin care industry.