You have probably already guessed or heard that hormones cause pregnancy acne. But they don’t. All acne is caused by a genetic condition called RH that causes skin cells to get backed up in our follicles regardless of what triggers it, how severe it is, and at what age it’s dormant or active. This causes a backup of debris that creates little seeds called microcomedones which then grow thanks to various triggers. One of hundreds of potential acne triggers is a hormone called testosterone which is responsible for signalling oil production. So when testosterone levels surge, the sebaceous gland goes into overdrive, and if you already have follicles that are prone to get backed up due to RH then it’s like fuel to a fire. Acne is a genetic condition that is always present but it requires a trigger to become exacerbated or to go from a dormant to an active phase and vice versa. And for some people, pregnancy is that trigger

Your acne might get worse and/or worse
Just because there is a surge of hormones during pregnancy doesn’t mean that your acne is going to get worse. Even within the population of people who have the RH gene, there are many cases where their acne gets better or even completely goes away and never comes back. Unfortunately, there is no way to predict how any person is going to respond to hormones and because acne is a multifactorial disease, there are so many other factors that come into play at any given moment. Your hormone levels also shift throughout pregnancy, breastfeeding, and after breastfeeding so your acne might go up and down from conception to months after you stop breastfeeding as your hormones level out. The most common thing I see is that for those whose acne gets worse while they are carrying, their acne tends to get better once they stop breastfeeding. And those whose acne gets better while they are carrying tend to get worse after breastfeeding.

Pregnancy might be your initial trigger or a subsequent trigger
Acne is a condition that typically morphs throughout our lives: we may go through different stages where our acne switches from active to dormant, it might move or spread to a different location on our face, our sensitivity to triggers can change, and the type and severity of our breakouts might get better or worse. Most pregnant women I see report that they had mild acne that manifested as an occasional pimple once in a while (this counts as acne by the way!) during puberty, it went away, then it came back with a vengeance during pregnancy. In this case, puberty was the initial trigger that caused their acne to go into an active mild phase, their acne went dormant after puberty, and then pregnancy was a subsequent trigger that caused their acne to reactivate into a more severe phase. So if your acne reappears or appears for the first time during pregnancy, it’s completely normal.

Your triggers might shift during pregnancy
Acne is like a puzzle with lots of different pieces that make up the final pictures and getting and staying clear is always about trying to balance lots of potential trigger pieces at once. If your hormones are improving your condition, you might actually have more freedom to be exposed to other triggers that would normally cause a visible breakout. For example, maybe dairy used to trigger you if you had it more than three times a week but now that your pregnancy hormones are part of the picture they might be “suppressing” the effects of dairy so you are able to have it everyday without seeing a visible breakout. Or vice versa: maybe your acne is way worse than it was before you got pregnant so the liquid makeup you used to use without a problem is now causing a breakout. When you are pregnant, you already have a significant piece of the acne puzzle that you cannot control (hormones) so if you want to get clear, it is especially important that you manage the pieces of the puzzle that are within your control. Be flexible, don’t think that just because something didn’t trigger you before doesn’t mean it won’t trigger you now, and prepare to adapt to whatever changes you notice.

Pregnancy acne is not a separate type of acne so it should be targeted with the same approach
Pregnancy acne, like teen acne, is caused by and triggered by the same factors that cause and trigger all acne cases. Hormone fluctuations are actually a potential trigger for everyone with acne and every human deals with fluctuating hormones throughout their lives: it just happens to be more exaggerated during pregnancy. Because the underlying cause of acne and the majority of its triggers are the same, a comprehensive acne program will account for oil and hormones anyways regardless of whether or not you are pregnant because a good program will target the potential triggers AND the underlying cause of acne.