I have acne and after several years of tinkering, I've found the right combination of several prescription products daily to control it — benzoyl peroxide 6%, Solodyn, dapsone, Retin-A, clindamycin, and the list goes on. While I'm not pregnant now, I'd like to try and conceive in the next three years or so and I understand I shouldn't be using these products while pregnant or breastfeeding. Do you have any recommendations on what I should do? I was considering trying Accutane (prior to trying to get pregnant, of course), but I know it has serious side effects.
—Worried About Spots
As someone who's been trying to get pregnant, I've thoroughly researched this topic and am so glad you asked this question so I can share some knowledge with you! I'm glad that you’ve found a system that works for you in terms of your acne now. But since you’re interested in conceiving in the next few years, I will share with you information on Accutane as well as what is considered safe for acne treatment while pregnant, so keep on reading.
Accutane, also known as isotretinoin, is a medication used for the treatment of severe acne. It is a retinoid, meaning it is derived from vitamin A, and is found in small quantities naturally in the body. The exact mechanism of Accutane is unknown. However, it is known that the effects of the medication are to decrease the size and sebum (oil) output from the sebaceous (oil-producing) glands. Accutane is typically used after other acne treatments fail to produce improvement. However, it can be used as a first-line agent for severe cases of acne. Common adverse reactions to Accutane include: dryness of skin, lips, and mucous membranes, infection of the cuticles, skin fragility, skin peeling, flushing, nose bleeds, hair loss, eye irritation, increased liver enzymes, increased blood lipids/cholesterol, permanent thin skin, headaches, muscle or joint pain, back pain, and temporary or permanent hair thinning. Some adverse effects can persist even after discontinuation of the medication including: hair loss, joint pains, decreased night vision, inflammatory bowel disease, degenerative disk disease, keloid formation, and bone disease.
Perhaps the most important side effect in your case is teratogenicity. A teratogen is a compound or agent that causes a defect or malformation in the development of an embryo or fetus. If taken when pregnant, Accutane is highly likely to cause birth defects. A few of the more common birth defects according to the Illinois Teratogen Information Service are: hearing or visual impairment, missing or malformed earlobes, facial dysmorphisms, and mental retardation. The American Pregnancy Association also reports that there is an increased risk of miscarriage and infant death associated with Accutane. The FDA classifies Accutane as category X; this means that studies in animals and humans have demonstrated fetal abnormalities and there is positive evidence of human fetal risk. Because of the high risk of fetal birth defects, women who take Accutane must be tested for pregnancy before it can be used. In addition, two simultaneous forms of birth control must be used for one month prior as well as during treatment (typically oral birth control pills and another form of contraception) and for at least one month after stopping the medication. iPLEDGE is a program that was created by the FDA in order to attempt to ensure that women on Accutane do not get pregnant. Only women who are registered and activated in this program may be prescribed Accutane.
During pregnancy, acne is very common due to hormonal changes that cause the oil glands to enlarge and produce more oil. Typically, women who are pregnant are not advised to use any medications (especially during their first trimester) to treat acne. Good facial hygiene is recommended along with the use of water-based versus oil-based cosmetics. However, in certain cases of moderate to severe acne, there are some medications that can be used with the approval of your healthcare provider including: topical antibiotic creams such as clindamycin or erythromycin and benzoyl peroxide. Hydrocortisone, salicylic acid, tetracycline/minocycline lotion, and Retin-A, and dapsone have been shown to be harmful during pregnancy.
In your case, I highly recommend you have a lengthy discussion with both your dermatologist and obstetrician/gynecologist regarding your intentions for conceiving a child and your concerns about acne treatment during the trying-to-conceive phase and the pregnancy phase. Ultimately, you and your physicians will have to weigh the risks and benefits of treatment in order to make the safest decision for you and a possible baby in the future.
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