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I'm using a topical retinoid while pregnant! Is there a risk? 

 

Oral retinoids are undoubtedly teratogenic and all acne guidelines suggest that topical retinoids should be avoided in pregnancy. A large Nordic cohort study has tried to address and quantify this point.

Between 2006 and 2024, linked individual-level data from Denmark, Iceland, Norway and Sweden was used to perform a population-based cohort study. They used nationwide registers to estimate prevalence of retinoid use during pregnancy and the risk of major congenital malformations. 

The study looked at all infants born with a gestational age of at least 22 weeks. They compared major congenital malformations among infants with first trimester exposure to topical retinoids, with unexposed infants and infants with a first trimester exposure to other non-retinoid topical acne treatments, such as azelaic acid and topical clindamycin. 

Of more than 3.8 million infants included in the cohort, 0.86 per 1000 were exposed to a topical retinoid in the first trimester. 2,172 children were identified as having been exposed to topical retinoids in the first trimester. There was a congenital malformation rate of 3.3 compared to 3.0 amongst the unexposed and 2.6 amongst infants exposed to azelaic acid or clindamycin.

The prevalence of topical retinoid use among women of reproductive age increased 3.3 fold during the 18 year study period. The study demonstrated that despite this increase in topical retinoid use, an increased risk of congenital malformations associated with topical retinoids was not identified. 

Perhaps one limitation of this data is that the investigators were unable to look at the early pregnancy spontaneous miscarriage rates. Therefore, harm produced by topical retinoids may have been underestimated. 

However, overall, this offers some reassurance to women (and their spouses) who have had inadvertent topical retinoid exposure in pregnancy. Guidelines remain unchanged and topical retinoids should be avoided, but if pregnancy does occur, then the risk of severe congenital malformations are not significantly raised.

Dr Ian Coulson, Dermatologist and DermNet Editor-in-Chief

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Reference: 

Refsum E, Furu K, Cesta CE, et al. Topical retinoid use in women of reproductive age and risk of major congenital malformations in exposed pregnancies: a Nordic cohort study. Br J Dermatol. 2026;194(4):640-647. Journal