Acne is a common problem during pregnancy and it can continue during breastfeeding.† It is important to know which acne medications, herbal ingredients and topical products are safe to use during breastfeeding and which should be avoided.† Newborn infants or ill infants may be more affected by drugs in breast milk than healthy infants 6 months or older.
The movement of substances from the mother to the baby in breast milk
Drugs get into breast milk via the motherís blood circulation. The amount of drug excreted in a motherís milk is usually not more than 1-2% of the amount ingested by the mother.† Drugs that have a high solubility in lipids (fats) are much more likely to get into breast milk.† Drugs that bind strongly to the maternal plasma protein are more likely to stay in the motherís blood than to transfer into the breast milk.† If you must take an oral medication while breastfeeding, the best plan of action is to breastfeed prior to taking the medication, that way there will be less drug in the motherís blood at the time of breastfeeding.† This strategy works best for drugs that are taken several times a day and do not stay very long in the motherís blood circulation.† Drugs that have a long duration in the motherís blood- such as drugs taken once a day- most likely maintain higher levels of the drug in the motherís circulation throughout the day, so there may not be a ďsafeĒ time to take them.† If you have a choice, ask your doctor for a shorter lasting medication that is taken several times a day rather than a once a day medication and breast feed just prior to taking the medication. It is important to discuss the use of any oral medications with your doctor before using them during breastfeeding. The guidelines from the American Academy of Pediatrics for the use of drugs during breastfeeding can be found at this link.
Oral Medications During Breastfeeding
Tetracycline is the most commonly used oral antibiotic for acne.† It should not be taken during pregnancy because it can have an effect on the infantís teeth.† However, tetracycline can be taken while breastfeeding.
Oral contraceptives are used to treat acne but these have hormones that can be passed into the breast milk.† These are often prescribed during breast feeding but the use of these should be discussed with your physician prior to their use.
Accutane (isotretinoin)- this acne medication should not be taken during pregnancy or while breastfeeding.
Topical Acne Products During Breastfeeding
Topical antibiotics- Although the safety of topical antibiotics during breastfeeding has not been studied, it is unlikely that a significant amount of antibiotic will enter the maternal bloodsteam and pass into breast milk.† Therefore, the use of these during breastfeeding is likely safe.† There are safer alternatives such as light treatments that have no risk at all.
Topical Retinoids- medications such as Retin A (tretinoin), tazarotene, and adapalene should not be used while pregnant or breast feeding.† Non-prescription retinoids such as retinol should be avoided as well.† These medications are unlikely to cause a problem while breast feeding but there are safer options.
Other topical acne medications-† Benzoyl peroxide is a safe way to kill bacteria on the skin while breastfeeding.† Salicylic acid (SA) will help unclog pores.† SA is in the same the family as aspirin and high doses should not be used during pregnancy but it is perfectly safe to use during breastfeeding. Azelaic acid, glycolic acid, lactic acid and Vitamin C can all safely be used while breastfeeding.
Herbal, botanical and organic medications for acne
There are many topical herbal remedies for acne including tea tree oil, thyme, turmeric, rosewater, pine and orange peel.† These provide no risk to the breastfeeding mother when applied topically.† There are many Chinese herbal remedies that are taken by mouth that could be harmful while breastfeeding, especially those that contain alkaloids such as coptis and phellodendron ,sophora root, ma-huang ,and evodia or those with hormonal effects such as fennel and anise.† Taking these oral herbs in large doses over a prolonged period of time is more harmful than a small infrequent dose.† A table of herbs to avoid during pregnancy can be found at this link.
Light therapy for acne
Blue and red light therapy has been found to be very effective in treating acne and the inflammation associated with acne.† My favorite device is the Tria Acne Light.† Blue and red light kill the bacteria P. acnes that causes acne and seem to lessen inflammation through an unknown mechanism.† Blue light treatments can also be performed in a dermatologistsí s office.
Lifestyle Modifications for acne treatment
Getting a good nightís sleep can help clear acne by stabilizing stress hormones such as cortisol that can cause acne.† This may be impossible while breastfeeding.† Dairy products and sugar can worsen acne, so it si best to avoid these and try and eat green vegetables high in Vitamin A instead.† (It is not recommended to take Vitamin A supplements while breastfeeding.)
The best acne treatment for breastfeeding women
In my opinion, a combination of blue light treatments, a 2% salicylic acid cleanser, and a 5% benzoyl peroxide gel or lotion is the best treatment for acne in breastfeeding women.† If acne is moderate or severe, it is best to see your dermatologist for a prescription topical antibiotic.† Do not forget to take the test at www.SkinTypeSolutions.com† while breastfeeding to find out more about your skin issues.† Once you finish breastfeeding, take the quiz again because your skin type may change once your hormones have stabilized.