Safe Topical Medications and Creams During Pregnancy: What You Can and Can’t Use

When you’re pregnant, even the smallest skin irritation can feel like a big problem. Eczema flares up. Acne breaks out. Fungal infections creep in. You want relief-but you’re terrified of doing something that might hurt your baby. The good news? Most topical creams and medications are safe during pregnancy because they barely get into your bloodstream. The bad news? Not all of them are. And confusion is everywhere-from drugstore shelves to well-meaning friends who swear they used something “just like this” and had a perfect pregnancy.

Why Topical Treatments Are Usually Safer Than Pills

When you swallow a pill or get a shot, the medicine goes straight into your blood, travels to your organs, and crosses the placenta. Topical treatments-creams, gels, lotions-mostly stay on your skin. Only a tiny amount, often less than 10%, gets absorbed. For many drugs, that’s not enough to reach your baby in meaningful amounts. That’s why doctors often recommend topical options over pills for things like acne, eczema, or yeast infections during pregnancy.

But here’s the catch: absorption isn’t the same everywhere. Your face, neck, armpits, and groin soak up more than your forearm or back. So even a “safe” cream can become risky if you slather it on thin skin or use it for weeks on end.

Acne Treatments: What’s Okay, What’s Not

Pregnancy acne is real. Hormones spike, oil glands go wild, and suddenly your cheeks look like a battlefield. You might be tempted to grab your old acne cream-but don’t. Topical retinoids like tretinoin (Retin-A), adapalene (Differin), and tazarotene are off-limits. Even though they’re applied to the skin, case reports link them to rare but serious birth defects when used in early pregnancy. The American College of Obstetricians and Gynecologists (ACOG) says to stop them before you even try to conceive.

So what can you use instead?

• Benzoyl peroxide (5-10%)-safe. It kills bacteria and doesn’t absorb much. You’ll find it in over-the-counter washes and spot treatments.
• Topical clindamycin (1-5%)-safe. Antibiotic gel or lotion that works well for inflammatory acne. Less than 5% gets absorbed, and studies show no harm to babies.
• Topical erythromycin-safe. Another antibiotic option. Often combined with benzoyl peroxide for better results.
• Azelaic acid (15-20%)-safe. It reduces redness, kills bacteria, and even helps with melasma (pregnancy mask). Many women report clear skin with zero side effects.

Avoid salicylic acid in high concentrations (over 2%) or used over large areas. While low-dose face washes are probably fine, oral aspirin-like drugs are linked to complications, so caution is key.

Eczema and Itchy Skin: Corticosteroids Explained

Itchy, flaky skin is common in pregnancy. You might get pruritic urticarial papules and plaques of pregnancy (PUPPP), or your old eczema might return. Hydrocortisone cream is the go-to for many-but not all steroids are equal.

• Mild hydrocortisone (0.5-1%)-safe for short-term use on face, arms, legs. Use it for a few days at a time. No evidence of harm.
• Moderate steroids (like triamcinolone)-okay for small areas on body, but avoid face and skin folds. Limit to 1-2 weeks.
• Potent steroids (like clobetasol)-avoid unless your doctor says so. Long-term or widespread use has been linked to lower birth weight in rare cases.

The key is using the weakest effective strength for the shortest time. Don’t cover large areas with thick layers. And never use steroid creams on your breasts if you plan to breastfeed-your baby could ingest it during feeding.

Fungal Infections: Yeast and Ringworm

Vaginal yeast infections are super common during pregnancy. Up to 30% of pregnant women get them. Over-the-counter antifungal creams like clotrimazole (Lotrimin) and miconazole (Monistat) are first-line treatments. They stay mostly in the vaginal area, with almost no absorption into the blood. Safe at any stage.

For ringworm, athlete’s foot, or jock itch:

• Clotrimazole, miconazole, nystatin-safe.
• Econazole-avoid in first trimester. Use sparingly later on.
• Terbinafine (Lamisil)-not recommended. Too little data.

If you’re treating a fungal infection on your skin, wash your hands after applying it. Don’t share towels. Keep the area dry. These infections thrive in moisture.

Pain and Inflammation: Topical NSAIDs

You’ve got back pain. Your hips ache. You reach for the diclofenac gel or ibuprofen cream. Tempting-but risky later in pregnancy.

Topical NSAIDs like diclofenac (Voltaren gel) and ketoprofen absorb less than pills, but they still enter your bloodstream. And around week 30, they can cause the baby’s ductus arteriosus-a vital blood vessel-to close too early. That can lead to high blood pressure in the baby’s lungs and serious heart problems.

• Before 30 weeks-use only if needed and for a few days. Talk to your doctor first.
• After 30 weeks-avoid completely.

For pain relief, try acetaminophen (Tylenol) pills instead. Or use heat, massage, or pregnancy support belts. They’re safer and just as effective for most women.

Antiviral Creams: Cold Sores and Herpes

If you get cold sores, you’re not alone. Pregnancy can trigger outbreaks. The good news? Topical antivirals are safe.

• Acyclovir cream-safe. Applied directly to the sore, it blocks the virus without entering your blood in harmful amounts.
• Trichloroacetic acid-safe for warts or sores. Used by dermatologists.

Avoid podofilox and podophyllin resin. These are used for genital warts and can be toxic to the fetus. If you have genital warts, talk to your OB-GYN-they’ll guide you to the safest option.

What About OTC Moisturizers and Sunscreens?

You don’t need a prescription to care for your skin. In fact, keeping skin hydrated helps prevent stretch marks and itching.

• Mild, fragrance-free moisturizers (CeraVe, Vanicream, Eucerin)-perfect.
• Mineral sunscreens (zinc oxide, titanium dioxide)-safe. They sit on top of your skin and don’t absorb. Avoid chemical sunscreens like oxybenzone if you’re worried-though evidence of harm is weak.
• Essential oils-skip them. Many aren’t tested in pregnancy. Tea tree oil? Maybe okay in tiny amounts, but avoid internal use or high concentrations.

What to Do If You Accidentally Used Something Risky

You didn’t know you were pregnant. You used tretinoin for a week. Or you kept using your hydrocortisone cream for two months. Panic sets in.

Here’s the truth: most women who accidentally use a risky topical cream have healthy babies. The risk is low because absorption is minimal. But it’s still smart to call your doctor or midwife. Tell them exactly what you used, how much, and for how long.

The InfantRisk Center (a trusted U.S. resource) handles over 1,200 pregnancy medication questions every month. They can help you weigh real risks-not fear. You can also ask your pharmacist-they’re trained to answer these questions.

How to Stay Safe: A Simple Checklist

• ✅ Always check the active ingredient-don’t rely on brand names.
• ✅ Use the smallest amount needed for the shortest time.
• ✅ Avoid retinoids (tretinoin, adapalene, tazarotene) completely.
• ✅ Avoid potent corticosteroids on large areas or thin skin.
• ✅ Skip topical NSAIDs after 30 weeks.
• ✅ Use benzoyl peroxide, azelaic acid, clindamycin for acne.
• ✅ Use clotrimazole or miconazole for yeast infections.
• ✅ Choose mineral sunscreen and fragrance-free moisturizers.
• ✅ When in doubt, call your OB-GYN or pharmacist. Don’t guess.

Final Thought: You’re Not Alone

Pregnancy skin issues are common. So is the fear of using anything. But you don’t have to suffer in silence. Millions of women have safely used topical treatments during pregnancy. The key isn’t avoiding everything-it’s knowing what’s truly risky and what’s just misunderstood.

Talk to your care team. Ask questions. Bring your creams to your next appointment. You’re not being paranoid-you’re being smart. And that’s exactly what your baby needs.