Acne is a common problem during pregnancy, and it can continue after giving birth while breastfeeding. Since anything a new mom puts on her skin or inside her body can potentially be passed along to the baby in breast milk—and newborns may be more affected by drugs than infants six months or older—it’s important to know which acne medications and topical products are safe to use during breastfeeding and which should be avoided.
Transmitting drugs from mother’s milk to baby
Drugs get into breast milk via the mother’s blood circulation. The amount of drug excreted in a mother’s milk is usually not more than 1 to 2 percent of the amount ingested by the mother. If you must take an oral medication while breastfeeding, the best plan of action is to breastfeed prior to taking the medication, that way there will be less drug in the mother’s blood at the time of breastfeeding.
This strategy works best for drugs that are taken several times a day and do not stay very long in the mother’s blood circulation. Drugs that have a long duration in the mother’s blood—such as drugs taken once a day—most likely maintain higher levels of the drug in the mother’s circulation throughout the day, so there may not be a “safe” time to take them. If you have a choice, ask your doctor for a shorter lasting medication that is taken several times a day rather than a once-a-day medication, and breastfeed just prior to taking the medication.
Guidelines from the American Academy of Pediatrics for the use of drugs during breastfeeding can be found at www.aap.org and search for breastfeeding and medication.
Oral acne medications during breastfeeding
Tetracycline is the most commonly used oral antibiotic for acne. It should not be taken during pregnancy because it can have an effect on the infant’s teeth. However, tetracycline can be taken while breastfeeding. Oral contraceptives are also used to treat acne, but these medications contain hormones that can be passed into the breast milk. These are often prescribed during breastfeeding, but their use should be discussed with your physician prior to their use.
Topical acne products during breastfeeding
Although the safety of topical antibiotics applied during breastfeeding has not been studied, it is unlikely that a significant amount of antibiotic will enter the maternal bloodstream and get passed into breast milk. Therefore, the use of these during breastfeeding is likely safe. However, there are safer alternatives such as light treatments that have no risk at all.
Topical retinoids such as Retin-A (tretinoin), tazarotene, and adapalene should not be used while pregnant or breastfeeding. Non-prescription retinoids such as retinol should be avoided as well. These medications are unlikely to cause a problem while breastfeeding, but again, there are safer options.
As for other topical acne medications, benzoyl peroxide is a safe way to kill bacteria on the skin while breastfeeding. Salicylic acid (SA) can also safely unclog pores. SA is in the same the family as aspirin and high doses should not be used during pregnancy, but it is perfectly safe to use during breastfeeding. Azelaic acid, glycolic acid, lactic acid and vitamin C can all safely be used while breastfeeding as well.
Light therapy for acne
Blue and red light therapy has been found to be very effective in treating acne and the inflammation associated with breakouts. Blue and red light kill the bacteria P. acnes that causes acne and seem to lessen inflammation through an unknown mechanism.
Lifestyle modifications for acne treatment
Getting a good night’s sleep can help clear acne by stabilizing stress hormones such as cortisol, which can cause acne—although this may be nearly impossible for a breastfeeding mom. Dairy products and sugar can also worsen acne, so it is best to avoid these and try and eat fruits and vegetables high in vitamin A (spinach, sweet potatoes, mangoes, carrots, asparagus, tomato, watermelon, apricots, among others.
Best acne treatment for breastfeeding women
In my opinion, a combination of blue light treatments, a 2 percent salicylic acid cleanser and a 5 percent benzoyl peroxide gel or lotion is the best treatment for acne in breastfeeding women. If acne is moderate or severe, it is best to see your dermatologist for a prescription topical antibiotic.
Dr. Leslie Baumann is a board-certified dermatologist, New York Times best-selling author and CEO of Baumann Cosmetic & Research Institute in Miami.