Which medicines and cosmetics should you avoid during pregnancy?

Learn which medicines and cosmetic products should be avoided or used with caution during pregnancy, and which alternatives may be considered.

A woman’s body undergoes numerous changes during pregnancy, particularly as a result of hormonal, endocrine and immunological variations. Many of these changes affect the skin, hair and nails. Some are temporary and gradually resolve after childbirth, while others may persist for longer.

Skin care remains important during pregnancy, but certain medicines, creams and cosmetic products should be avoided or used with particular caution because of potential risks to the developing baby. Below, we review some of the main ingredients and treatments that require special consideration.

Medicines and cosmetics that should be avoided during pregnancy

Retinoids and vitamin A derivatives

They should be avoided. Retinoids are among the most important active ingredients to avoid during pregnancy. This group includes retinoic acid and related compounds, including retinol, which are commonly found in dermatological treatments and skincare products. Oral retinoids such as isotretinoin are known to be teratogenic and can cause serious fetal abnormalities.

For this reason, oral retinoids are strictly contraindicated during pregnancy and require specific pregnancy-prevention measures before, during and after treatment. Topical retinoids have much lower systemic absorption, but they are also generally avoided during pregnancy as a precaution.

Women who become pregnant while using a cosmetic product containing retinoids should stop using it and discuss any concerns with their doctor.

Benzoyl peroxide

Its use should be assessed individually. Benzoyl peroxide is commonly used in topical acne treatment. Systemic absorption is limited and it is rapidly metabolised, but pregnancy treatment should nevertheless be tailored to the individual patient.

Other topical options that may be considered depending on the clinical situation include azelaic acid, and, where specifically indicated, certain topical antibiotics. Any acne treatment during pregnancy should be reviewed by a dermatologist to ensure that the chosen medicine is appropriate.

Hydroquinone

It is generally avoided during pregnancy. Hydroquinone is a depigmenting active ingredient used to treat hyperpigmentation.

Because systemic absorption through the skin can be relatively high compared with many other topical ingredients, its use is generally avoided during pregnancy as a precaution.

This is particularly relevant because pregnancy itself is associated with increased pigmentation in areas such as the areolae, perineum, navel, underarms, inner thighs, linea alba and recent scars. Facial pigmentation, known as melasma or chloasma, may also develop, particularly on sun-exposed areas such as the forehead, cheeks, chin and upper lip.

In many cases, treatment of pregnancy-related pigmentation can be postponed until after pregnancy and, where appropriate, breastfeeding. If pigmentation is particularly noticeable or troublesome, a dermatologist can advise on suitable treatment options.

Strict photoprotection is one of the most important measures for preventing or reducing pregnancy-related pigmentation. This includes regular use of a broad-spectrum SPF 50 sunscreen together with physical protection such as clothing, hats and sunglasses.

Salicylic acid

High concentrations and extensive use should be avoided. Salicylic acid is a beta hydroxy acid used in chemical peels and some acne treatments because of its keratolytic properties. Small amounts used on limited areas of skin differ substantially from high-concentration treatments or application over large areas. During pregnancy, high-dose, prolonged or extensive use should generally be avoided unless specifically advised by a doctor.

Pregnancy can also make the skin more reactive, so irritating products may increase the likelihood of inflammation and subsequent pigmentation.

Minoxidil

It is generally avoided during pregnancy. Minoxidil is used, either alone or with other treatments, for several types of hair loss.

It is available as topical formulations and, in selected patients, as oral medication. Because safety data during pregnancy are limited, minoxidil is generally avoided as a precaution.

Women receiving minoxidil who are planning a pregnancy should discuss when to discontinue treatment with their dermatologist expert in hair disorders.

The approach may differ depending on whether minoxidil is being used topically or orally and on the individual clinical situation.

Use during breastfeeding should also be assessed individually rather than assumed to be appropriate in all cases.

Caffeine in cosmetics

Usually not a major concern in topical cosmetics, but individual products should still be reviewed. Caffeine is present in some eye-contour products and body cosmetics. Topical exposure from cosmetic products is generally much lower than dietary intake. Nevertheless, during pregnancy it is reasonable to review cosmetic formulations and avoid unnecessary active ingredients if there is uncertainty about their safety or concentration.

Medicines, cosmetics and aesthetic treatments that require caution during pregnancy

Glycolic acid

It depends on the concentration and type of use. Glycolic acid is commonly used in chemical peels in aesthetic dermatology and in skincare products because of its exfoliating effect. Low-concentration topical products may be suitable in some cases, whereas professional peels and higher concentrations require individual assessment.

Pregnant skin may also be more sensitive and prone to irritation or pigmentation, so any procedure involving glycolic acid should be considered carefully.

Essential oils

Some may be suitable, while others should be avoided. Essential oils are not a uniform category and their safety depends on the specific oil, concentration, route of administration and stage of pregnancy. For this reason, they should not automatically be assumed to be safe simply because they are “natural”. Pregnant women should check the specific product with a healthcare professional before use, particularly if it is concentrated or intended for therapeutic application.

Oral antibiotics

It depends on the antibiotic. Antibiotics can be prescribed during pregnancy when clinically necessary, but the choice of drug matters. Some antibiotics have established safety records during pregnancy, while others should be avoided or restricted to particular situations.

Penicillins such as amoxicillin and ampicillin and many cephalosporins are commonly used when indicated. Certain macrolides and clindamycin may also be considered depending on the clinical context. By contrast, tetracyclines are generally avoided during pregnancy because of potential effects on fetal bone and tooth development. Antibiotics should never be started during pregnancy without medical assessment and prescription.

Antiperspirants

Routine cosmetic use should be assessed according to the formulation. Not all antiperspirants or aluminium-containing products carry the same level of exposure. Routine topical use differs significantly from high-concentration medical treatments for excessive sweating. If a pregnant patient is using a prescription-strength antiperspirant or a treatment for hyperhidrosis, it is advisable to review it with a dermatologist or pharmacist.

Body aesthetic treatments during pregnancy

Some should be postponed. Aesthetic body treatments involving laser, intense pulsed light, radiofrequency or other energy-based devices are generally postponed during pregnancy. This is primarily because robust safety data in pregnant women are lacking and the precautionary principle is applied. Pregnancy may also make the skin more sensitive to heat, irritation and pigmentation changes.

Manual treatments that do not involve energy-based devices may be considered in some cases, provided they are appropriate for pregnancy and there are no obstetric or medical contraindications. Any treatment should be assessed individually.

Product labels and patient information leaflets should also be reviewed carefully, although these do not replace medical advice. When there is any doubt about whether a medicine, cosmetic product or treatment is suitable during pregnancy or breastfeeding, it should be discussed with a dermatologist, obstetrician, GP or pharmacist before it is continued, stopped or substituted.

Medicines and cosmetic products that may be used during pregnancy

Some treatments and skincare ingredients can be used during pregnancy when clinically appropriate. Examples may include: mild topical corticosteroids, when prescribed and used appropriately; vitamin C in topical skincare; certain alpha hydroxy acids, depending on concentration and tolerance; hyaluronic acid in topical skincare products; broad-spectrum sunscreens; and certain hair dyes, when used according to product instructions and individual medical advice.

However, “safe during pregnancy” does not mean that every formulation, concentration or treatment is appropriate for every patient. Products should therefore be selected according to the individual’s skin condition, medical history and stage of pregnancy. Among these measures, sun protection is particularly important because pregnancy can increase susceptibility to pigmentation changes such as melasma.

We invite you to share this article about medicines and cosmetics to avoid during pregnancy with family and friends who may find it useful.