US dermatologist, Leslie Baumann reveals how to handle acne during breastfeeding.

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Acne is a common problem during pregnancy and it can continue during breastfeeding. It is important to know which acne medications, herbal ingredients and topical products are safe to use during breastfeeding and which should be avoided.

The movement of substances from the mother to the baby in breast milk

Drugs get into breast milk via the mother’s blood circulation. The amount of drug excreted in a mother’s milk is usually not more than one-two per cent of the amount ingested by the mother.  Drugs that have a high solubility in lipids (fats) are much more likely to get into breast milk. Drugs that bind strongly to the maternal plasma protein are more likely to stay in the mother’s blood than transfer into the breast milk. If you must take an oral medication while breastfeeding, the best plan of action is to breastfeed prior to taking the medication, that way there will be less drug in the mother’s blood at the time of breastfeeding.

 Oral medications during breastfeeding

Tetracycline is the most commonly-used oral antibiotic for acne. It should not be taken during pregnancy because it can have an effect on the infant’s teeth. However, tetracycline can be taken while breastfeeding.

Oral contraceptives are used to treat acne but these have hormones that can be passed into the breast milk. They are often prescribed during breast feeding but their use should be discussed with your physician prior to their use. Accutane (isotretinoin) acne medication should not be taken during pregnancy or while breastfeeding.

Topical acne products during breastfeeding

Topical antibiotics – although the safety of topical antibiotics during breastfeeding has not been studied, it is unlikely that a significant amount of antibiotic will enter the maternal bloodstream and pass into breast milk.

 Topical Retinoids – medications such as Retin A (tretinoin), tazarotene, and adapalene should not be used while pregnant or breast feeding.  Non-prescription retinoids such as retinol should be avoided as well.

 Other topical acne medications – benzoyl peroxide is a safe way to kill bacteria on the skin while breastfeeding. Salicylic acid (SA) will help unclog pores and is in the same family as aspirin. While high doses should not be used during pregnancy, it is perfectly safe to use during breastfeeding. Azelaic acid, glycolic acid, lactic acid and vitamin C can all safely be used while breastfeeding.

Herbal, botanical and organic medications for acne

There are many topical herbal remedies for acne including tea tree oil, thyme, turmeric, rosewater, pine and orange peel. These provide no risk to the breastfeeding mother when applied topically. There are many Chinese herbal remedies taken orally that could be harmful while breastfeeding, especially those containing alkaloids such as coptis and phellodendron, sophora root, ma-huang and evodia or those with hormonal effects such as fennel and anise. Taking these oral herbs in large doses over a prolonged period of time is more harmful than a small, infrequent dose.

 Light therapy for acne

Blue and red light therapy has been found to be very effective in treating acne and the inflammation associated with acne. Blue and red light kill the P. acnes bacteria and seem to lessen inflammation through an unknown mechanism.  Blue light treatments can also be performed in a dermatologist’s office.

Lifestyle modifications for acne treatment

Getting a good night’s sleep can help clear acne by stabilising stress hormones such as cortisol that can cause acne. This may be impossible while breastfeeding. Dairy products and sugar can worsen acne, so it is best to avoid these and eat green vegetables high in vitamin A instead. It is not recommended to take vitamin A supplements while breastfeeding.

Dr Baumann was a keynote speaker at Cosmetex 2013, the annual conference of the Australasian College of Cosmetic Surgery www.cosmetex.org/melbourne2013. Contact Dr Leslie Baumann via www.skintypesolutions.com and www.derm.net