Motherhood is a hormonal roller coaster, and your skin has no choice but to go along for the ride. Here's how to treat adult acne if you’re pregnant or breastfeeding with safe medications and tactics.

By Beth Janes
October 07, 2019
Illustration by Sarina Finkelstein; Adobe Stock (1)

When Melissa Nhaissi developed acne in her early 20s, she took the Pill and it solved the problem, full stop. But ten years later she decided to try for a baby, and within three months of her going off the Pill, multiple painful cystic pimples spread over her jawline, chin, back, shoulders, and chest.

“I was so self-conscious,” says the 33-year-old mom from New York City. “And I couldn’t even tell myself, ‘It’s okay because I’m pregnant!’ I was stressed about trying to get pregnant and stressed about my skin. It was horrible.”

The pimples held their ground after Nhaissi conceived and while she breastfed her daughter. Ultimately, she had to go back on the Pill to resolve the problem.

If Nhaissi’s story sounds familiar, there’s a reason: Dermatologists and researchers alike say acne is on the rise in adult women, estimating that between 15 and 54 percent of them live with it. Women seem more overextended these days, and stress is clear-skin kryptonite, explains Rachel Nazarian, M.D., a dermatologist in New York City. They’re also having kids later, which means they take acne-masking birth-control pills longer. (Plus, more women are switching from oral birth control to the IUD—its use has quadrupled since the early 2000s—and the device doesn’t control acne well.)

New moms often suffer the most because they have to deal with stress and shockingly little sleep, both of which make acne and its ripple effect on mental health worse, says Amy Wechsler, M.D., a dermatologist in New York City. We talked to experts to get their advice on how to get rid of your acne, no matter what stage of motherhood you’re in.

What Causes Acne?

The quick-and-dirty science on how a pimple forms: The skin’s oil glands secrete sebum (oil) into pores, and if it’s sticky and thick enough, the sebum traps dead skin cells and dirt, clogging pores. Those plugs create an all-you-can-eat buffet and perfect hiding spot for Propionibacterium acnes bacteria, which then flourish and trigger zits you see and feel.

Hormonal Acne, Explained

So where do hormones come in? In your mid-to-late 20s estrogen starts declining, and if androgens—male hormones—take a more dominant position, they may stimulate extra sebum production and make that sebum thicker and stickier, says Dr. Nazarian.

Not every woman breaks out when hormones shift. Some just happen to be more sensitive, or their skin may be primed for acne thanks to other factors, and hormonal changes set a breakout in motion. Combination estrogen-progestin birth-control pills can help heal your skin by stabilizing hormones and lowering levels of circulating androgens, says Dr. Wechsler. But if you stop taking the pills, acne may rebound, as it did for Nhaissi, or you could even develop pimples for the very first time. Melissa Bakst, 31, of Chicago, was blindsided when she went off the Pill in adulthood and developed acne on her chin and jaw. When she got pregnant, though, another surprise: Her skin cleared up.

Pregnancy can have unpredictable effects on skin. A surge of progesterone at the start tends to ramp up oil production in all women. In some, like Bakst, the oil is lighter and hydrating, giving you that famous “glow.” In others, it leads to acne. And after you have the baby? All bets are off.

Acne is way more than skin-deep. Stress, sleep, and hormonal changes—all issues new moms deal with—are the invisible factors that can lead to a breakout.

The Best Acne Treatment for Moms

Establish a smart daily routine.

Many women who have acne go full kamikaze with products, bombing their skin with harsh formulas and starving it of moisturizer in an effort to clear pores and dry up oil, says Dr. Nazarian. Be forewarned: That strategy typically leaves you with more inflammation and a weakened skin barrier that is vulnerable to irritation. Black learned this lesson the hard way.

“I probably spent $500 on new makeup brushes, a full skin-care regimen, a derma roller, masks, you name it. My skin just got worse,” she recalls.

Instead, start with a few gentle over-the-counter products, says Steven Feldman, M.D., Ph.D., professor of dermatology at Wake Forest School of Medicine in Winston-Salem, North Carolina. Get a mild cleanser, then a benzoyl-peroxide treatment for nighttime and an adapalene cream (a type of OTC retinoid) for the morning. If your skin becomes irritated or overly dry, scale back on the retinoid. And don’t forget moisturizer and sunscreen. (See page 66 for our product suggestions.)

If your acne doesn’t improve within a few weeks of following a consistent routine, or if your acne is severe or really bothers you, go to a board-certified dermatologist rather than trying new products, says Dr. Nazarian. Adult acne is notoriously hard to treat—what works for one mom may not work for you—and a personalized prescription regimen can be effective.

Black’s dermatologist helped her realize that her acne flare-ups coincided with her period. Her doctor prescribed spironolactone, a medication that blocks the effects of acne-causing androgens.

“I took it for one month and my acne was gone,” she says. A series of peels and a topical retinoid treated her scars, and now her skin is flawless.

Nursing, pregnant, or TTC? You can still take action.

It’s a good thing babies are so dang cute, because during pregnancy and breastfeeding, most acne medications— including retinoids, oral isotretinoin, spironolactone, oral tetracyclines (a group of antibiotics), and combination birth-control pills—are off the table. But several over-the-counter topicals, like benzoyl peroxide and glycolic and azelaic acid, are considered safe in limited amounts (to be sure, talk to your obstetrician first). You can also try a series of derm-administered laser treatments or blue-light therapy, which kills P. acnes bacteria. The average cost for either option can be around $275 per session.

Stick to your regimen.

It sounds obvious, but how many times have you flopped into bed, too tired even to get up and pee, let alone do your skin-care regimen?

“We know that people don’t take pills well, and it’s worse with creams,” says Dr. Feldman, who studies medication adherence. This is especially true for moms, who are short on time and often give up at the first sign of skin irritation. Sometimes it takes trial and error to strike the right balance, adds Dr. Nazarian.

Whatever you do, don't pop.

Adolescents typically get pimples everywhere, and they’re prone to whiteheads—those raised orbs that call out to be squeezed. Women, on the other hand, often break out around the jawline, chin, and mouth, and pimples look red and feel inflamed rather than poppable, Dr. Nazarian says. Plus, skin heals more slowly as you age, so an errant, scab-inducing “squeeze” can take weeks to vanish. Carla Black, of Chicago, developed stubborn breakouts at 35, two years after having her daughter.

“They really hurt and were red and puffy,” she says. “If I tried to pop one, it didn’t work and then five more would form.”

And remember: There’s no shame in pimples!

We’re not saying you need to walk around feeling good about your acne, but pimples are no reason to hide from the mom squad at preschool pickup. In fact, more and more celebs and influencers are posting Instagram photos featuring brightly colored pimple patches or their unfiltered zits. (We see you, Jenny Mollen!)

“The ‘pimple-positive movement’ helps women realize how common acne really is and that they shouldn’t feel bad about it,” says Dr. Nazarian. Isn’t it nice to be out of high school?

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