Question:

Is it safe to use products that contain salicylic acid to control acne breakouts during pregnancy? Is there any acne medication that I can take?

Answer:

Salicylic acid products (which include aspirin) inhibit prostaglandins. Because of this, the can have varying effects on pregnancy and babies. One of the most problematic is the ability to cause early closure of the ductus arteriosis, an extra arterial conduit that fetuses have because they live "underwater." If this closes too early, it causes inappropriate shunting of the blood and leads to oxygen deprivation. This can occur if the salicylate is ingested in the third trimester.

Aspirin, but not other salycilates, also causes problems with platelet function, thereby inhibiting blood clotting.

Most studies indicate that using aspirin in small amounts, infrequently, and before the third trimester is probably safe.

All salicylates are classified as category C (either studies in animals have revealed adverse effects on the fetus [teratogenic or embryocidal or other], or there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus).

In the third trimester they are classified as category D (there is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk [that is if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective]).

Most topical treatments for acne are safe in pregnancy, but unless the acne is severe and likely to cause disfiguring scars, I usually recommend waiting until after pregnancy to treat. One needs to balance the benefits gained against the risks involved, and in most cases of acne, the risks probably outweigh the benefits.