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

When you’re pregnant, even the smallest skincare decision can feel overwhelming. That rash, breakout, or itchy patch doesn’t go away just because you’re expecting. But now, every ingredient on the label makes you pause. Is this cream safe? Could it hurt my baby? The good news: topical medications are often much safer than pills or injections during pregnancy. Most of what you put on your skin stays on your skin. But not all topicals are created equal. Some can still sneak into your bloodstream-and your baby’s. Knowing what’s safe, what’s risky, and what to avoid entirely can ease your mind and protect your health.

Why Topical Creams Are Usually Safer Than Pills

Your skin is a strong barrier. Most creams, lotions, and gels applied to the surface don’t get absorbed into your blood in large amounts. Studies show that only 1% to 10% of topical medication enters your system, depending on the product, how much you use, and where you apply it. For example, applying hydrocortisone cream to your forearm results in almost no absorption. But if you rub a strong steroid on your eyelids, face, or groin, your body absorbs more. That’s why location matters just as much as the ingredient.

This low absorption rate is why doctors often recommend topical treatments over oral ones during pregnancy. Instead of swallowing a pill that goes straight into your bloodstream and crosses the placenta, you’re using a localized fix. Think of it like putting a bandage on a cut-you’re treating the problem where it is, not flooding your whole body with chemicals.

Safe Topical Options for Common Pregnancy Skin Issues

Many skin problems flare up during pregnancy: acne, eczema, fungal infections, and even melasma (that dark patch on your face). Here’s what’s generally considered safe, backed by guidelines from the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Dermatology, and the European Academy of Dermatology and Venereology.

• For acne: Benzoyl peroxide, clindamycin, and erythromycin are top choices. These are Category B medications, meaning animal studies show no risk, and no harmful effects have been found in human pregnancies. A 2023 review in the Skin Therapy Letter confirms that even though a small amount of clindamycin gets absorbed, serum levels stay far below what could cause concern. Avoid topical retinoids like adapalene or tretinoin-these are linked to rare birth defects in early pregnancy, even though absorption is low.
• For eczema and itching: Low-potency hydrocortisone cream (1%) is safe for short-term use. Stronger steroid creams (like clobetasol or betamethasone) should be avoided unless absolutely necessary and only under a doctor’s supervision. High doses of potent steroids over long periods have been tied to lower birth weight in some studies.
• For fungal infections (like yeast infections): Clotrimazole, miconazole, and nystatin are first-line treatments. They’re not absorbed significantly and have been used safely for decades. Avoid econazole in the first trimester unless your doctor says it’s needed.
• For melasma (pregnancy mask): Azelaic acid is a great option. It’s Category B and has been shown in user reports and clinical studies to fade dark patches without side effects. Sunscreen (mineral-based, with zinc oxide or titanium dioxide) is equally important-sun exposure makes melasma worse.
• For minor pain or swelling: Avoid topical NSAIDs like diclofenac gel or ibuprofen cream after 30 weeks. Even though they’re applied to the skin, they can still reach your baby and increase the risk of premature closure of a vital blood vessel (ductus arteriosus). Use them only before 30 weeks and only if your doctor approves.

Topical Medications to Avoid During Pregnancy

Some products are off-limits, no matter how small the dose. The risks aren’t theoretical-they’re documented.

• Topical retinoids: This includes tretinoin (Retin-A), adapalene (Differin), and tazarotene. Even though they’re applied to the skin, case reports exist of babies born with birth defects after mothers used these during the first trimester. The American College of Obstetricians and Gynecologists recommends stopping all retinoids before trying to conceive.
• Podofilox and podophyllin resin: Used for genital warts, these are highly toxic and can cause serious fetal harm. They’re strictly contraindicated during pregnancy.
• Salicylic acid in high concentrations: Low-dose salicylic acid (under 2%) in acne cleansers is generally fine. But avoid peels, high-strength spot treatments, or full-body applications. Oral aspirin and high-dose salicylic acid are linked to complications, and while topical use is less risky, caution is still advised.
• Hydroquinone: Used for skin lightening, hydroquinone has limited safety data in pregnancy. Some animal studies show potential harm, and it’s not recommended unless absolutely necessary.

What About Over-the-Counter Products?

You don’t need a prescription to buy most creams. But that doesn’t mean they’re all safe. Many OTC products contain hidden ingredients that could be risky.

For example, some acne spot treatments combine benzoyl peroxide with salicylic acid. That’s fine in small amounts. But if you’re using multiple products with the same active ingredients, you might be overdoing it. Always check the label. Look for products with one or two clear ingredients. Avoid anything labeled “anti-aging,” “skin brightening,” or “chemical peel” unless your doctor approves it.

Also, be careful with natural or herbal creams. “Natural” doesn’t mean safe. Some plant extracts, like retinol (a form of vitamin A), tea tree oil in high concentrations, or essential oils, can be absorbed and may affect fetal development. Stick to well-studied, simple formulations.

How to Use Topical Products Safely

Even safe creams can become risky if misused. Here’s how to apply them wisely:

• Use the smallest amount needed. A pea-sized dab is enough for a palm-sized area.
• Avoid applying to large areas of skin, especially if you’re using steroids or other potent medications.
• Don’t apply to broken, irritated, or open skin-it increases absorption.
• Wash your hands after applying to avoid accidentally transferring the product to your eyes or mouth.
• Don’t use products past their expiration date. Ingredients can break down and become unpredictable.
• Keep a list of everything you’re using and share it with your OB-GYN at every visit.

When in Doubt, Ask Your Doctor

You don’t have to guess. The InfantRisk Center handles over 1,200 pregnancy medication questions every month. Their database is one of the most trusted sources for real-time safety info. Most OB-GYNs now consult dermatologists for skin issues in pregnancy-82% do, according to a 2022 ACOG survey.

If you’re unsure about a product, call your provider. Don’t rely on Reddit threads, Instagram influencers, or vague product labels. Many topical creams still use outdated FDA pregnancy categories (A, B, C, D, X), even though the system was replaced in 2015. The new labeling system gives better details, but not all manufacturers have updated their packaging yet.

Real Stories, Real Concerns

One woman on a pregnancy forum shared that she used tretinoin cream for acne before realizing she was pregnant. She panicked-but her doctor reassured her that the risk was extremely low. She went on to have a healthy baby. Another woman accidentally used a high-strength steroid cream on her face for weeks, thinking it was just a moisturizer. She later learned it could affect fetal growth. Her baby was born slightly smaller than average, but healthy.

These stories show that fear isn’t always based on real risk. But they also show why knowing the facts matters. You don’t need to avoid every product. You just need to know which ones are safe, which ones to skip, and when to ask for help.

What’s Changing in 2025?

New research is slowly filling the gaps. The American Academy of Dermatology is funding large, long-term studies on topical medication safety in pregnancy, with results expected by 2026. Meanwhile, pharmaceutical companies are updating their labels-92% of topical dermatological products now include clearer pregnancy guidance, according to the FDA’s 2023 review.

The bottom line? Topical treatments are your friend during pregnancy. But like any tool, they need to be used correctly. Stick to simple, well-studied options. Avoid anything with retinoids, high-dose salicylic acid, or untested herbal extracts. And when in doubt? Ask. Your body is doing something incredible. You deserve to feel good-and safe-while it happens.