Treatment options for acne during pregnancy are limited.  Category X is defined as drugs that are toxic during pregnancy and while nursing (i.e. tetracyclines).  Category B drugs are defined as safe to use during pregnancy and nursing.  Category C is defined as no well controlled trials exist in pregnant or nursing women.  Topical and oral retinoids (i.e. Accutane, Isotretinoin, topical tretinoin, adapalene, tazorac, Ziana, etc.) are avoided because of toxicity and potential harm to an unborn fetus.  All oral contraceptives are still classified as a pregnancy category X by the FDA and are therefore considered off limits for use as an acne treatment for pregnant women.  Spironolactone often used for recalcitrant hormonal acne is contraindicated during pregnancy.

The Debate: Benzoyl Peroxide and Salicylic Acid

Though high doses of salicylic acid in its oral form have been associated with birth defects, many dermatologists consider topical salicylic acid (Category C drug) to be perfectly safe for the acne treatment in pregnant women.  Benzoyl Peroxide, another Category C drug, is likewise avoided by some and freely prescribed by others.  It is always best to consult with your dermatologist before using any over-the-counter or prescription treatments/medications during pregnancy.