Pregnancy: Which Dermatological Treatments are Safe?

Dermatological treatments during pregnancy require extra attention, as many changes in the body also affect the skin. Consider conditions such as melasma, stretch marks and increased hair growth. Although it is usually recommended to postpone non-essential treatments until after childbirth, some treatments may still be necessary. It is important to know which options are safe in order to protect both the mother’s and the baby’s health.

What dermatological treatments are allowed?

This overview article by Garg et al from 2022 provides a clear and comprehensive analysis of various treatments. It distinguishes safe options from situations where it is better to adopt a wait-and-see attitude. However, there are also treatments that may be necessary in specific cases, such as:

Treatments that are safe or cannot wait

Some dermatological procedures simply cannot wait during pregnancy, especially if they are important for your health and well-being. In such cases, the doctor carefully considers the balance between risks and benefits, prioritizing your safety and that of your baby.

Suspected and Bleeding Skin Spots

Removing suspect skin spots: If there is a skin abnormality that may be a melanoma or another form of skin cancer, immediate intervention is very important. Tackling such a spot early prevents more serious problems from arising later.

Treatment of Pyogenic Granuloma: These are benign, rapidly growing lumps that often occur during pregnancy. They can be quite painful and bleed quickly, causing both discomfort and an increased risk of infection. In such cases, a simple treatment can provide you with much relief.

Cryotherapy

Cryotherapy: Cryotherapy is a commonly used method to treat annoying or painful skin abnormalities, such as warts, actinic keratosis, or small benign skin lesions. During this procedure, the skin abnormality is frozen with extremely low temperatures, usually using liquid nitrogen. The nitrogen reaches a temperature of about -196°C, causing the cells in the treated area to die off. This process destroys the abnormality and stimulates the skin to renew itself.

The treatment is generally fast, minimally invasive, and safe, provided it is performed carefully. It is important that cryotherapy is carried out by an experienced practitioner, as too aggressive freezing can cause damage to surrounding healthy skin or leave scars. Most patients only experience a brief burning or prickling sensation during the treatment, followed by redness or slight swelling. Cryotherapy is a safe choice for many patients, including during pregnancy, as long as the procedure is conducted in a controlled manner.

Electrocauterization

Electrocautery is considered safe for the fetus when applied to the mother. This is a medical procedure where a small electrically heated device (electrode) is used to treat tissue. The heat is produced by electric current and can be used for various purposes, such as removing skin spots, cauterizing blood vessels or destroying unwanted tissue such as warts.

However, it is important to take measures to reduce exposure to the smoke plume, as this can have mutagenic and carcinogenic properties. Since regular masks offer limited protection against this smoke, it is recommended to use a smoke extraction system. This device significantly helps reduce exposure to harmful substances in the smoke, thus contributing to a safer work environment during the procedure.

Non-essential but relatively safe treatments

During pregnancy, it is generally recommended to postpone cosmetic procedures. However, aesthetic concerns can be a source of stress for some women, especially if they are in the public eye. In specific cases, treatments can be considered, provided the risk-benefit ratio is carefully weighed. It is important that the practitioner provides clear explanations about the possible risks and asks for written consent, possibly supported by video consent.

Common aesthetic indications during pregnancy are pigment discoloration, acne scars, wrinkles, unwanted hair growth, and visible veins. The safety of the following cosmetic treatments during pregnancy are:

Chemical peels can – small area and low concentration

1. Glycolic Acid (GA)
   Glycolic Acid causes skin exfoliation by loosening the top layers of the skin. It is a superficial peel that is considered safe during pregnancy due to minimal penetration into the deeper skin layers.
2. Lactic Acid (LA)
   Lactic acid has keratolytic properties and is anecdotally used for pregnancy acne in concentrations up to 2%, without risks to the fetus.
3. Salicylic Acid (SA)
   Salicylic acid, a beta-hydroxy acid, has comedolytic and keratolytic properties. Although it is considered safe in low concentrations (as in aspirin for pregnancy complications), in peelings with salicylic acid, it is advised to keep the application area small and provide good guidance, due to a higher penetration (up to 25%).
4. Jessner’s peeling
   This combination peel contains salicylic acid, lactic acid, and resorcinol. Due to the presence of salicylic acid, caution must be exercised.
5. Trichloroacetic Acid (TCA)
   TCA peels can work at superficial to medium depths. Although high doses of TCA have been linked to fetal growth retardation in animal studies, low concentrations (as used in dermatology) are considered safe. For example, TCA is used in the treatment of genital warts during pregnancy.

Energy-based devices (lasers, IPL) – safety unknown

1. Laser Hair Removal and IPL
   These treatments are discouraged during pregnancy, due to a lack of sufficient safety data and hormonal fluctuations that can stimulate new hair growth. Waxing, shaving, and chemical hair removers are considered safer alternatives.
2. CO₂- en Nd:YAG-lasers
   • CO₂ laser: Suitable for the treatment of genital warts and superficial skin problems. It has limited penetration depth and does not cause damage to the fetus, if applied carefully. However, it is recommended to use a smoke evacuator to minimize exposure to mutagenic particles.
   • Nd:YAG laser: The Nd:YAG laser (wavelength 1064 nm) is a safe option during pregnancy for the treatment of pyogenic granulomas and genital warts. The laser works by selectively heating blood vessels and wart tissue, without damaging surrounding skin. This leads to the shrinkage and disappearance of the lesions. Due to deep penetration and minimal effect on surrounding structures, the Nd:YAG laser is safe for both mother and fetus. For extra safety, smoke extraction is recommended to avoid harmful particles in the smoke plume.
3. Pulsed Dye Laser (PDL)
   The PDL laser (Pulsed Dye Laser) is a safe and effective treatment for handling pyogenic granulomas and warts. This laser operates by specifically targeting hemoglobin in the blood vessels of the lesions. The thermal energy closes off these blood vessels, causing the lesions to gradually decrease and disappear. The PDL laser has an excellent safety profile and causes minimal damage to surrounding tissues. Side effects are usually limited to mild redness and a mild, temporary pain at the treated location. The recovery period is typically short.

Other Treatment

Microdermabrasion: This is a safe and non-invasive treatment that removes dead skin cells and improves skin texture. It works by gently exfoliating the top layer of skin with fine crystals or a diamond tip, while a vacuum system sucks up the loose cells. This stimulates cell renewal, improves blood circulation, and results in fresher skin. The treatment is mild, suitable for all skin types, and requires no recovery time. It is a good option during pregnancy as it does not use deep skin penetration or chemicals. However, it is important to use a sunscreen after the treatment, as the skin may be more sensitive to UV radiation.

Which treatments should you better avoid?

Although some cosmetic and medical treatments are considered safe during pregnancy, there are also procedures that are better postponed. This is mainly due to the lack of sufficient research into their safety or potential risks to the mother and unborn child. Below we discuss some common treatments that are better to wait for until after delivery:

Injectables such as fillers and botulinum toxin

Injectables are popular cosmetic treatments, such as fillers to restore volume in the face and botulinum toxin (like Botox) to relax muscles and reduce wrinkles. Although there is no evidence that these treatments are harmful to the fetus, there is also insufficient research done to fully guarantee their safety during pregnancy. Because these are non-essential treatments, it is advised to postpone them until after delivery as a precaution.

Liposuction and Fat Transplantation

Liposuction removes excess fat from the body, while fat transplantation relocates this fat elsewhere, for example to restore volume in the face or breasts. These procedures are discouraged during pregnancy because they can heavily burden the body and reduce the available nutrients and energy for the baby’s growth. In addition, they carry an increased risk of complications, such as infections, which can be more severe in pregnant women.

Sclerotherapy

Sclerotherapy is used to treat varicose veins or visible veins. It involves injecting an irritating substance into the vein, which causes it to close off and disappear over time. Although some studies suggest that sclerotherapy may be safe during pregnancy, the results are conflicting. There is a possible risk that the injection fluid or the increased pressure during the procedure could affect the blood flow or the fetus. For this reason, it is usually recommended to postpone this treatment.

Platelet-Rich Plasma (PRP)

PRP is a treatment where blood is drawn, the platelets are concentrated, and then injected into the skin or scalp to stimulate regeneration and hair growth. However, hormonal changes during pregnancy extend the hair growth phase (anagen phase), making the hair naturally appear fuller. PRP adds little during this period and also carries a risk of infection, which can be harmful to both the mother and the baby. Therefore, PRP is not recommended during pregnancy.

Why are some treatments riskier during pregnancy?

Pregnancy brings various physiological changes that not only influence the body as a whole, but also the skin. Consider:

Hormonal Fluctuations

During pregnancy, hormonal changes occur, particularly an increased production of estrogen, progesterone, and melanocyte-stimulating hormone (MSH).

• More pigment spots (hyperpigmentation): This can lead to conditions such as melasma (pregnancy mask) and dark discolorations of existing scars or moles. Treatments such as chemical peels or lasers may therefore give less predictable results.
• Excessive Hair Growth: Due to hormonal stimulation, women may experience more hair growth in undesirable places, such as the face or stomach. This could lead to an increased demand for hair removal procedures, which sometimes may be better off delayed.

Increased Blood Volume and Reduced Venous Backflow

During pregnancy, blood volume increases by 30-50%, while the pressure on the blood vessels, especially in the legs, increases due to the growing uterus. This has implications for dermatological procedures:

• Increased chance of bleeding: Due to increased vascularity, even a minor procedure such as a biopsy or laser treatment can carry a greater risk of bleeding.
• Varicose Vein Problems: Pregnancy can worsen existing varicose veins, and treatments such as sclerotherapy might be better postponed due to the risk of complications.

Changed Wound Healing

Hormonal and immunological changes during pregnancy also affect the way the skin heals:

• Hypertrophic scars and keloids: Due to the increase of hormones such as estrogen and progesterone, the production of collagen is stimulated. This can lead to hypertrophic scars or keloids (excessive scarring) in some women, particularly if they are genetically predisposed. Invasive treatments such as microneedling or laser resurfacing are discouraged during pregnancy, as they can increase the risk of complications and excessive scarring.
• Slower or unpredictable healing: The immune system is adjusted during pregnancy to protect the fetus. This can slow down the initial phase of wound healing, which is normally crucial for a proper recovery. In addition, the skin barrier can change due to hormonal fluctuations, which can also affect healing. On the other hand, not all pregnant women experience slower wound healing. Some actually notice accelerated recovery due to increased blood flow to the skin. The effect varies from person to person and depends on factors such as genetics, skin type, and the size of the wound.

FAQ

Can I undergo a chemical peel during pregnancy?

Yes, but only mild peels, such as lactic acid peel, are recommended. Avoid strong peels such as salicylic acid peel.

Are laser treatments safe during pregnancy?

Certain lasers, such as CO₂ and Nd:YAG lasers, are considered safe for small, superficial skin problems. However, hair removal with lasers is discouraged.

What about sunscreen during pregnancy?

Always use a broad-spectrum sunscreen with physical (mineral) filters such as zinc oxide and titanium dioxide. These filters reflect UV radiation and are gentle on sensitive skin. There is also protection against visible blue light (HEV), which is emitted by screens and artificial light. These ingredients in creams not only protect against sun damage, but also help prevent pigmentation spots such as melasma and post-inflammatory hyperpigmentation.  Want to know more about HEV-light?

Can I use self-tanning products during pregnancy?

Yes, self-tanning products (such as creams or lotions with dihydroxyacetone, DHA) are generally considered safe during pregnancy. DHA only reacts with the top layer of the skin and is not absorbed into the bloodstream in significant amounts. Avoid spray or mist forms to prevent inhalation. If in doubt, you can always opt for a natural glow with a mineral bronzer or a tinted moisturizer.

Can I use retinol or vitamin A products during pregnancy?

No, the use of retinol (vitamin A) and its derivatives (such as retinoic acid or tretinoin) is discouraged during pregnancy. High doses of vitamin A can harm the fetus and are associated with birth defects. Opt for pregnancy-safe antioxidants such as vitamin C or niacinamide, which help protect and brighten the skin without risks.

In other words

Although not all treatments during pregnancy are safe, a careful selection of dermatological procedures offers opportunities to address skin problems without endangering the health of the mother or baby. Always consult a dermatologist before undergoing a treatment and discuss the risks and benefits.

Now that you’re here

During pregnancy, your body changes in various ways. You breathe faster, your heart pumps harder, and your body produces more blood. Moreover, hormonal changes cause a series of adaptations that you can also see and feel on your skin.

For some, pregnancy is a period full of energy and a beautiful skin glow. For others, it brings months of fatigue, nausea, and skin problems. Common complaints include acne, dry and sensitive skin, stretch marks, and dark spots (melasma). In addition, existing skin conditions such as eczema, psoriasis, or rosacea may improve, but can also worsen due to hormonal fluctuations.

Do you want to know how to take care of your skin during pregnancy? On our special pregnancy page, we discuss everything you need to know:

• How do you keep your skin healthy and radiant?
• Which ingredients should you better avoid?
• Which ingredients are safe and effective?

Read more on our pregnancy page