Is salicylic acid BHA safe for pregnancy?

What you need to know about the safety of topical acids in pregnancy - AHA, BHA, hyaluronic acid, and azelaic acid.

Topical acids have been a great addition to the skincare market. They have many uses, and targeted effects that address the three most common skin concerns: acne, ageing, and hyperpigmentation. However, when it comes to pregnancy, some chemicals that up-regulate skin cell turnover may not be appropriate for use as they could have an impact on the rapidly growing fetus.

AHAs

Alpha hydroxy acids (AHAs) are a category of acids that include acids such as glycolic acid, lactic acid, mandelic acid, magic acid, and tartaric acid. AHAs are chemical exfoliants that dissolve dead skin cells at the surface of the skin. They have a tendency to make the skin sensitive to the sun, so they are best used as part of your nighttime instead of daytime routine. They are water loving, have hydrating bents, and stimulate collagen production. They are best used for reducing fine lines, evening skin tone and texture, fading hyperpigmentation, refinishing dull skin, and restoring moisture and plumpness to the skin.

Most AHAs are considered unsafe in pregnancy. This is why I typically recommend switching from an AHA chemical exfoliation to an alternative physical exfoliator in pregnancy. Glycolic acid is an AHA that is considered safe to use in pregnancy. Choose a glycolic acid that is 7% concentration or lower for safe use in pregnancy. Lactic acid is another AHA that is safe in pregnancy. Again, choose a modest concentration of the acid. I recommend 5% concentration or lower in pregnancy. Lactic acid generally does the same thing as glycolic acid for your skin, but tends tends to operate at a lower strength and be less irritating.

BHAs

Beta hydroxy acids (BHAs) is the category of acids that classifies salicylic acid. These acids are oil loving, and thus penetrate deep into a pore dissolving dead skin cells, blackheads, and sebum. These acids do not make you sensitive to sun exposure, and thus can be used both day and night. Salicylic acid has anti-inflammatory and antibacterial properties that aid in the fight against acne. BHAs are great for congested skin - acne, clogged pores, whiteheads, blackheads, rosacea. By keeping your pores clear BHAs help pores appear smaller. They also help treat the inflammatory process of ingrown hairs.

It is best to avoid salicylic acid in pregnancy. However, salicylic acid is an extract derived from willow tree bark which contains a lot of salicylates. There are products that contain willow bark (sailx alba/nigra) and salicylates but not salicylic acid itself. The salicylates would need to be chemically converted to salicylic acid, which is a process that only happens with oral consumption of the herb by stomach acids. These willow-containing topical skincare products are considered safe in pregnancy, as the salicylates cannot be converted to salicylic acid by the skin.

HYALURONIC ACID

Hyaluronic acid (HA) is an extremely hydrating skincare ingredient, and useful for the purpose of anti-ageing skincare. Hyaluronic acid is safe in pregnancy. It is best to use HA in a serum form, right after cleansing, and before applying your moisturizer. HA binds, absorbs, and retains about 1,000x times its weight in water. I like to suggest leaving your face slightly damp before applying your HA serum because of its ability to bind and drive moisture deep into the skin to support skin hydration and plumping.

AZELAIC ACID

Azelaic acid (AA) is neither an AHA or a BHA. It is produced by a yeast that occurs naturally on our skin and is known for its gentle exfoliating and skin-smoothing benefits. Azelaic acid is most commonly used to treat acne, as it has both anti-bacterial and anti-inflammatory properties. For these reasons it is also useful in reducing the appearance of fine lines, wrinkles, uneven texture, and treating rosacea. AA also has the capacity to slow down the production of excess melanin, which can help reduce hyperpigmentation and dark spots. Azelaic acid is often found over-the-counter at 5-8% concentrations but it works best at a concentration of 10%. Best of all, azelaic acid is considered safe to use in pregnancy. According the the American Academy of Dermatology AA is a great alternative to typical first line treatments for acne that are not appropriate in pregnancy.

HOW TO GET YOUR PREGNANT GLOW

Bottom line is you need to know the ingredients in your skincare when you are pregnant. Knowing what is in your skincare products and what is not helps you ensure that both you and baby stay safe throughout pregnancy. While safety is important, you also want to have effective skincare products so that you continue to get the results you are looking for while you are pregnant.

DO’s

• Establish and maintain a skincare routine throughout pregnancy

• Avoid products containing parabens, phthalates, “fragrance”

• Use hyaluronic acid

• Use 10% azelaic acid

• Consider using glycolic acid or lactic acid in low concentrations

• Consider a non-irritating physical exfoliator instead of a chemical exfoliator

• Wear sunscreen - choose a physical instead of chemical sunscreen

• Consider a cleanser or moisturizer with tea tree leaf, green tea oil, honey or willow bark for your skincare needs

• Book a consultation if you need more guidance

DON’Ts

• Abandon all skincare out of fear

• Use salicylic acid

• Use AHAs (except those listed above)

• Use retinol - contraindicated in pregnancy as it can cause fetal development abnormalities

• Botox injections - allow 3 months from last appointment before getting pregnant

• Filler injections - allow 3 months from last appointment before getting pregnant

Looking for guidance when it comes to skincare in pregnancy? I am a member of the Canadian Society of Skin Medicine, and have experience in fertility, reproductive medicine, and pregnancy care. Book a consultation to discuss an individualized skin care plan to support you throughout pregnancy.

Take care, 

Dr. Laura Nicholas, ND 

This content is not intended to be substituted or interpreted as medical advice and should not be used to diagnose, treat, or prevent any disease or health concern. Please book a consultation with me or a qualified healthcare professional before acting on any information presented here.

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