The best course is to "say no" to any unnecessary drugs if you're pregnant or breastfeeding. Your baby is your first concern and you want to minimize any potentially harmful agents that might reach her. That said, the best way to treat acne during pregnancy is with a topical acne-fighting preparation.
If you're planning to get pregnant, discuss your acne treatments with your dermatologist or healthcare provider. Some of the medications that are safely used to treat acne when you aren't pregnant may be potentially harmful to a developing fetus.
The treatments that your doctor may prescribe during pregnancy
Erythromycin
There are many topical prescription products that contain this antibiotic.
Benzamycin Gel
Benzamycin Gel combines erythromycin and benzoyl peroxide.
Azelaic Acid
This is a natural chemical produced by yeast. It is the active ingredient in the prescription products Azelex and Finevin.
Because passage of the drug into maternal milk may occur, this drug should be used during pregnancy or by nursing mothers only if clearly needed.
On the whole, I recommend that you avoid all oral medicines to treat acne when you're pregnant. However, oral erythromycin if you're not allergic to it may be taken safely if your acne is really bad. If you're allergic to erythromycin or it's not working, your dermatologist may prescribe another oral antibiotic that can be used in pregnancy.
But, when it comes to benzoyl peroxide, sulfacetamide, and sulfur drugs, they've been around for ages and no evidence has ever shown them to be harmful to a fetus. With some of the other drugs mentioned below, definitive evidence isn't available one way or the other, so I recommend that you avoid them unless your healthcare provider or dermatologist says otherwise.
The following acne drugs have been used for many years and are probably safe to apply during pregnancy and nursing:
Benzoyl peroxide
This drug has been around for generations. It's very effective for treating acne and can be purchased over the counter. If you're pregnant or breastfeeding your baby, you shouldn't use benzoyl peroxide topical without first talking to your doctor. You can then decide if the risks are low enough and the benefits are high enough for you to use it. If during pregnancy or breastfeeding, you're advised to use a benzoyl peroxide combination product, it's probably wisest to use one that contains erythromycin such as Benzamycin Gel, rather than one that contains clindamycin.
Sulfacetamide/sulfur combinations
As with benzoyl peroxide products, these have been used safely for many years. Combinations of sulfacetamide and sulfur are contained in such products as Rosula, Rosac, Rosanil, Nicosyn, and Novacet.
These medications should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. These medications may pass into breast milk, so breastfeeding while using these medications isn't recommended.
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