Acne Treatment While Breastfeeding: What's Safe and What to Avoid

The postpartum period is already a lot.

You're healing from birth. You're sleeping in two-hour stretches (if you're lucky). Your hormones are changing by the day. And just when you think you've adjusted to everything else, your skin decides it's gonna erupt. Or at least that was the case for me.

I have hormonal acne, something that’s been true since I was a girl. But I never accounted for what that would mean when I factored in the hormones of pregnancy, postpartum, and weaning. I remember assuming there wasn't much I could do until I was done breastfeeding.

Thankfully, that's not necessarily true.

Many acne treatments are compatible with breastfeeding, while others should be avoided or used with extra caution. The trick is knowing which is which.

Why There's No Simple Yes or No Answer

One of the biggest frustrations is that most acne medications haven't actually been studied specifically in breastfeeding parents.

The National Institutes of Health notes that there is a lack of updated guidance and research on acne management during pregnancy and lactation.

So instead of relying on large clinical trials, healthcare providers evaluate medications by asking questions like:

• Is it taken by mouth or applied to the skin?

• How much enters your bloodstream?

• How much transfers into breast milk?

• How much would your baby actually absorb?

• Are there reports of adverse effects in breastfed infants?

Because topical medications generally have very little absorption into the bloodstream, they're often much lower risk than medications taken by mouth.

That doesn't automatically make every topical treatment safe, but it's an important starting point.

Acne Medications That Should Be Avoided While Breastfeeding

Oral Isotretinoin (Accutane and Similar Medications)

Examples include:

• Accutane

• Claravis

• Absorica

• Myorisan

• Amnesteem

• Epuris

• Isotrex

• Roaccutane

Because of the potential for serious side effects and the lack of breastfeeding safety data, isotretinoin is not recommended during lactation.

Sarecycline (Seysara)

Sarecycline is one of the newer tetracycline antibiotics. Because there is very little research in lactating parents, and because safer alternatives exist, most experts recommend avoiding it while breastfeeding.

Oral Dapsone

Oral dapsone enters breast milk and may increase the risk of hemolysis, particularly in:

• premature infants

• babies with G6PD deficiency

Topical dapsone (Aczone) likely results in much lower infant exposure, but the evidence is still limited enough that many providers recommend alternative treatments first.

Acne Medications That May Be Appropriate With Guidance

These medications are often compatible in certain situations but deserve an individualized conversation with your dermatologist, pediatrician, or IBCLC.

Topical Retinoids

Examples include:

• tretinoin (Retin-A)

• adapalene (Differin)

• tazarotene

• trifarotene

Very little of these medications is absorbed through intact skin, making infant exposure likely quite low. However, because evidence is limited, many dermatologists recommend trying other treatments first. Reminder: Never apply topical retinoids on or near the nipple or breast.

Tetracycline Antibiotics

Such as:

• doxycycline

• minocycline

Short courses of these medications are generally considered compatible with breastfeeding by many experts because only very small amounts enter breast milk, and calcium in milk further limits infant absorption. Long-term therapy deserves an individualized discussion with your healthcare provider as they can cause discoloration of developing teeth, as well as bone growth issues.

Spironolactone

Spironolactone produces extremely low milk levels and has not been associated with adverse effects in breastfed infants.

It is generally considered compatible with breastfeeding but should never be used during pregnancy.

Acne Treatments That Are Generally Compatible With Breastfeeding

If you're looking for treatments that dermatologists commonly recommend during lactation, these are often excellent places to start.

• Benzoyl Peroxide: One of the first-line acne treatments for breastfeeding parents. Because very little is absorbed into the bloodstream, transfer into breast milk is expected to be minimal.

• Salicylic Acid: Topical salicylic acid has limited absorption through intact skin and is generally considered compatible when used appropriately.

• Azelaic Acid: Azelaic acid is naturally found in foods and only minimally absorbed through the skin. It's considered one of the safest prescription acne medications during lactation and is frequently recommended for hormonal acne, rosacea, and post-inflammatory hyperpigmentation.

• Topical Clindamycin: Only tiny amounts are absorbed through the skin. Breast milk exposure is expected to be very low, although parents should watch for diarrhea or gastrointestinal upset in infants (which is uncommon).

Don't Forget Your Regular Skincare Routine

The good news?

Almost all of your favorite non-medicated skincare products can stay in your routine while breastfeeding.

These include:

• Ceramides

• Hyaluronic acid

• Niacinamide

• Vitamin C serum

• Peptides

• Glycolic acid

• Lactic acid

• Glycerin

• Colloidal oatmeal

• Mineral sunscreen

• LED red- and blue-light therapy

• Hydrating eye masks

Sometimes the best postpartum skincare routine isn't the fanciest one, it's the one you'll actually have time to do between feedings.

Important Reminders

No matter which treatment you're using:

• Don't apply acne medications to the nipple or areola where your baby may ingest them.

• Wash your hands after applying prescription creams.

• Talk with your dermatologist before starting any new medication.

• Your pediatrician and IBCLC can also help you weigh the benefits and risks of treatment while breastfeeding.

You Don't Have to Wait Until You Wean

There are many effective treatments that can improve acne while keeping breastfeeding goals intact. The best choice depends on your specific skin, your baby's age and health, and the medication being considered.

If you're unsure whether a medication is compatible with breastfeeding, don't guess. Ask your dermatologist, pediatrician, and/or IBCLC. You’ve been through a lot, you deserve to feel good in your skin.

References

• Hale TW. Medications & Mothers' Milk.

• LactMed Database.

• InfantRisk Center.

• Baumann L. How to Treat Acne When Breastfeeding.

• National Institutes of Health. Acne Management During Pregnancy and Lactation.