Acne During Pregnancy, IVF and Egg Freezing: Causes and Treatment in Singapore

22 Sep Acne During Pregnancy, IVF and Egg Freezing: Causes and Treatment in Singapore

By Dr Rachel Ho | Aesthetic Doctor, Founder, The Skin Longevity Clinic, Singapore

Preparing for pregnancy brings plenty to think about, and an unexpected breakout can feel like one more decision to manage. You may be wondering whether to continue your usual skincare, change an acne medicine or seek help for inflamed acne. A clear treatment plan can make these choices easier, while keeping your fertility and maternity care prioritised.

Acne during pregnancy can be treated with appropriately selected skincare, prescription medicines and, in some circumstances, targeted clinic treatments^1,2. The starting point is your stage of care, the type of acne and what you are already using^1,2.

Our acne assessment and treatment guide explains the clinic’s wider approach to managing breakouts. This article focuses on the decisions that arise during pregnancy, IVF, egg freezing and breastfeeding.

Why can acne change during pregnancy?

Hormonal and physiological changes during pregnancy can influence oil production and inflammation, contributing to new breakouts or changes in existing acne^1,6. The response varies, so treatment should follow what is happening to your skin rather than an assumed pattern for every pregnancy^1,6.

Acne develops through a combination of follicular blockage, sebum production, bacterial activity and inflammation⁸. Understanding these contributing factors helps explain why treatment may involve more than changing a cleanser⁸.

Can IVF and egg freezing cause acne?

Acneiform eruptions, meaning breakouts resembling acne, have been documented during IVF³. In a prospective study of 200 patients undergoing IVF, 3% developed acneiform eruptions, although this single study cannot predict the likelihood for every fertility protocol³.

Ovarian stimulation changes steroid hormone production, providing a plausible context for skin changes during treatment⁴. Establishing why an individual breakout appeared still requires a review of the medicines, timing and skin findings, rather than attributing it automatically to one hormone.

Does progesterone support cause acne?

A breakout that begins after progesterone support is worth mentioning to your treating team. The IVF study documented skin changes but did not establish progesterone as the cause of its acneiform eruptions³.

Keep fertility medicines on the schedule prescribed by your fertility specialist, and contact that team before making changes. The acne discussion should focus on finding suitable care alongside the fertility plan.

Is acne during egg freezing managed differently from pregnancy acne?

Egg freezing without an imminent pregnancy and IVF with a planned embryo transfer require different treatment discussions. Egg freezing stores unfertilised eggs, whereas embryo transfer introduces an embryo with the intention of establishing pregnancy⁵.

For a patient who is not pregnant and is freezing eggs without an upcoming transfer, some treatment decisions can be assessed differently. The stimulation medicines, collection schedule and possibility of pregnancy still need to be clarified with the fertility team.

Stage of care	What to establish before choosing acne treatment
Trying to conceive or preparing for embryo transfer	Which medicines need changing and whether a waiting period is required before conception6.
Ovarian stimulation for IVF	Whether a fresh transfer is planned or embryos will be stored, alongside the current medication schedule.
Egg freezing without an imminent pregnancy	Whether the proposed acne treatment is appropriate during stimulation and egg collection.
Established pregnancy	The trimester, acne severity, previous response and relevant medical history1,2.

Review your acne routine before embryo transfer rather than waiting for a positive pregnancy test⁶. Bring your fertility schedule and the names of prescription medicines, cosmetic retinoids and supplements to the consultation.

Can spironolactone be continued during egg freezing?

A retrospective study included 402 patients undergoing ovarian stimulation, of whom 83 continued spironolactone⁷. The researchers found no statistically significant differences in the numbers of eggs retrieved or mature eggs frozen compared with the relevant comparison groups⁷.

These findings are reassuring about the outcomes measured, while leaving questions about embryo development and pregnancy safety unanswered⁷. Continuing spironolactone during egg freezing should therefore be agreed with the fertility specialist and prescriber; it should be stopped before attempting pregnancy and avoided during pregnancy^6,11.

What can pregnancy or fertility treatment acne look like?

Breakouts may include blackheads, whiteheads, inflamed bumps, pustules or deeper nodules, affecting the face, chest or back⁸. Their depth, extent and associated scarring help guide treatment, alongside how much the acne is affecting your comfort and confidence⁸.

Mention increased facial hair, scalp hair thinning or irregular periods that preceded fertility treatment, as these findings may make assessment for androgen excess relevant⁹. Your history helps distinguish an established hormonal pattern from a new skin change during treatment.

Which acne treatments can be used during pregnancy?

Several topical treatments can be considered during pregnancy, including azelaic acid, benzoyl peroxide and selected prescription antibiotics^1,2. The complete formulation, treatment area and application schedule matter as much as the ingredient name^1,2.

Pregnancy recommendations draw on clinical experience, observational evidence and knowledge of absorption, because direct treatment trials in pregnant patients are limited¹¹. A product review helps translate that evidence into a manageable routine.

Treatment	How it can help	Pregnancy consideration
Azelaic acid	Treats acne and can improve the brown marks left afterwards6.	Commonly considered an appropriate topical option1,2.
Benzoyl peroxide	Reduces acne associated bacteria and helps control inflammatory lesions12.	Can be considered in limited amounts after reviewing the product11.
Topical clindamycin or erythromycin	Prescribed for inflammatory acne10.	Usually combined with benzoyl peroxide to reduce the development of antibiotic resistance10,12.
Salicylic acid	Helps loosen blocked pores2.	Limited topical use may be considered; extensive application and strong professional peels require separate assessment6,11.

Azelaic acid for acne and brown marks

Azelaic acid is a useful option when active breakouts occur alongside residual pigmentation⁶. It can address both concerns within the same treatment plan, provided the formulation and frequency suit your skin⁶.

Dr Rachel Ho’s azelaic acid guide explains the ingredient and differences between available formulations. Bring your current product to the consultation so its concentration and other ingredients can be reviewed.

Benzoyl peroxide and topical antibiotics

Benzoyl peroxide can be helpful for inflamed acne and is often used alongside a prescribed topical antibiotic¹⁰. The combination supports acne control while reducing the risk of antibiotic resistance^10,12.

Check the full ingredient list of combination gels, because some also contain a retinoid that changes the pregnancy assessment¹¹. Agree on an application schedule that your skin tolerates rather than choosing a stronger product simply because the acne is frustrating.

Can salicylic acid be used during pregnancy?

Limited use of topical salicylic acid can be considered after reviewing the product and treatment area¹¹. A facial spot treatment involves a different exposure from prolonged application over large areas or beneath an occlusive covering⁶.

Professional salicylic acid peels use a different concentration and application protocol from everyday skincare¹⁴. These stronger peels are generally avoided during pregnancy, while other approaches can be selected for the acne being treated¹⁴.

What if topical skincare is not enough for acne during pregnancy, IVF or egg freezing?

More extensive or painful acne can still be treated during pregnancy. Selected oral antibiotics, including cephalexin or certain macrolides, may be considered according to the trimester, medical history and response to topical care^1,2.

The prescription should have a clear purpose and review point, with an appropriate supporting topical routine^10,12. Bring any supplements to the appointment too, particularly before adding zinc to prenatal vitamins.

Which acne medicines need to change before pregnancy?

A medication review before conception creates time to choose an alternative and clarify any required waiting period⁶. The following medicines deserve specific attention rather than being continued simply because they previously controlled your acne¹¹.

Medicine	What to discuss
Oral isotretinoin	It is contraindicated during pregnancy. Wait at least one month after the final dose before attempting conception or embryo transfer, following the prescriber’s pregnancy prevention advice6.
Spironolactone	Arrange discontinuation before conception. A washout period of at least one month is recommended in the pregnancy acne review6.
Topical retinoids and cosmetic retinol	Review and pause these when planning pregnancy; topical retinoids are generally avoided during pregnancy6,11.
Doxycycline, minocycline and other tetracyclines	These are generally replaced for acne during pregnancy, with the timing of exposure relevant to assessment2,11.
Other oral antibiotics	Trimethoprim with sulfamethoxazole and fluoroquinolones are generally avoided for pregnancy acne; suitable alternatives require a prescribing review2.

Confirm medication changes before the planned transfer or conception date. The fertility specialist and acne prescriber should work from the same treatment timeline⁶.

What should I do after an unplanned exposure?

Contact your prescriber and maternity team with the medicine name, route of administration, amount used and dates of exposure. These details allow the discussion to focus on what actually happened rather than assumptions about an ingredient category.

Stop oral isotretinoin immediately and seek prompt medical advice if pregnancy occurs while taking it¹¹. An accidental topical exposure requires its own assessment and should be distinguished from taking an oral medicine¹¹.

Can chemical peels, LED, injections or Q switched laser help?

Clinic treatments can be useful when a particular concern needs additional attention. The discussion should establish what the procedure is intended to improve, whether it suits your current stage and how it fits alongside the rest of your acne care.

Superficial chemical peels for congestion and mild acne

A carefully selected superficial chemical peel can help improve blocked pores and mild acne¹³. A systematic review of randomised trials found benefits from several peeling agents, supporting their role as an additional treatment for suitable patients¹³.

For pregnancy, superficial glycolic or lactic acid peels on limited areas may be considered cautiously after assessment¹⁴. Our chemical peel treatment guide explains preparation, treatment and recovery. Discussing the proposed acid and timing helps you understand whether a peel belongs in the current plan or a later stage.

Blue and red LED light treatment for inflammatory acne

Blue and red LED light treatments offer a light energy based approach that can complement acne care without adding another topical medicine². A systematic review of home LED devices found improvements in acne lesions, although those findings apply to the devices and protocols studied rather than every clinic or home device¹⁵.

Pregnancy reviews describe LED as an option for individual consideration, and the 2026 procedural review classifies photobiomodulation as acceptable with caution¹⁴. Read our LED light treatment for acne guide before your appointment. Ask how the response will be reviewed and what improvement would justify continuing treatment.

Steroid injections for a painful acne nodule

For acne cysts and nodule, a small intralesional corticosteroid injection can provide more rapid relief of inflammation and pain¹². It treats the individual lesion directly and can be useful when cysts and nodules are causing disproportionate discomfort¹².

Focused intralesional doses are expected to produce minimal systemic absorption, and this treatment may be considered during pregnancy after an individual medical assessment⁶. Our cystic acne guide explains how cysts and nodules are assessed. Your doctor can discuss whether an injection is appropriate, its local side effects and the surrounding treatment plan.

Q switched laser for selected acne concerns

Q switched 1064 nm Nd:YAG laser has been studied as an additional treatment for active acne¹⁶. In a small 2026 randomised study, acne severity improved with Q switched treatment alongside oral azithromycin, supporting further consideration of this combined approach in suitable patients¹⁶. Our Q switched Nd:YAG laser guide provides more information about laser treatments during pregnancy.

An acne skincare routine during pregnancy or fertility treatment

A manageable routine makes it easier to follow the agreed treatment and recognise which products suit your skin. Start with gentle cleansing, moisturiser, broad spectrum sunscreen and the acne treatment selected for your circumstances.

Time	Suggested approach
Morning	Cleanse gently, moisturise as needed and apply sunscreen. Use prescribed morning treatment as directed.
Evening	Remove sunscreen and makeup gently, then apply the agreed acne treatment and moisturiser.
When introducing a product	Make one change at a time and check its full ingredient list.
When skin becomes uncomfortable	Review persistent stinging, redness or scaling before adding further exfoliation.

Dr Rachel Ho’s pregnancy skincare guide covers broader questions about skincare and pigmentation. Use it alongside the acne plan agreed with your treating doctor.

Does acne treatment change during breastfeeding?

Breastfeeding requires a fresh medication review because potential exposure through milk and direct contact with treated skin differ from exposure during pregnancy⁶. Some options change after delivery, so your previous pregnancy plan should be reassessed rather than automatically continued or replaced⁶.

Tell your doctor that you are breastfeeding and mention any health concerns affecting your baby. Keep topical acne medicines away from the nipple and other areas the baby may touch or lick, and follow the instructions for each prescribed treatment⁶.

When should I see a doctor for acne during pregnancy or fertility treatments?

Arrange an assessment when acne is painful, extensive, persistent or beginning to leave scars, or when it is affecting your confidence and daily life^8,12. A consultation can address both the immediate discomfort and the plan for reducing further breakouts.

A new widespread or itchy eruption during IVF also deserves review, because fertility treatment studies describe skin reactions other than acne³. Share these symptoms with your fertility or maternity team as well as the doctor assessing your skin.

Before the appointment, gather your fertility schedule, medication list, skincare products and details of previous acne treatment. Ask about the consultation fee and how any proposed medicines or procedures will be explained before proceeding.

A treatment plan that supports your skin and your fertility care

The aim is to make acne care one less uncertainty during a demanding time. Start by clarifying your stage of treatment, identifying the skin concern and agreeing on a practical plan with clear review points.

Read our acne treatment and assessment guide for the wider approach, or contact The Skin Longevity Clinic to arrange an appointment. Bring your fertility or pregnancy details so the discussion can focus on options appropriate to you.

References

1. Rau A, Keri J, Murase JE. Management of Acne in Pregnancy. American Journal of Clinical Dermatology. 2024;25:465 to 471. doi:10.1007/s40257-024-00851-6

2. Kong YL, Tey HL. Treatment of Acne Vulgaris During Pregnancy and Lactation. Drugs. 2013;73:779 to 787. doi:10.1007/s40265-013-0060-0

3. Sood A, Sahu S, Karunakaran S, Joshi RK, Raman DK. Dermatological Manifestations in Patients Undergoing In Vitro Fertilisation: A Prospective Study. Journal of Cutaneous Medicine and Surgery. 2018;22(3):280 to 284. doi:10.1177/1203475417752370

4. Andersen CY, Ezcurra D. Human steroidogenesis: implications for controlled ovarian stimulation with exogenous gonadotropins. Reproductive Biology and Endocrinology. 2014;12:128. doi:10.1186/1477-7827-12-128

5. Human Fertilisation and Embryology Authority. Egg freezing. Patient information on egg collection and storage. Accessed September 2026.

6. Ly S, Kamal K, Manjaly P, Barbieri JS, Mostaghimi A. Treatment of Acne Vulgaris During Pregnancy and Lactation: A Narrative Review. Dermatology and Therapy. 2023;13:115 to 130. doi:10.1007/s13555-022-00854-3

7. Ghofranian A, Estevez SL, Dubois B, et al. Spironolactone use and oocyte maturation in patients undergoing controlled ovarian hyperstimulation. Journal of Assisted Reproduction and Genetics. 2024;41:1991 to 1996. doi:10.1007/s10815-024-03214-6

8. Eichenfield DZ, Sprague J, Eichenfield LF. Management of Acne Vulgaris: A Review. JAMA. 2021;326(20):2055 to 2067. doi:10.1001/jama.2021.17633

9. Cussen L, McDonnell T, Bennett G, et al. Approach to androgen excess in women: Clinical and biochemical insights. Clinical Endocrinology. 2022;97(2):174 to 186. doi:10.1111/cen.14710

10. Chien AL, Qi J, Rainer B, Sachs DL, Helfrich YR. Treatment of Acne in Pregnancy. Journal of the American Board of Family Medicine. 2016;29(2):254 to 262. doi:10.3122/jabfm.2016.02.150165

11. American Academy of Dermatology. Is any acne treatment safe to use during pregnancy? Patient guidance. Accessed September 2026.

12. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. 2024;90(5):1006.e1 to 1006.e30. doi:10.1016/j.jaad.2023.12.017 The Academy’s official summary describes the recommendations for antibiotic stewardship and targeted corticosteroid injections.

13. Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018;8:e019607. doi:10.1136/bmjopen-2017-019607

14. Kovacs T, Nadir U, Goldenberg M, et al. Cosmetic Dermatology in Pregnancy and Lactation: A Risk Benefit Framework for Clinical Practice. International Journal of Dermatology. Published online 24 August 2026. doi:10.1111/ijd.70620

15. Ershadi S, Barbieri JS. At Home LED Devices for the Treatment of Acne Vulgaris: A Systematic Review and Meta Analysis. JAMA Dermatology. 2025;161(5):552 to 555. doi:10.1001/jamadermatol.2025.0019

16. Maghsoodloo D, Jafarzadeh A, Ghassemi M, Sadeghzadeh Bazargan A, Goodarzi A. Comparison of the Efficacy of Q Switched Versus Long Pulsed Fractional 1064 nm Nd:YAG Laser in the Treatment of Active Facial Acne: A Pilot, Double Blind, Randomized, Controlled, Split Face Study. Health Science Reports. 2026;9(4):e72354. doi:10.1002/hsr2.72354