Pregnancy and breast feeding are special and sometimes stressful periods of time in a woman’s life. We realize our bodies are capable of doing amazing things–growing and nurturing a person!—but we also experience enormous shifts in hormones; changes in sleep, exercise, and diet. Understandably, there also may be anxiety about the health of the baby as we face these new challenges. For some women, pregnancy and breast feeding can cause skin conditions such as acne or eczema to appear for the first time, or make these conditions dramatically worsen in those already affected. For other woman, pregnancy and breast feeding are times when chronic skin conditions improve, even without medications. But for all of us who are pregnant or breast feeding, it is important to know how to care for our skin in a way that is safe for a developing baby. Although I’m always thinking about the best and safest ways to care for my patients, I recently had my second child and so these issues are particularly on my mind!
During pregnancy, the developing baby is exposed to the same food, drink, or medication that enters the mother’s blood. Although most topical products (medications or over the counter items) are absorbed into our blood less than pills, even topical products are absorbed to some degree. Because of that, it’s important to be aware of all the things that are going onto your skin as well as into your body during pregnancy. So how do we safely care for our skin during pregnancy?
First, maintain a regular and gentle regimen of cleansing, moisturizing, and sun protection. Wash off makeup before bed even if you feel exhausted; find a moisturizer with sunscreen that doesn’t irritate you, and commit to not scrubbing, picking, or popping lesions on your skin. Although there is no clear consensus on whether or not chemical sunscreen use during pregnancy is dangerous, if you want to be as careful as possible, choose products with physical sunscreen agents such as those containing titanium dioxide or zinc oxide. I recommend Revision Intellishade TruPhysical because it is a purely physical blocker – the spring is finally here and it’s time for everyone to up their sunscreen game!
If you have acne during pregnancy there are safe options for treatment, and you should see your dermatologist. Pregnant women with acne can safely use some topical medications for short periods of time or over small areas; topical clindamycin, azelaic acid, salicylic acid, and other alpha hydroxy acids are generally considered safe. Gentle facials (such as ZO Medical Oilacleanse) and some laser or light-based therapies are also safe during pregnancy, and these can be a nice alternative to topical or oral medications for acne. Pregnant women with more moderate or severe acne should also see their dermatologist. In these situations, cautious use of specific low-risk oral antibiotics or local steroid injections might be indicated.
Other chronic skin conditions such as eczema and psoriasis occur or flare during pregnancy. Again, there are some treatments for these conditions that are safe and appropriate during pregnancy, so it is important to see your dermatologist. Light treatments (such as Excimer laser or phototherapy) and short courses of mid- to low-potency topical steroids can often be used safely during pregnancy. Gentle skin care and thick, bland moisturizers (such as Hymed Reconstructive Creme) are helpful for these conditions as well.
When a mother is breastfeeding, some of the food, drink, and medications that she take move from the blood to the breast milk. Some things, like alcohol, move directly into the breast milk at the same concentration as the blood. Other things, such as certain medications, are found in only limited amounts in the breast milk. Mothers can be more comfortable using some products, especially topical products, when breastfeeding compared to during pregnancy; however, it is still important to let your dermatologist and your baby’s pediatrician know about any topical products or medications that you are using during breastfeeding. You and your doctor can work together to decide if it is appropriate for you to start or restart topical acne medications. For psoriasis or eczema, small amounts of topical steroids are generally considered safe during breastfeeding, although it is important to minimize treatment to the breasts or nipples directly, or to make sure the medication is washed off these areas before the baby latches.
I have occasionally had a patient say to me, “I didn’t come in when I was pregnant and breastfeeding because I figured that there was nothing I could do.” This is almost never true – even if certain medications are not safe, we as dermatologists can always help a woman understand what her options are and give suggestions to maximize healthy skin. We’re here to help at this unique and wonderful stage of life, just as we are for all other stages!