It’s all about the hormones.
Hormones can play a major role in acne vulgaris, and pregnancy involves large changes in hormonal balance. During pregnancy, women produce increasing amounts of the female hormones progesterone and estrogen. In addition, blood sugar levels rise to provide additional energy to the growing fetus. The fetus itself and the placenta produce additional hormones. Immune function is modulated to protect the baby and support the pregnancy.
In summary, there are a tremendous number of changes that take place in the female body during pregnancy, and these changes can have both positive and negative effects on acne symptoms. Onset of acne or a worsening of acne symptoms is very common during pregnancy. At the same time, a smaller percentage of women report an improvement in their acne symptoms during pregnancy.
Pregnancy and Sex Hormones
The fundamental regulators of pregnancy are the sex hormones. These sex hormones include both female hormones (progesterone and estrogen) and male hormones (testosterone and other androgens). Both sets of hormones cause major physiological and metabolic changes in the body. During pregnancy, levels of all of these hormones tend to rise. Increasing levels of progesterone and estrogen help to stabilize the uterus, direct nutrients to the placenta and facillitate growth of the fetus. These hormones are also the active ingredients in combined hormonal contraceptives (the pill). Use of the pill has been shown to improve acne in some women and worsen it in others, with comparable frequency. The role of the androgens in the process of pregnancy is less well known. What is known is that androgen levels increase throughout pregnancy and spike in the third trimester. Androgen tends to stimulate proliferation of the sebaceous glands and elevated levels of androgens are strongly correlated with increased frequency and severity of acne symptoms. Signs of elevated androgen levels in women include increased body/facial hair growth (hirsutism), hair thinning (on the head) and masculinization of features (in severe cases). Androgen levels are usually elevated by anabolic steroid use.
The Role of Post-Pregnancy Sex Hormones
Research indicates that pregnancy can induce long lasting changes in hormonal balance. This can include elevated levels of both male and female sex hormones. Many women report experiencing problems with acne that began with a pregnancy and continued after. This could be the result of semi-permanent changes in sex hormone levels. It could also be a result of continuing infection with acne causing bacteria that began during pregnancy. For women who are not pregnant, there are several options available to both modulate hormone levels and to treat acne directly. These include androgen inhibitors, which can block the effect of elevated androgen levels.
Common Changes in the Skin during Pregnancy
In most cases, pregnancy induces noticeable changes in the appearance of the skin, especially in facial skin. People often refer to a “glow” in the skin of pregnant women. These changes result from vascular (blood vessel) dilation and proliferation which results in increased blood flow to the skin. Another very common change is hyper-pigmentation, which occurs in approximately 90% of women. Approximately 50% of women experience pregnancy induced melasma, which is the increased pigmentation of patches of skin, primarily found on the nose, cheeks and upper lip. Some of these effects subside after completion of pregnancy, but some remain permanently.
Acne Medications and Pregnancy
Pregnant women are much more limited in their options for acne treatment than men or non-pregnant women. Because pregnancy is such a delicate process, it is essential that pregnant women maintain a healthy diet and limit their exposure to substances that may effect the development of the fetus. Some acne medications, like retinoic acids (Isotretinoin, Accutane, Retin-A) are highly toxic to the fetus and even small amounts or topical applications can cause birth defects or death of the fetus. Other medications like tetracycline or androgen inhibitors can disrupt normal development. Allergic reactions to medications can also be dangerous to the fetus. Even homeopathic treatments, like mineral supplementation (zinc, copper), can be dangerous to a developing embryo. It is important to thoroughly discuss any medication or homeopathic treatment with your physician or Ob/Gyn before beginning treatment. For a more complete discussion about the risks of certain medications, I attached this bulletin from the Illinois Teratogen Information Service: Acne and Pregnancy – Medications.
References and Sources
Physiologic Skin Changes During Pregnancy: A study of 140 Cases.
Muzaffar, et al. 1998.
Acne and Pregnancy.
O’Connell, et al. 2000.
Maternal serum androgens in human pregnancy: early increases within the cycle of conception.
Castracane, et al. 1998.
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