Good morning, friends! It’s back to the grind for many of us today since Christmas has passed. Hope your Tuesday is off to a good start!

Today on the blog I wanted to talk about The Rules for skin care during pregnancy. We have to avoid lots of things, but there are lots of other affordable products out there, too, that can keep skin care woes that are unique to pregnancy at bay.

Big thanks to Dr. J. Matthew Knight, an awesome dermatologist here in Orlando, who answered our questions. Give him a call if you want to book an appointment or talk further!

Here we go!

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We’re always hearing about what ingredients to stay away from when we’re pregnant, but the advice can differ. Give us your list of absolute no-no ingredients for pregnant ladies.

Dr. Knight: The bitter reality is that most prescription medications are off-limits during pregnancy. [Editor’s Note: See this brief description of drugs’ potential danger and/or safety on this list.] This is often sad news for ladies whose acne or psoriasis is flaring during gestation. In fact, many skin creams are prescription (instead of over-the-counter) chiefly because their use should be restricted in pregnant ladies.

Unfortunately, the creams that penetrate the skin barrier, and therefore have meaningful effect, are usually the ones that require a doctor’s signature – and also are the ones that should be avoided in pregnancy. Pregnancy Category A drugs [these are considered safest during pregnancy] are few and far between.

Many pregnancy Category C and worse drugs are the mainstays of dermatology, including retinoids (i.e. Retin-A), steroid creams, and antibiotics.

Patients often ask why Retin-A cream is off-limits in pregnancy. Simply, its sister drug isotretinoin (a pill) causes severe birth defects. A developing baby needs precise vitamin-A metabolism in order to develop normally. Using topical Retin-A (tretinoin) is just not worth the risk.

Most cosmeceuticals that you can purchase at the store are OK during pregnancy. But, because they don’t penetrate the skin’s outer layers, they don’t do much either.  One exception is that I like ladies to avoid hydroxy-acid products (i.e. glycolic, salicylic, etc).

In the spa setting, I would avoid hydroxy acids and stronger peels during pregnancy, especially beta-hydroxy peels (i.e. salicylic acid).

What drugstore brand products can you suggest for pregnant women, including cleanser, toner, moisturizer and SPF? What about the higher-end stuff?

Ladies’ skin is often dry and more sensitive during pregnancy, so picking a mild cleanser is important. Cleansers (called synthetic detergents in our world) are pH balanced and unlikely to over-dry and irritate skin like traditional lye-based soaps can.

I would avoid toners and astringents in pregnancy as they tend to make skin irritated as well. Moisturizers act to trap water in our skin which is important in pregnancy, especially here in Florida where we spend our lives in low-humidity air-conditioned spaces.

Good moisturizers often contain other ingredients like humectants and emollients that act to further hydrate and smooth dry skin.  Like always, a good sunscreen is important – and I recommend inert ingredients like Zinc Oxide and Titanium Dioxide: using nanotechnology, these are often sheer and they’re excellent UV blockers.

An important (and ironic) point is that the “higher end” stuff you see out there is largely untested and highly unlikely to be better than what [companies like] Johnson and Johnson, P&G, etc., offer with their multi-million dollar research and development budgets, and access to the world’s top dermatologists and researchers. This sounds crazy but it’s true. The cosmeceutical industry relies on repeat shoppers bouncing from product to product.

Stick with relatively inexpensive major brands (i.e. Cetaphil, Neutrogena, Purpose, CeraVe, Vanicream, etc) and you’ll be just fine.

So often we hear the phrase “that pregnancy glow.” What is going on that makes some women’s skin so much better during pregnancy? On the flip side, why do some women see their skin freak out with acne, breakouts or other issues?

Your immune system is relatively suppressed, or mediated, during gestation.  There are major hormonal fluctuations during this period as well. Truly inflammatory skin conditions like psoriasis and eczema (atopic dermatitis) tend to improve during pregnancy but may flare significantly when the immune system returns to full-strength. Acne may worsen in some, especially during the 1st trimester, but generally improves later in pregnancy. This is daunting because, as above, there’s little dermatologists can do to help as most Rx are off-limits. We can offer things like blue light treatment to help bridge the gap.

The “glow” of pregnancy can be due to several things but I believe that the #1 factor is increased blood flow to the skin, which goes up significantly. Hormone fluctuations make the oil glands more active which can impart a radiance to the epidermis (too much of this is one of the causes of gestational acne). Water retention in the skin’s deeper structures can also play a role in this phenomenon.

Are any skin treatments off-limits when pregnant?

There are many, unfortunately. Most prescription medications are contraindicated in pregnancy, as they’ve been suggested to cause problems. International guidelines also call for a restriction on all laser procedures during pregnancy. There’s not a great reason for this policy but it’s just something that every laser surgeon on the planet avoids; there are just too many unknowns.

Botox is a no-no during pregnancy. In my book, you should also wait on peels. I avoid placing fillers or performing elective surgery during this period as well. Most spa treatments and facials are OK during pregnancy but it’s always best to ask your OB first and get the official opinion.

How soon after having the baby can we get back onto the products with the retinols/retinoids/any other “bad” ingredient?

All of that depends on if the patient is breast feeding or not. If not, there are no restrictions that I can think of.

If breast feeding, there are “lactation categories” for all medications and you should check with your doctor. I’m a purist when it comes to lactation, so I generally advise my patients to wait to re-start retinoids and lightening agents like hydroquinone. Unfortunately, this is when melasma can get really bad for ladies. Treatment is a balancing act and based on a conversation with the patient:  Retin-A and hydroquinone/kojic acid are extremely unlikely to enter the bloodstream if applied as a skin cream.

I also don’t inject Botox if a patient is breast feeding, but I know dermatologists who do. Most laser procedures, fortunately, are fine if lactating.

What funky rashes and skin conditions tend to plague pregnant women? Which are potentially dangerous, if any?

Melasma, often called “the mask of pregnancy,” is the big one. This condition is always frustrating for patients and doctors, and this is especially true in pregnancy since we really can’t treat it safely. You just have to wait.

As we mentioned, acne and dry skin can worsen in pregnancy. Most chronic skin conditions (like psoriasis) tend to improve during this period but not always. Also, these conditions can flare severely when baby comes and you’re getting 2 hours of sleep a day. Very trying for patients.

There are some unique rashes in pregnancy, and most are annoying but not serious. This includes a unique itchy rash in some ladies pregnant for the first time called PUPP. It goes away with delivery and doesn’t harm the baby.

Unfortunately, there are some dangerous rashes in pregnancy including one called gestational pemphigoid. If you develop severe blisters or rashes during pregnancy, call your OB and make an appointment with a board-certified dermatologist as soon as possible.

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Thanks for reading, guys! If you have any questions, leave them on Facebook and we will try to set up a Q&A with Dr. Knight!

See you soon!