One thing we must always be cognisant of when caring for women of childbearing age is the possibility of pregnancy or even nursing. In this case, it is never rude to ask your patient if they are pregnant or nursing because it may significantly impact what you prescribe for them.
Two Main NO Categories
1) Retinoids of any kind - this includes over the counter, lower strength forms (like Retinyl Palmitate) all the way up to prescription tretinoin. We never, ever recommend these while pregnant or nursing.
WHY - Vitamin A is felt to be a possible teratogen when consumed in excessive doses, and this includes topical preparations. Though the evidence is not incredibly strong for systemic absorption of topical preperations, the benefit does not outweigh the risk here.
Be wary of ANY product, and ensure it does not contain a retinoid before recommending to a pregnant or nursing woman. Good examples of this include ZO's Daily Power Defense (tiny amount of retinyl palmitate) and multiple eye creams with hidden retinoids.
2) Hydroquinone - Though many women will long to use a skin bleaching agent while they experience significant melasma or chloasma that may be directly related to their pregnancy, there is significant systemic absorption of hydroquinone. Even though a causal relationship between HQ and birth defects has not been formally established, again the benefit does NOT outweigh the risk here. Hydroquinone products are typically very clearly labeled, so you are unlikely to have a hidden HQ product.
Possibly avoid or discuss with patient:
- Products with human growth factors in them.
WHY? We do not have evidence that they are harmful, however we do not have evidence otherwise either.
- Lavender and Tea Tree Oil - known endocrine disruptors with strong documented evidence during topical use
So what CAN I use for my pregnant and nursing patients?
The answer is shocking: Almost everything else! According to ACOG guidelines, there are multiple other compounds and products that are considered generally low risk during pregnancy and nursing. Why? Because most other ingredients do not show evidence of much systemic absorption.
Fine to use:
- Salicylic acid (I have heard up to 2% but cannot find a reference for that specific number)
- Lactic acid
- Kojic acid
- Azelaic acid
- Glycolic Acid
- Plant growth factors
- Topical antibioitics (when discussed with OB)
- Benzoyl Peroxide
Note: You'll also never be "wrong" if you have your patient check with their OB!