Skin Care & Beauty Guidance for the Modern Breastfeeding Mother

It is hard to get on social media these days as a 20, 30, or 40-something and not be targeted with skin care products or routines. The skin care or beauty industry is huge! As many women begin trying for a baby or get that positive pregnancy test, they know to make adjustments to their routines, but what about when breastfeeding? What is safe? Are there products to avoid? What about injections or treatments?

For the most part, topical products are safe and effective in breastfeeding mothers. Your standard, lab-tested makeup and hair products are considered safe. It is fine to get your hair dyed, get a gel mani/pedi, wax, get a massage, and have a facial. However, you should check with your salon about their policies surrounding pregnant and breastfeeding women because some do have restrictions. 

Additionally, some products are safer than others. Here are some more details to help guide you with skin care prescriptions and other over-the-counter beauty products. This article references up-to-date information from the best resources available, mainly Hale’s Medications & Mother’s Milk. Nothing, though, should replace a discussion with a healthcare provider (your PCP, your IBCLC, your OB, your derm, or your baby’s PCP) if you have concerns about using a product or service while breastfeeding. 

What is tretinoin and is it safe for breastfeeding?

Tretinoin is a commonly used retinol. Retinols or retinoids are popular anti-aging and acne treatments. Retinoids cause birth defects and are absolutely contraindicated in those seeking pregnancy or who are pregnant. To treat acne and wrinkling, they are most commonly administered either topically or orally. Oral use of retinol while breastfeeding is not recommended. Transfer to milk with oral use is likely, and since milk is high in fat or lipid soluble, high concentrations could occur. Depending on the oral medication evaluated, Hale’s usually classified retinoids as an L3 (no data - probably compatible) to L5 (no data - hazardous). Overall, the recommendation would be to avoid oral use. 

Topical use is considered safer, especially the commonly used retinol, tretinoin (Retin-A). According to Hale’s, absorption via topical sources is reported to be minimal and in breast milk would likely be minimal to none. Overall, if you need acne treatment, you should work with your provider to select the safest topical agent, at the lowest dose, for the shortest course, or consider alternatives that may also work.  

Can I do Botox while I breastfeed?

Botox and Dysport are commonly used for the treatment of fine lines and wrinkles. When injected properly, directly into the muscle, the toxin does not enter the systemic circulation. Thus, levels in maternal plasma and milk are very unlikely. Waiting a few hours for the dissipation of any toxin would all but eliminate any risk to the infant. You should avoid the use of generic or unknown sources of botulinum toxin, as botulism itself can be deadly to an infant. Hale classifies it as L3 (no data - probably compatible), meaning we haven’t done any large studies on Botox or Dysport, but there are no indications that they are not safe. 

The biggest hesitation regarding the use of Botox is that it is most commonly used cosmetically, meaning it is not necessary to treat disease. Therefore, many providers will advise against use in breastfeeding women because the risk is zero, as opposed to exceedingly minimal.

Hormones are not my friend, and my acne is out of control! What can I use for acne treatment while breastfeeding?

Before turning to any tried-and-true acne treatments used before pregnancy, take a look at all active ingredients. Here are the recommendations for some of the most popular acne-treating agents, based on topical use. 

• Benzoyl peroxide: Hale’s classifies it as L2 (no data - probably compatible) because thus far, there is no data on its transfer into human milk. 

• Salicylic acid: Hale’s classifies it as L3 (no data - probably compatible). The systemic absorption of this medication depends on the concentration of the product, the amount applied, and the surface area treated. Absorption increases with duration of use and due to the significant systemic absorption, prolonged use should be cautioned in the breastfeeding mother. 

• Azelaic acid: Hale’s classifies it as L3 (no data - probably compatible). Small amounts are normally present in human milk, and when absorbed topically, it does not change the levels normally found in the bloodstream or breast milk. It is not likely to penetrate milk or produce untoward effects in an infant because it has poor penetration to the bloodstream and a rapid half-life (time use after feed with long stretch prior to next feed). 

Overall, the research favors the use of topical applications in the treatment of acne in breastfeeding mothers, and several over-the-counter and prescription products should be considered safe.

What can I use for itching caused by bug bites, allergic dermatitis, or skin rash?

There are multiple anti-itch topicals or steroid creams to help against itching that are safe for the breastfeeding mother.  

• Benadryl (diphenhydramine): Benadryl levels in milk are low and potentially undetectable in breast milk when taken orally or given by IM injection. Therefore, the topical cream should not have an impact on nursing. Hale’s classifies it as L2 (limited data - probably compatible with breastfeeding). 

• Cortisone Cream (hydrocortisone): The most common topical steroid used for bug bites, itching, or rashes is cortisone cream. It can be purchased over the counter or prescribed at more potent doses. It is also an L2 (limited data - probably compatible with breastfeeding), according to Hale’s. With topical application, the amount transferred into human milk, though not reported, is believed to be minimal. Nipple application should be limited after feeding and wiped off before feeding again.

Hopefully, this provides confidence for modern breastfeeding families and answers some of the more common skin care questions. The beauty industry can include breastfeeding mamas safely. Just make sure to always check your products and be knowledgeable about the best treatments for common skincare or beauty concerns. Remember, if you are ever in doubt, reach out to a healthcare provider.