July 2001

Some potent drugs used to treat acne should not be used by women who are pregnant or who may become pregnant because of potential harm to a fetus. These drugs may be considered for use with adequate birth control precautions, but only under the supervision of a dermatologist and with adequate monitoring of both the drug’s effects and any indications of failure in birth control measures that would require a person to stop using the drug.

A woman who is pregnant or who may become pregnant should consult her dermatologist regarding safe and effective acne therapy. Consultation with her gynecologist may also be appropriate in regard to birth control precautions or use of hormonal therapy for acne.

Acne medications that have potential for harming a fetus include:

Retinoids (Vitamin A derivatives, natural and synthetic)

Isotretinoin is a synthetic, orally-administered systemic retinoid that virtually revolutionized acne therapy due to its effectiveness in treating severe and therapy-resistant acne. A number of side effects are associated with isotretinoin therapy, the most serious being the potential to cause severe birth defects to a developing fetus. The drug should not be used by a woman who is pregnant or who may become pregnant during the course of isotretinoin treatment, and it is imperative that women of childbearing potential follow the manufacturer’s pregnancy prevention program and guidelines. Women planning a pregnancy should discontinue taking isotretinoin and maintain birth-control methods for at least one month before trying to become pregnant. Isotretinoin must not be used when a woman is trying to become pregnant, pregnant or breast feeding.

Topical retinoids (tretinoin, adapalene, tazarotene) carry warnings against use by women who are pregnant or who may become pregnant during a course of treatment. Their use by pregnancy-age women should be discussed with a dermatologist in order to make decisions regarding precautions to avoid pregnancy while receiving topical retinoid therapy.

Hormonal therapy using the "female" hormone estrogen or the anti-androgens spironolactone or flutamide is sometimes used in the treatment of acne in females. These agents should not be used while a woman is pregnant.

Systemic tetracyclines are broad-spectrum antibiotics sometimes used in a low-dose for the long-term treatment of acne, or in high doses for the treatment of very severe acne. Tetracyclines are capable of causing inhibition of bone growth and discoloration of teeth in a fetus and should not be used by a woman who is pregnant or who may become pregnant during a course of treatment.

Each month we pose a question that is answered the following month. This month’s question:

Are there any acne treatments specifically for people with dark skin? Are there any treatments specifically harmful for dark skin?

We’ll have the answer and a discussion of the answer on AcneNet 
next month.

Last month’s question was:

Are there any acne treatments specifically for people with dark skin? Are there any treatments specifically harmful to dark skin?

Answer: There are no acne treatments specifically for use on dark skin. Acne treatments are generally as safe and effective on dark skin as on light skin. Some treatments for acne scars may cause temporary lightening of dark skin.

Acne is a common skin disease that has the same causes and follows the same course in all colors of skin.

Very dark or black skin may be less well-moisturized than lighter skin. Topical anti-acne agents such as benzoyl peroxide that have a drying effect on the skin should be used under the supervision of a dermatologist. Benzoyl peroxide also is a strong bleach and therefore must be applied carefully to avoid inadvertent decolorization of a patch of hair, towels or clothing.

Darker skin has a tendency to develop post-inflammatory hyperpigmentation (excessive skin darkening at places where the skin was inflamed). Severe inflammatory acne may result in dark spots. The spots resolve over time; a dermatologist may be able to recommend cosmetic measures to make the spots less apparent until they resolve. Some acne treatments, such as topical retinoids and azelaic acid, may also help fade the discoloration.

Removal of acne scars by dermabrasion or chemical peeling may cause temporary lightening or darkening of dark skin in the areas of treatment. Scar treatment should be discussed with a dermatologist or dermatologic surgeon before it is undertaken.

Alterations of melanin (dark pigments that give the skin its color) pigmentation such as vitiligo and melasma are not related to acne, but they may be present simultaneously with acne. The diagnosis and treatment of melanin pigmentation disorders such as vitiligo requires a dermatologist with knowledge and experience in treating these conditions.