Azelaic acid is thought to be safe to use during pregnancy. Benzoyl peroxide is often found in acne treatment you can buy without a prescription, and experts say it is safe to use in limited amounts. Most experts recommend stopping adapalene during pregnancy.

Topical therapies, such as benzoyl peroxide, azelaic acid, or keratolytics, can be used to treat mild-to-moderate disease. First-line treatment recommendations for mild-to-moderate acne during any phase of pregnancy or lactation include azelaic acid, benzoyl peroxide, or topical clindamycin. Topical retinoids are generally avoided during pregnancy.

The EMA states that "oral retinoids (acitretin, alitretinoin, bexarotene, isotretinoin and tretinoin) are highly teratogenic and must not be used during pregnancy."[7] It further says: "Topical retinoids (those applied to the skin) must also not be used during pregnancy, and by women planning to have a baby," although it notes that systemic absorption after topical application is negligible and the products are unlikely to cause fetal harm.[7] As a precaution, the EMA concludes that topical retinoids are contraindicated in pregnant women and women planning a pregnancy, whereas oral retinoids are strictly prohibited because they can harm the unborn child.[7]

ACOG’s patient guidance on acne and pregnancy explains that many pregnant women experience acne flares and that treatment options exist. It notes that some **over-the-counter topical products, including benzoyl peroxide and azelaic acid, are generally considered safe when used as directed**, but advises consulting a clinician before starting any medication. ACOG warns that **oral isotretinoin and other retinoid medications must not be used during pregnancy because they can cause serious birth defects.** It recommends individualized management balancing acne severity against medication risks.

March of Dimes explains that "Taking isotretinoin or other oral retinoids during pregnancy can cause serious birth defects in babies" and advises: "If you’re pregnant or planning to get pregnant, don’t take isotretinoin."[5] Because these medicines are so dangerous, users must agree to use birth control while on them to avoid pregnancy.[5] For topical retinoids used to treat acne, such as tretinoin and adapalene, the organization notes: "We don’t know if topical retinoids are safe during pregnancy. But small amounts may be absorbed by the skin, so it’s best not to take them if you’re pregnant or thinking about getting pregnant."[5]

This clinical review on acne in pregnancy states: "**Topical azelaic acid or benzoyl peroxide can be recommended as baseline therapy.**" It adds: "A combination of **topical erythromycin or clindamycin with benzoyl peroxide is recommended for inflammatory acne. Oral erythromycin or cephalexin is generally considered safe for moderate to severe inflammatory acne when used for a few weeks." The paper cautions that: "**Oral retinoids are teratogenic and absolutely contraindicated for women who are pregnant or considering pregnancy.**" Thus, while certain prescription acne drugs (retinoids) are problematic in pregnancy, several other prescription and over‑the‑counter agents (including azelaic acid, benzoyl peroxide, clindamycin, erythromycin, and some oral antibiotics) are described as acceptable when appropriately used.

Topical antibiotics, benzoyl peroxide, and azelaic acid are considered safe in pregnancy. Topical retinoids, including tretinoin, adapalene, and tazarotene, must be avoided during pregnancy. If a topical product has been used by accident for a short period, harm to the unborn baby is unlikely.

In this retrospective study of pregnant patients with acne, the authors conclude: "**Therefore, azelaic acid is a good option in the treatment of mild to moderate acne during pregnancy.**" They note: "In studies conducted on azelaic acid… **no fetal side effects were observed after use during pregnancy** and its use twice a day has been found safe." They further state that in their cohort: "it is noteworthy that there were **no side effects that required discontinuation of the drug or treatment**" and reiterate: "Considering the results of our study, we see that **azelaic acid is more successful in the treatment of mild to moderate acne vulgaris during pregnancy**, even though all three topical drugs are in pregnancy category B."

UF Health describes isotretinoin as "a **potent acne medication that can cause severe birth defects if taken during pregnancy**." It explains that since FDA approval in 1982, "the drug has been heavily regulated by the agency to **prevent its use during pregnancy**." Women using isotretinoin must "agree to use contraceptives and present a negative pregnancy test" before each prescription; physicians must enter the negative test in a computer system before pharmacies can dispense the drug, reflecting the high level of concern about isotretinoin exposure in pregnancy compared with other acne treatments like doxycycline or minocycline.

This public health law analysis notes that under the PLLR, in effect since June 30, 2015, "only a **small percentage of drugs are contraindicated for use in pregnancy**" and that the new narrative format "emphasizes human data" and requires a **risk summary** describing a drug’s risks during pregnancy. It explains that if a drug has a pregnancy exposure registry, the labeling must state that and that new registry data trigger label updates, reinforcing that many medications may be used when benefits outweigh risks rather than being automatically avoided throughout pregnancy.

This review of topical tazarotene states that pharmacokinetic studies show low systemic exposure from topical retinoids, but the exposure level that could cause teratogenicity in humans is unknown.[2] It explains that under both previous and current FDA pregnancy labeling, "tazarotene is not recommended for use during pregnancy" and that, more broadly, "topical or oral retinoid use during pregnancy is not recommended."[2] The authors mention case reports of in utero exposure to topical tretinoin and adapalene with unclear impact on fetal development, and describe that human pregnancy outcome data for topical tazarotene remain limited.[2]

The UK Teratology Information Service (BUMPS) advises: "Retinoid creams and gels should not be used in pregnancy," describing this as the "quick take" guidance.[9] It explains that most reports of women who used topical retinoids in pregnancy show unaffected babies, but there are case reports of babies with birth defects, and it is not yet possible to rule out that the defects were caused by the retinoids.[9] The leaflet therefore recommends avoiding topical retinoids in pregnancy as a precaution, noting that while only tiny amounts are likely to reach the baby when used as directed, absorption can vary between women and high-dose oral forms are well known to cause miscarriage and birth defects.[9]

MGH summarizes the FDA rule, stating that the new requirements aim to provide "a more consistent way to include relevant information about the **risks and benefits** of prescription drugs and biological products used during pregnancy and breastfeeding." The system abolishes letter categories and instead requires that the **Pregnancy** subsection provide information relevant to use in pregnant women, including dosing and potential risks to the fetus, and that the **Lactation** subsection describe drug levels in breast milk and potential effects on the child. A third subsection on "Females and Males of Reproductive Potential" covers pregnancy testing and contraception, underscoring that risk is drug‑specific and must be weighed against benefits, not assumed for all prescriptions.

This review for clinicians explains: "**Azelaic acid is considered pregnancy category B… When used topically in pregnant women, practitioners agree that azelaic acid is generally safe.**" It notes limited systemic absorption ("4–8%" absorbed through the skin). For **benzoyl peroxide**: it is "categorized as pregnancy category C with no human or animal clinical data," but "only 5% is absorbed into the blood" and is rapidly converted to a common food additive; therefore, "**many practitioners say that this agent is safe to use topically in limited areas.**" Regarding **topical antibiotics**: "The two most common topical antibiotics used for acne include **clindamycin and erythromycin, both of which are considered safe to use in pregnancy and are labeled pregnancy category B.** These agents demonstrate minimal absorption through the skin and studies in animals have not shown any negative effects on the developing fetus."

Oral retinoids are known to be teratogenic and therefore must be avoided during pregnancy. For topical retinoids, there is some controversy concerning their teratogenicity despite generally low transdermal absorption, but until there are larger studies, topical retinoids should be avoided during pregnancy and in the preconception period. Benzoyl peroxide is considered safe during pregnancy because systemic absorption is minimal. Azelaic acid is considered safe to use topically.

This review of antibiotics for acne in pregnancy notes that oral tetracyclines (including doxycycline and minocycline) are "**contraindicated in the second and third trimesters because of the risk of permanent discoloration of teeth and possible effects on bone growth**," whereas limited first‑trimester exposure does not appear to be a major teratogenic risk. It contrasts these systemic agents with topical therapies such as benzoyl peroxide, azelaic acid, and topical clindamycin, which the authors describe as generally considered safe or low risk for pregnant patients with acne.

This clinical review on acne in pregnancy (similar topic to the Johns Hopkins summary) notes that **acne is common in pregnancy** and discusses treatment choices. It reports that **topical agents such as benzoyl peroxide, azelaic acid, and certain topical antibiotics are generally considered safe** due to minimal systemic absorption. By contrast, it emphasizes that **oral isotretinoin and other systemic retinoids are teratogenic and contraindicated in pregnancy.** The paper recommends choosing treatments according to severity, favoring safer topical medications as first-line options for pregnant women.

This review examines topical dermatologic drugs and states that several acne therapies have reassuring safety profiles in pregnancy. It reports that **topical benzoyl peroxide and azelaic acid show minimal systemic absorption and no evidence of teratogenicity in available data**, and that **topical clindamycin and erythromycin are considered low risk** based on animal and limited human data. The authors contrast this with **topical retinoids**, for which case reports of congenital malformations and animal teratogenicity lead many experts to recommend avoiding their use during pregnancy, especially in the first trimester.

ACOG patient guidance has commonly advised that certain topical acne ingredients, including benzoyl peroxide and azelaic acid, may be used in pregnancy, while topical retinoids should be avoided. This is consistent with dermatology guidance that topical retinoids are generally not recommended during pregnancy.

Common pregnancy-conscious acne options may include azelaic acid and limited-use benzoyl peroxide. Many clinicians recommend stopping topical retinoids, retinol, adapalene, tazarotene, and isotretinoin during pregnancy. Avoid starting prescription acne medications or stronger peels without medical guidance during pregnancy.