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 can feel huge. That itchy rash? The breakout on your forehead? The dark patches on your cheeks? You want relief-but you’re terrified of doing something that might hurt your baby. The good news: most topical medications during pregnancy are far safer than you think. Your skin isn’t a sponge. It doesn’t let everything in. But not all creams are created equal. Some are fine. Some you should avoid. And some? You need to talk to your doctor before even touching the tube.

Why Topical Creams Are Usually Safer Than Pills

When you swallow a pill, it goes into your bloodstream and travels everywhere-including your baby. Topical creams? Most of them stay right where you put them. Studies show that only 1% to 10% of the active ingredient gets absorbed into your blood, depending on the cream, how much you use, and where you apply it. That’s why doctors often recommend topical treatments first for skin issues during pregnancy. Less system-wide exposure means less risk to your baby.

But here’s the catch: that doesn’t mean everything on your skin is harmless. Some ingredients still cross the barrier in enough amounts to matter. And some? Even tiny amounts could be dangerous. So you can’t just assume “it’s on the skin, so it’s safe.” You need to know which ones are truly low-risk.

Safe Topical Treatments for Common Pregnancy Skin Problems

Many skin conditions flare up during pregnancy-eczema, acne, fungal infections, even melasma (that “pregnancy mask”). The good news? There are safe, effective options for each.

• For eczema and rashes: Low-potency hydrocortisone cream (1%) is widely recommended. It’s been used for decades in pregnant women with no proven link to birth defects. Avoid stronger steroids unless your doctor says it’s necessary-and even then, use it for the shortest time possible. Apply it only where needed, not all over.
• For acne: Benzoyl peroxide (5-10%) is considered safe. It doesn’t absorb much into your blood. Topical clindamycin and erythromycin are also first-line choices. Studies show less than 5% gets absorbed, and serum levels stay far below any dangerous range. Avoid retinoids like tretinoin, adapalene, or tazarotene. Even though they’re topical, case reports link them to rare birth defects, so the advice is clear: don’t use them.
• For fungal infections (like yeast infections or athlete’s foot): Clotrimazole, miconazole, and nystatin are safe. These are the go-to antifungals recommended by the European Academy of Dermatology. Avoid econazole in the first trimester, and don’t use terbinafine or naftifine unless your doctor approves it.
• For melasma (dark patches): Azelaic acid (15-20%) is a top pick. It’s Category B, meaning animal studies show no risk, and it’s been used safely by thousands of pregnant women. Many report visible improvement without side effects.
• For cold sores: Acyclovir cream is safe. It’s been studied extensively and shows almost no absorption. You can use it as directed without worry.

Topical Medications to Avoid During Pregnancy

Some creams sound harmless-but they’re not. These are the ones to keep off your skin entirely:

• Topical retinoids: This includes tretinoin (Retin-A), adapalene (Differin), and tazarotene. Even though they’re applied to the skin, they’re chemically related to vitamin A, which is known to cause serious birth defects when taken orally. Case reports exist of babies born with malformations after mothers used these during early pregnancy. The American College of Obstetricians and Gynecologists (ACOG) says to stop using them before you even try to conceive.
• Topical NSAIDs: Diclofenac gel, ibuprofen cream, ketoprofen patches. These might seem like harmless pain relievers, but they can affect your baby’s heart. After 30 weeks, they can cause the ductus arteriosus-a vital blood vessel-to close too early. This can lead to serious heart problems in the newborn. Avoid them after 30 weeks, and even before then, use only if your doctor says it’s absolutely necessary.
• Podofilox and podophyllin: Used for genital warts. These are highly toxic and can be absorbed in significant amounts. They’re linked to fetal death and severe birth defects. Never use them during pregnancy.
• Salicylic acid in high concentrations: Low-dose salicylic acid (under 2%) in acne toners or cleansers is generally okay. But avoid peels, high-strength treatments, or using it over large areas. High doses are related to the same risks as oral aspirin, including bleeding complications and low birth weight.

What About Corticosteroids? Potency Matters

Not all steroid creams are the same. The amount your skin absorbs depends on where you put it. Your forearm? Only about 1% gets in. But your face, eyelids, neck, armpits, or groin? That’s a different story. Those areas absorb more-sometimes up to 10 times more.

That’s why doctors recommend:

• Use mild or moderate steroids (like hydrocortisone 1%) for most areas.
• Only use potent steroids (like clobetasol or betamethasone) for short periods on small areas, and only if absolutely needed.
• Avoid using potent steroids on large areas or for more than 2 weeks without supervision.
• Studies link very high cumulative doses of potent steroids to lower birth weight. It’s rare-but it happens.

Over-the-Counter Products: Just Because It’s “Natural” Doesn’t Mean It’s Safe

You might be tempted to reach for “natural” or “organic” creams. But “natural” doesn’t mean safe during pregnancy. Some essential oils, herbal extracts, and plant-based ingredients can be absorbed and affect fetal development. Tea tree oil, for example, has estrogen-like effects in lab studies. Lavender and chamomile? Limited data. Better to stick with well-studied, over-the-counter options like hydrocortisone or benzoyl peroxide.

Also, watch out for hidden ingredients. Some moisturizers, sunscreens, and cleansers contain retinol (a form of retinoid) or salicylic acid. Always check the label. If you’re unsure, skip it.

What If You Used Something Unsafe Before Knowing You Were Pregnant?

This happens more often than you think. A woman uses her acne cream, then finds out she’s pregnant. Panic sets in. But here’s the truth: most of the time, the risk is extremely low.

For example:

• If you used a small amount of tretinoin cream in the first 4 weeks of pregnancy-before you even knew you were pregnant-the chance of harm is tiny. Studies show no consistent pattern of birth defects from accidental exposure.
• If you used hydrocortisone for a rash? No problem.
• If you used a topical NSAID after 30 weeks? Talk to your doctor. They may want to check your baby’s heart with an ultrasound.

Don’t assume the worst. Don’t panic. Don’t terminate a pregnancy over a single cream. But do call your OB or a specialist like the InfantRisk Center (they handle over 1,200 pregnancy-medication questions every month). They’ll help you weigh the real risk.

How to Use Topical Products Safely

Even safe products can cause problems if misused. Here’s how to use them wisely:

1. Use the smallest amount possible. A pea-sized dab covers a palm-sized area.
2. Apply only where needed. Don’t spread it over your whole body.
3. Wash your hands after applying.
4. Avoid using on broken or raw skin-it increases absorption.
5. Don’t use under occlusive dressings (like plastic wrap) unless your doctor says so.
6. Check the expiration date. Old creams can degrade and become less safe.

When to Call Your Doctor

You don’t need to stress about every little thing-but you should call if:

• You used a product you weren’t sure about, especially a retinoid or NSAID.
• Your skin condition isn’t improving after 1-2 weeks of using a safe cream.
• You develop a rash, swelling, or burning after applying a cream.
• You’re considering a new product and can’t find clear safety info on the label.

Most OBs don’t know every topical medication by heart. That’s why 82% of them consult a dermatologist when treating pregnant patients. If you’re unsure, ask for a referral. It’s not overkill-it’s smart.

Final Thoughts: You Can Take Care of Your Skin-Safely

Pregnancy doesn’t mean you have to suffer through rashes, acne, or fungal infections. You have options. Most topical treatments are safe. You just need to know which ones.

Stick with the well-studied: hydrocortisone, benzoyl peroxide, azelaic acid, clotrimazole, and acyclovir. Avoid retinoids, strong steroids, NSAIDs after 30 weeks, and anything with “retinol” or “tretinoin” on the label.

When in doubt? Read the label. Ask your pharmacist. Call a pregnancy hotline. Your baby’s safety matters-but so does your peace of mind. You don’t have to choose between comfort and safety. You can have both.