Pregnancy is a temporary, yet a very important phase in every woman’s life. When women are trying to get pregnant or are pregnant, they know that they will have to avoid eating certain types of food and will be able to take only a selected few medications. Patients often ask about which skin care creams are safe to use, especially when it comes to dealing with acne and unusual hair growth which is quite common during pregnancy. These physiological changes occur in women because of increased androgen levels during pregnancy .
The most common options for the topical treatment of acne include antibacterials, retinoids and agents like salicylic acid and benzoyl peroxide. There are also other agents, which are used to enhance and maintain the appearance of the skin including hydroquinone used in skin lightening agents and oxybenxone, octinoxate, and avobenzone used in sunscreens.
For removing unwanted hair and hindering its occurrence, the common topical agents used include hydrogen peroxide used in hair-bleaching creams, potassium, calcium, and sodium hydroxide used in depilatory creams, and salts of thioglycolic acid.
Since there are hundreds of cosmetic brands selling thousands of different types of skin care creams in the market, it is best that we at individual ingredients and their effects on women during pregnancy.
Only 5 percent benzoyl peroxide is absorbed through the skin when it is applied topically like Nerium skin care. While it is within the skin, it is completely metabolized to benzoic acid, and then it is excreted out of the body unchanged through the urine. There are no scientific evidence available which can elucidate benzoyl peroxide’s effect on pregnant women and their unborn baby, but given to its systematic effects and degree of absorption, it can be concluded that there won’t be any alarming concerns after its usage.
Although the degree of absorption of this ingredient through the skin is very low, there have been cases reported in which babies were born with birth defects. The literature of these cases has linked this with the use of topical tretinoin, which is consistent with the embryopathy associated with retinoids. However, the effect of topical retinoids is still unclear and is somewhat controversial.
In two studies focused on the effect of topical retinoids on pregnant women, it has been found that no high risk of physical deformity was reported in 106 and 96 pregnant women who were in their first trimester. Moreover, there was no evidence of retinoid embryopathy either. However, pregnant women are advised to avoid using skin care products with topical retinoids as this evidence is not enough to consider that it is safe to use during pregnancy.
Topical Hair Removal and Bleaching Agents
Several topical agents are available for reducing the appearance of hair or addressing the issues of hair removal in the form of hair-bleaching and hair removal creams. Thioglycolic acid in depilatory products is permitted to concentrations less than or equal to 5 percent, and the permitted pH range is between 7 and 12.7, according to Health Canada guidelines.
Depilatory creams have potassium, calcium, and sodium hydroxide which breakdown into potassium, calcium, sodium, and hydroxide ions. Chemical products have relatively negligible amount of these ions as compared to that found in the body. Although they might permeate through the skin, these ions do not increase the serum levels as their systematic absorption is quite low, and would not pose a risk if topically used during pregnancy.
Antibacterials like erythromycin and clindamycin are used as topical treatments of acne, usually with other agents, and sometimes alone. Several studies have shown that erythromycin, when taken orally, didn’t increase the incidence of a congenital malformation in thousands of pregnant women candidates.
According to a clinical survey focused on examining the use of clindamycin, it has been concluded that no high risks of deformity or malformations were observed among 650 women in their first trimester. Various other studies on the same subject have indicated that no high rates in negative outcomes were found during systematic application of clindamycin during the 2nd or 3rd trimester.
Sunscreens are used for protecting the skin against the harmful rays of the sun. Since the systematic or dermal absorption of sunscreens is very limited, they can be used during pregnancy to prevent or treat melasma. Moreover, there have been no adverse events or risks of physical deformity reported which are associated with the use of sunscreen lotions by pregnant women.
The famous topical depigmenting agent, hydroquinone, is prescribed by many dermatologists for treating conditions such as melasma and chloasma, and it is also an effective skin-whitening agent. About 35 to 45 percent of hydroquinone is systematically absorbed through the skin when it is used topically. There is only a single study published on the effect of hydroquinone on pregnant women so far, which concluded that no high risks of adverse events were found. However, the results of this study cannot be taken as a baseline as the sample size of pregnant women was quite small.
Based on the available data and substantial systematic absorption of hydroquinone, it is best to minimize or completely avoid the use of products containing this ingredient, until further studies confirm its safe use.
This ingredient is found in many acne and cosmetic products, and the degree of its systematic absorption varies in different skin products. Various studies have been conducted in which pregnant women were given low-dose acetylsalicylic acid. All of them concluded that no high was observed in the risk of negative outcomes, like low birth weight, preterm birth, or major malformation . Moreover, quite a small percentage of salicylic acid is absorbed when used topically, which is why it is highly unlikely that it will pose any danger to the mother or the developing baby.
What can be Concluded?
From the above discussion, it can be concluded that majority of the ingredients in skin care creams are safe. Apart from topical retinoids and hydroquinone, other ingredients are not expected to have high risks of malformations or deformity and any other negative effects on the pregnant women and their unborn babies.