So you’re growing an entire human, and your skin has decided now is the perfect time to throw a full-on revolt. Cool, cool, cool. If pregnancy acne has you side-eyeing every mirror and wondering what fresh hell this is, you’re definitely not alone. Up to 43% of pregnant people experience acne during pregnancy, and for many, it’s not just a few stray pimples—we’re talking painful, under-the-skin breakouts that feel like a cruel cosmic joke.
The good news? According to Aegean H. Chan, MD, FAAD, a dual board-certified dermatologist and dermatopathologist, you absolutely do not have to just grin and bear it until your hormones decide to chill out postpartum. There are safe, effective options that can help. It’s just a matter of knowing what actually works.
Why pregnancy acne hits different
Here’s what’s happening behind the scenes: Your body is basically swimming in progesterone right now. While this hormone is busy doing the important work of supporting your pregnancy, it’s also moonlighting as a skin saboteur.
“Pregnancy acne is primarily driven by an increase in androgens like progesterone,” Dr. Chan explains. “These hormones stimulate the sebaceous glands, which means more oil production and a higher likelihood of clogged pores and inflammation.” That excess oil teams up with dead skin cells and bacteria, and boom—you’ve got breakouts.
Research confirms that progesterone levels surge dramatically during pregnancy, particularly in the first trimester, stimulating increased sebum production that can trigger acne flares. And if you’ve dealt with hormonal acne before, especially along your jawline or lower face, your sebaceous glands are already primed to overreact to these hormonal shifts.
When does pregnancy acne start (and when it might get better)
“The first trimester is when the endocrine changes of pregnancy accelerate,” says Dr. Chan. “Progesterone and human chorionic gonadotropin (hCG) increase rapidly, and estrogen fluctuates before stabilizing later in pregnancy.” Translation: Your hormones are doing the most right when you’re already dealing with morning sickness and exhaustion. Fantastic timing, body.
The breakouts tend to be most active during the first and second trimesters, though some people notice improvement by the third trimester as hormone levels start to plateau. But—and this is important—it really varies from person to person. Some people’s skin calms down as pregnancy progresses, while others struggle with breakouts throughout.
Studies show that pregnancy acne is most common in women with a history of acne. In fact, one study found 90% of pregnant women experiencing breakouts had dealt with acne before pregnancy. And here’s something that might make you feel slightly better: for some lucky people, acne actually improves during pregnancy, likely thanks to shifts in immune balance and estrogen levels.
What pregnancy acne actually looks like
If you’re noticing deep, painful bumps under your skin rather than your typical surface-level zits, that’s classic pregnancy acne. “Since acne during pregnancy is fueled by androgen hormones such as progesterone, it’s more common to have bumps under the skin surface, clogging and congestion of the lower face, and deeper nodules or tender cysts,” Dr. Chan notes.
And pregnancy acne doesn’t always limit itself to your face. Many pregnant people find breakouts spreading to places they’ve never dealt with acne before—your chest, back, shoulders, even your bump. The lower face, especially around the chin and jawline, tends to be a hotspot since that’s where hormonal acne typically shows up. But honestly? Pregnancy acne is an equal opportunity annoyer and can pop up pretty much anywhere you have oil glands.
What actually works (and what’s safe)
The frustrating reality is that many go-to acne treatments are off-limits during pregnancy. But Dr. Chan is clear: “One of the biggest myths I hear is that you just have to ‘wait it out’ and there’s nothing you can safely do for acne during pregnancy. That’s simply not true.”
Her top recommendations for pregnancy-safe acne fighters:
Azelaic acid
“Azelaic acid is my go-to for pregnancy acne,” says Dr. Chan. “It fights inflammation and bacteria, and it’s one of the safest options we have.” It also helps with post-inflammatory hyperpigmentation (those annoying dark spots that linger after breakouts heal) and is gentle enough for sensitive pregnancy skin. You can find it over the counter or get a stronger prescription from your dermatologist.
Gentle acids
Lactic acid, mandelic acid, and PHAs are all excellent options because they help unclog pores and smooth texture without irritating your skin. “I personally used The Ordinary’s 10% Lactic Acid + HA throughout all of my pregnancies, about 2-3 times a week,” Dr. Chan shares. Low-concentration glycolic acid (under 10%) is also considered safe. Just remember that many people notice increased skin sensitivity during pregnancy, so don’t overdo it.
Benzoyl peroxide and salicylic acid cleansers
When used in cleanser form (which you obviously wash off), these are considered low-risk during pregnancy and can be good additions to your routine.
Sulfur
This old-school ingredient has natural antibacterial and anti-inflammatory properties. “It helps absorb excess oil without being harsh or irritating,” says Dr. Chan. You can use it as a spot treatment or in a daily cleanser. Yes, it can smell a bit funky, but many newer formulas have minimized the distinctive rotten egg scent.
For severe cases
Certain oral antibiotics like erythromycin are safe during pregnancy for more widespread or deeply inflamed acne. Dr. Chan also notes that painful cystic lesions can be treated in-office with low-dose corticosteroid injections—a quick, localized treatment that reduces inflammation without significant systemic absorption.
What to absolutely avoid
Let’s be crystal clear about what’s off the table:
Retinoids
All topical and oral retinoids are contraindicated during pregnancy due to their potential to cause birth defects. This includes tretinoin, adapalene, isotretinoin (Accutane), and tazarotene.
Certain antibiotics
Tetracyclines (including doxycycline and minocycline) are avoided because they can affect fetal bone and tooth development.
Anti-androgen medications
Spironolactone and similar hormone blockers cross the placenta and can disrupt normal fetal development.
High-strength chemical peels
Peels with more than 20% salicylic acid or trichloroacetic acid should wait until postpartum.
Bakuchiol
This trendy “natural retinol alternative” doesn’t actually work through the same pathways as retinoids, and there’s no robust safety data for pregnancy use. “It’s structurally different from vitamin A, so it’s likely low-risk, but that’s based on assumption rather than evidence,” Dr. Chan explains. She doesn’t personally recommend it for acne during pregnancy since there isn’t enough evidence showing it’s more effective than proven safe options.
A simple pregnancy-safe routine
Dr. Chan’s go-to routine is refreshingly straightforward:
Morning: Hydrating benzoyl peroxide or salicylic acid cleanser, followed by azelaic acid, then moisturizer, finishing with broad-spectrum sunscreen.
Evening: Gentle cleanser (medicated or hydrating, depending on sensitivity), a leave-on AHA or PHA exfoliant, then moisturizer.
“It really doesn’t need to be complicated,” says Dr. Chan. “So many people feel like they have to ‘dry out’ or be aggressive with acne, but in reality, consistency with the right active ingredients is far more effective, and won’t disrupt your skin barrier in the process.”
The emotional piece matters too
There’s no denying that struggling with your skin while your body is already going through massive changes can be genuinely tough. “Your body and hormones are changing so much, and when your skin doesn’t feel like your own, it can really take a toll emotionally,” acknowledges Dr. Chan.
Her advice? Don’t go it alone. “I see so many women feel like they have to troubleshoot on their own, trying product after product, spending months and so much money, when they could have gotten relief by checking in with a dermatologist early on.” Having a dermatologist in your corner who understands pregnancy-safe options can make all the difference—both for your skin and your peace of mind.
The bottom line
Pregnancy acne is common, it’s frustrating, and it can make you want to live in a cave until your hormones normalize. But you don’t have to accept it as an inevitable part of pregnancy.
“Just because your body is changing doesn’t mean you have to accept breakouts as inevitable,” says Dr. Chan. “With the right guidance, pregnancy acne is absolutely something we can manage safely and effectively.”
And honestly? That’s exactly the kind of reassurance you need when you’re already dealing with everything else pregnancy throws at you.