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

When you’re pregnant, even the smallest decision about what you put on your skin feels huge. That eczema flare-up? The stubborn acne? The itchy stretch marks? You want relief-but you’re terrified of harming your baby. The good news: topical medications are often safer than pills or injections because they barely enter your bloodstream. But the bad news? Not all creams are created equal. Some are fine. Others? You need to avoid them completely.

Why Topical Medications Are Usually Safer in Pregnancy

Unlike swallowing a pill or getting an injection, creams and ointments applied to your skin don’t travel far. Most of what you put on stays right there-on the surface. Studies show that only 1% to 10% of topical medication gets absorbed into your blood, depending on the product, how much you use, and where you apply it. For example, applying cream to your forearm? Almost nothing gets absorbed. But if you rub it on your eyelids, face, or groin? Your body takes in more. That’s why doctors tell you to use the smallest amount possible, especially on thin skin.

Safe Topical Treatments for Common Pregnancy Skin Issues

Many skin problems flare up during pregnancy-eczema, acne, yeast infections, and melasma (that dark patch on your face, sometimes called the “mask of pregnancy”). The good news? There are safe, effective options.

• Hydrocortisone cream (1%): This mild steroid is safe for short-term use on eczema or rashes. Avoid using it on large areas or for weeks at a time. Stick to small patches, and don’t apply it near your breasts if you’re breastfeeding.
• Clindamycin and erythromycin gels: These antibiotics are top choices for acne. They don’t get absorbed much, and studies show no increased risk of birth defects. Many OB-GYNs and dermatologists recommend them as first-line treatments.
• Benzoyl peroxide (5% or less): This is the most common OTC acne treatment, and it’s considered safe. It kills bacteria on the skin and doesn’t enter your blood in meaningful amounts. Just avoid high concentrations (over 10%) unless your doctor says it’s okay.
• Clotrimazole, miconazole, and nystatin: These antifungal creams treat vaginal yeast infections and skin fungus. They’re safe during all three trimesters. Nystatin is especially gentle and often used for diaper rash in newborns.
• Azelaic acid (15-20%): Great for melasma and acne. It’s a Category B drug, meaning animal studies showed no harm, and human data supports its safety. Many women report noticeable improvement in dark patches with no side effects.

Topical Medications to Avoid During Pregnancy

Some creams sound harmless-but they’re not. Even if they’re applied to the skin, they can still cross the placenta. Avoid these completely:

• Retinoids: This includes tretinoin (Retin-A), adapalene (Differin), tazarotene, and isotretinoin (Accutane). Even though topical retinoids are absorbed less than oral ones, there are case reports linking them to birth defects, especially when used in the first trimester. The American College of Obstetricians and Gynecologists (ACOG) says to stop using them before trying to get pregnant.
• Topical NSAIDs: Creams like diclofenac or ibuprofen gel. While they absorb less than pills, they still carry the same risk: closing a fetal blood vessel called the ductus arteriosus after 30 weeks. That can lead to serious heart problems in the baby. Avoid them after 30 weeks, and use them sparingly even earlier.
• Podofilox and podophyllin: These are used for genital warts but are toxic to developing cells. They’re linked to fetal abnormalities and should never be used during pregnancy.
• High-potency corticosteroids: Products like clobetasol or betamethasone. They’re strong enough to affect fetal growth if used over large areas for long periods. If you need them, use the lowest dose for the shortest time possible-and tell your OB.

What About Over-the-Counter Moisturizers and Sunscreens?

You don’t need a prescription to keep your skin healthy. In fact, moisturizing is one of the best things you can do during pregnancy. Look for products labeled “fragrance-free” and “hypoallergenic.” Avoid anything with retinol, salicylic acid (over 2%), or essential oils like rosemary or sage in high concentrations.

For sunscreen, mineral options with zinc oxide or titanium dioxide are ideal. They sit on top of the skin and don’t absorb. Chemical sunscreens (like oxybenzone) are debated-some studies suggest low absorption, but since we don’t know the long-term effects, mineral sunscreens are the safer bet. Apply daily, even on cloudy days. Melasma gets worse with sun exposure, and prevention is easier than treatment.

How to Use Topical Products Safely

Even safe products can cause problems if used the wrong way. Here’s how to minimize risk:

1. Use the smallest amount needed. A pea-sized dab covers your whole face.
2. Avoid applying to large areas. Don’t cover your belly or thighs with steroid cream unless your doctor says so.
3. Don’t use on broken skin or open wounds. That increases absorption.
4. Wash your hands after applying. You don’t want to accidentally transfer it to your eyes or mouth.
5. Check the expiration date. Old creams can break down and become irritating.
6. When in doubt, call your doctor or pharmacist. Don’t rely on internet forums or well-meaning friends.

What the Experts Say

The American Academy of Dermatology, ACOG, and the European Academy of Dermatology all agree: most topical treatments are low-risk. But they also stress that data is still limited. Most studies are based on animal models or small human cases. There’s no huge, long-term trial tracking thousands of pregnant women using every cream on the market.

That’s why recommendations are cautious. For example, while azelaic acid and clindamycin are widely used and considered safe, newer ingredients like niacinamide or bakuchiol (a plant-based retinol alternative) haven’t been studied enough in pregnancy. Stick to the classics with decades of use.

Real Stories, Real Concerns

One woman in Adelaide told her doctor she was using adapalene gel for acne. She didn’t know she was pregnant until week six. She panicked. Her doctor reassured her that the risk was low-she’d used a small amount on her nose, not her whole face. She had a healthy baby. But she didn’t sleep for weeks.

Another woman used a strong corticosteroid cream on her legs for months to treat eczema. Her baby was born smaller than expected. Her doctor suspected the cream, but couldn’t prove it. She now uses only 1% hydrocortisone and keeps a journal of everything she applies.

These aren’t rare stories. The InfantRisk Center, which handles over 1,200 pregnancy medication questions a month, says nearly 1 in 5 calls are about topical products. Most are from women scared they’ve done something wrong.

What to Do If You’ve Used Something Unsafe

If you accidentally used a retinoid, NSAID cream, or something else you shouldn’t have:

• Stop using it immediately.
• Don’t panic. One use, especially early on, doesn’t guarantee harm.
• Call your OB-GYN or midwife. They’ll likely refer you to a specialist or a teratogen information service.
• Keep track of when you used it, how much, and where.

Most of the time, the risk is minimal. But knowing what happened lets your care team monitor your pregnancy more closely-just in case.

Bottom Line: You Can Care for Your Skin Without Risking Your Baby

Pregnancy doesn’t mean you have to suffer from itchy, acne-prone, or dry skin. There are plenty of safe, effective topical options. Stick to the ones with the most evidence: hydrocortisone 1%, clindamycin, benzoyl peroxide, azelaic acid, and antifungals like clotrimazole. Avoid retinoids, strong steroids, and NSAID creams after 30 weeks. Always use the least amount possible, and talk to your doctor before trying anything new-even if it’s labeled “natural” or “gentle.”

Your skin matters. Your baby matters. You don’t have to choose between them.