When you’re pregnant, even the simplest skincare decision can feel overwhelming. That rash on your belly? The breakout on your chin? The itchy patches after showering? You want relief-but you’re terrified of harming your baby. The good news: topical medications are often much safer than pills or injections because very little of the drug actually enters your bloodstream. But not all creams are created equal. Some are fine. Others? Avoid them completely.

Why Topical Creams Are Usually Safer

When you swallow a pill, it goes straight into your blood and travels everywhere-including to your baby. Topical creams? Most of the active ingredient stays on your skin. Studies show that for most topical treatments, less than 10% gets absorbed into your body. On your forearm? Maybe just 1%. On your face, eyelids, or groin? Higher. That’s why where you apply it matters as much as what you’re applying.

The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Dermatology agree: for most common skin issues during pregnancy, topical treatments are the first choice. They’re not risk-free, but they’re far safer than oral meds. Still, you can’t assume everything in the drugstore is safe. Some ingredients, even in cream form, can cross the placenta in harmful amounts.

Safe Topical Treatments for Common Pregnancy Skin Issues

Eczema and Itchy Skin

Mild to moderate hydrocortisone cream (1%) is widely considered safe for short-term use during pregnancy. It’s the go-to for eczema flare-ups, poison ivy, or bug bites. You can use it on your belly, arms, or legs-but avoid the face unless your doctor says so. Don’t use it every day for weeks. Limit it to a few days at a time, then take a break.

If 1% hydrocortisone isn’t enough, your doctor might suggest a slightly stronger prescription steroid like triamcinolone. These are still considered low-risk if used sparingly and only where needed. Avoid potent steroids like clobetasol unless absolutely necessary-and even then, only under close supervision. Long-term or high-dose use of strong steroids has been linked to lower birth weight in rare cases.

Acne

Pregnancy acne is common. Hormones go wild, oil glands go crazy. But don’t reach for your old tretinoin or adapalene cream. These are topical retinoids-vitamin A derivatives-and even though they’re applied to the skin, they’ve been tied to rare cases of birth defects when used in early pregnancy. ACOG recommends stopping them before you even try to conceive.

Instead, go for:

• Benzoyl peroxide (5-10%) - This kills acne bacteria and reduces oil. It’s absorbed minimally. Safe to use.
• Topical clindamycin (1-5%) - An antibiotic that works well for inflammatory acne. Studies show less than 5% gets into your blood. No known risks.
• Topical erythromycin - Another antibiotic option. Also safe.
• Azelaic acid (15-20%) - Great for acne and melasma (the pregnancy mask). Studies show it’s safe and effective. Many women report clear skin without side effects.

Fungal Infections (Yeast, Athlete’s Foot)

Vaginal yeast infections are super common during pregnancy. Over-the-counter antifungal creams like clotrimazole and miconazole are first-line treatments. They’re not absorbed well, and decades of use show no increased risk of birth defects.

Same goes for athlete’s foot or ringworm. Use clotrimazole or nystatin. Avoid econazole in the first trimester, and use it sparingly later on. Terbinafine and naftifine? Not well studied-better to stick with the ones with a proven track record.

Herpes Sores

If you get cold sores or genital herpes outbreaks, acyclovir cream is safe. It’s been used by thousands of pregnant women without issues. It doesn’t absorb much, and studies show no increased risk of problems.

Avoid podofilox or podophyllin resin. These are used for warts but can be toxic to a developing baby.

Topical Medications to Avoid During Pregnancy

Topical Retinoids

This is the big one. Avoid all forms of retinoids-even if they’re in a cream. That includes:

• Tretinoin (Retin-A)
• Adapalene (Differin)
• Tazarotene (Tazorac)

Even though absorption is low, there are documented cases of birth defects linked to these drugs when used in early pregnancy. The risk is small-but not zero. And since there are safe alternatives, why take the chance? Stop using them before you get pregnant.

Topical NSAIDs

Creams like diclofenac or ibuprofen gel might seem harmless. After all, you’re just rubbing them on your back. But here’s the catch: even small amounts absorbed through the skin can affect your baby’s heart after 30 weeks. They can cause the ductus arteriosus-a vital blood vessel-to close too early. That can lead to serious heart problems in the newborn.

The American Academy of Family Physicians says: avoid topical NSAIDs after 30 weeks. If you need pain relief earlier, talk to your doctor. Don’t use them daily for weeks.

Salicylic Acid (High Doses)

Low-dose salicylic acid (like in a 2% face wash) is generally okay for acne. But avoid high concentrations-think chemical peels, 30% solutions, or daily use over large areas. High doses can act like aspirin, which is linked to complications in late pregnancy.

Hydroquinone

Used for dark spots and melasma, hydroquinone is a skin-lightener. It’s not well studied in pregnancy. Some animal studies show potential risks. While not proven dangerous in humans, it’s better to wait until after pregnancy to use it. Azelaic acid is a safer alternative.

What About Over-the-Counter Products?

You don’t need a prescription to get skin relief. But don’t assume “natural” or “gentle” means safe.

• Tea tree oil? Use sparingly. It’s not absorbed much, but some studies suggest high doses may affect hormones. Stick to diluted products.
• Essential oils in creams? Avoid internal use, but topical use in low concentrations (like in a moisturizer) is usually fine.
• Mineral sunscreens (zinc oxide, titanium dioxide)? Safe and recommended. Chemical sunscreens like oxybenzone? Less studied. Stick to mineral if you’re unsure.
• Moisturizers with ceramides, glycerin, or hyaluronic acid? Perfect. These are just hydrators-no active drugs.

How to Use Topical Medications Safely

Even safe products can cause problems if used the wrong way.

• Use the smallest amount needed. A pea-sized dab covers a palm-sized area.
• Don’t apply to large areas. Avoid covering your whole belly with steroid cream every day.
• Don’t use under occlusion (plastic wrap, tight clothing). That increases absorption.
• Wash your hands after applying. You don’t want to accidentally rub it into your eyes or mouth.
• Stop if you get redness, burning, or swelling. That’s a sign of irritation, not an allergic reaction-but still, stop and check with your doctor.

When to Call Your Doctor

You don’t need to panic over every cream. But call your OB or dermatologist if:

• You accidentally used a retinoid cream during the first trimester.
• Your skin condition isn’t improving after 2 weeks of safe treatment.
• You’re using a prescription cream and aren’t sure if it’s safe.
• You’re feeling anxious about something you’ve used.

Most cases of accidental use don’t lead to problems. But it’s better to get reassurance early than to wait and worry.

What the Experts Say

The data isn’t perfect. Very few large studies have looked at every cream on the market during pregnancy. That’s why guidelines rely on decades of case reports, animal studies, and pharmacokinetic data.

The bottom line? For 90% of common skin issues, there’s a safe option. You don’t have to suffer through itchy skin or acne. But you also don’t need to guess. Stick to the proven, low-absorption options. Avoid the ones with known risks. And when in doubt-ask.

Most dermatologists and OBs now work together to make sure pregnant patients get the right care. In fact, 82% of obstetricians consult a dermatologist when treating skin conditions in pregnancy. You’re not alone in this.

Next Steps: What to Do Today

If you’re pregnant and dealing with a skin issue:

1. Stop using any retinoid or salicylic acid peel immediately.
2. Switch to 1% hydrocortisone for itching or eczema.
3. For acne, try benzoyl peroxide or clindamycin gel.
4. For fungal infections, use clotrimazole or miconazole.
5. Call your OB or dermatologist to review everything you’re using.
6. Keep a list of all creams, even OTC ones, and bring it to your next appointment.

You don’t have to suffer. You also don’t have to guess. With the right information, you can treat your skin safely-and feel confident doing it.