Research Points to Inconsistencies in Acne Treatment for Pregnant Women

Treatment in of acne in pregnant women is inconsistent, according to new results of a retrospective study published in International Journal of Women’s Dermatology.

Furthermore, treatment for the condition is not always in accordance with evidence-based guidelines, the study found. Based on their research, the study authors stress the importance that women and physicians caring for pregnant women “familiarize themselves with [American Board of Family Medicine] guidelines for treatment of acne in pregnancy.”

Common treatments for acne are known to be unsafe for pregnant women, but alternative treatments exist that are safe for use. However, actual treatment patterns within this cohort are unclear, the authors noted.

The inflammatory disease is also common in pregnancy and “many first-line acne treatments are teratogenic, complicating management of this condition,” researchers said. Treatments may alter the normal intrauterine development of fetal growth and physical functioning.

To better understand acne management in pregnant patients, the investigators assessed real-life data from the Northwestern Medicine Enterprise Data Warehouse.

The dataset includes information from over 40 clinic locations and 100 providers across the Chicago metropolitan area. A total of 4050 analyzed patient encounters with a diagnosis of acne vulgaris were identified while 115 of the visits occurred in pregnancy-related encounters. Of the 115 patients included, 66 were trying to become pregnant within the next year, 37 were pregnant, and 12 were breastfeeding.

Data revealed:

• Azelaic acid 15% gel and clindamycin 1% gel, solution, or lotion were the most commonly prescribed treatments with 83.3% and 69.7% of patients trying to get pregnant and 75.7% and 56.8% of pregnant patients prescribed these medications, respectively
• Only 13.5% of currently pregnant patients were prescribed category C prescriptions (benzoyl peroxide, tretinoin, adapalene, dapsone, spironolactone, trimethoprim-sulfamethoxazole), suggesting safe treatment of acne in pregnancy
• In nonpregnancy-related encounters, prescription rates of azelaic acid (4.5%) and clindamycin (54.0%) were lower, and recommendation rates of other pregnancy C medications (retinoids, spironolactone, dapsone) were higher vs pregnancy-related encounters

“These findings suggest substantial adjustment of acne treatment regimens for safety in pregnancy and peri-pregnancy and recognition of the teratogenic effects of acne medications by providers,” the authors wrote.

However, American Board of Family Medicine guidelines suggest avoiding antibiotic monotherapy for pregnant patients with acne, and instead encourage use of benzoyl peroxide as first-line treatment to help avoid antibiotic resistance.

Of the 37 pregnant patients included in the study, 16% were prescribed antibiotic monotherapy, a rate higher than the 7% of the nonpregnant population.

Benzoyl peroxide 2.5%-10% was also recommended at lower rates in the pregnant group compared with the nonpregnant group.

“The higher rates of antibiotic monotherapy and lower rates of benzoyl peroxide prescribed in pregnant patients may reflect the limitations for ideal acne treatment and highlight a potential area for improvement,” authors wrote.

The relatively small sample size marks a limitation to the study, and although trends and generalizations can be inferred from the dataset, the researchers caution the sample size was too small to determine statistical significance. Data were also only reflective of a single health care system.

Although the data do show adjustment of acne treatment regimens for pregnant patients to account for the negative effects some medications may have on fetal growth, the American Academy of Dermatology “identifies the treatment of acne in pregnant women as a research gap and there remains room for improvement,” the authors wrote.

“It is imperative for providers to heed attention to pregnancy medication classes and familiarize themselves with recommended guidelines for optimal patient management,” they concluded.

Reference

Garg SP, Alvi S, Kundu RV. Analyzing trends in treatment of acne vulgaris in pregnancy: a retrospective study. Int J Womens Dermatol. Published online March 9, 2023. doi:10.1097/JW9.0000000000000076