Introduction 

Postpartum acne is a common dermatological condition that manifests in women in the six to eight weeks following childbirth. This period, known as the postpartum phase, marks the transition of the mother’s body back to its pre-pregnancy state. During this period, the body undergoes significant hormonal changes, which serve as the primary cause of postpartum acne, frequently observed during this time.  

This article aims to explain the cause of postpartum acne and the symptoms which you may encounter. It is important to recognise that experiencing postpartum acne is a common occurrence and that any flare-ups during childbirth will likely be temporary. Understanding the reasons why you may have a flare-up of acne during this time could help to reduce any negative emotions associated with the condition.

Causes of postpartum acne 

Hormonal changes 

Postpartum acne is mainly caused by hormonal changes after having a baby. Throughout pregnancy, there is an increase in the levels of the hormones oestrogen and progesterone. These hormones play pivotal roles in pregnancy:

Oestrogen plays a crucial role during pregnancy. It contributes to the maintenance of the uterus lining which is essential for the growth of the foetus. This hormone also has a role in activating and regulating the production of other hormones needed for a healthy pregnancy. Throughout pregnancy, oestrogen levels gradually rise, reflecting its importance in supporting various aspects of foetal growth and development.  

Progesterone is important in several critical functions during pregnancy. It plays a key role in establishing and maintaining the placenta, the organ which exchanges nutrients and waste from the mother and foetus. Progesterone also promotes blood vessel growth to the uterus, so the developing baby gets an adequate blood supply. Furthermore, progesterone helps to prevent uterus contraction during pregnancy, minimising the risk of preterm labour. 

After pregnancy, the levels of these hormones, significantly drop which can impact the sebaceous glands. 

Sebaceous glands are small glands found in the skin that produce sebum, an oily substance. Sebum acts as a lubricant for the hair and skin to prevent dehydration.¹

Acne occurs when too much sebum is produced, and when combined with dead skin cells, blocks the hair follicle. As stated, the drop in oestrogen and progesterone after childbirth can cause an excessive production of sebum from the sebaceous glands and this results in acne in the postpartum period. 

Another hormonal contribution to postpartum acne is a rise in androgen levels which includes testosterone. This likely occurs because when progesterone and oestrogen levels decrease postpartum, there is a relative increase in other hormones such as testosterone. 

This hormonal shift can stimulate the sebaceous glands, leading to an increase in sebum production and the development of acne. Additionally, Breastfeeding may influence testosterone levels however, this effect varies amongst individuals. 

Stress and lack of sleep 

Having a baby usually brings sleep disturbances and increased stress as new parents navigate the demands of caring for a newborn. It is important to note that struggling with tiredness or feeling stressed does not reflect on your parenting ability. These feelings are a natural response to such a significant change. Remember that asking for help when you need it is a crucial part of growing a family. 

Studies have indicated that sleep deprivation can have an impact on skin health, potentially worsening pre-existing conditions such as acne.² Furthermore, a lack of sleep can disrupt hormonal regulation, which can cause the effects of hormonal imbalance as stated above. 

Stress has been shown to result in an increased prevalence of acne³ Having a child is an intense adjustment period and this can lead to an increase in stress, which results in hormonal dysregulation and possibly acne. 

as you adapt to your new routine postpartum and attain consistent sleep patterns, you may notice improvements in your postpartum acne. However, if your acne is impacting your well-being, it is advisable to seek professional assistance. 

Changes in routine 

When welcoming a new baby into your life, you may find that you experience significant changes in your routine. Many new parents struggle to prioritise themselves and their well-being. Consequently, self-care practices, including skincare routines, may take a backseat, leaving skin vulnerable to acne and leading to postpartum acne. 

Incorporating skincare practises into your daily routine can improve your skin health during this time and reduce the risk of developing or worsening postpartum acne. 

Genetics and predisposition to acne 

Some people may be more susceptible to acne and hormonal changes in general. This may be a genetic susceptibility to hormonal imbalance which increases your chances of developing postpartum acne. 

When navigating postpartum acne, seeking support from family members who have had similar experiences can be very valuable. This may provide insight, empathy and practical advice to deal with postpartum acne. 

Sharing your experience of postpartum acne with others can help you feel less alone and offer reassurance and validation. engaging in open conversations with the people around you can help navigate the postpartum journey.  

Symptoms of postpartum acne 

The symptoms of postpartum acne closely resemble those of general acne; These symptoms vary in type, severity and location and may include: 

Blackheads – Small bumps that develop on the skin that are black or yellow in colour.

Whiteheads – Look like blackheads but may be firmer and will not empty easily when squeezed.

Papules – Bumps that are often red and may feel sore or tender.

Pustules – Pus-filled pimples, which will have either a yellow or white centre and inflamed, red skin and are likely painful.

Nodules – Large, hard bumps that occur under your skin and will likely cause significant pain and discomfort. This type of acne also carries the risk of scarring if not properly treated. 

Cysts –  The most severe type of acne. They are painful pus-filled lumps under your skin. They are highly inflammatory and carry the risk of scarring if not treated properly.  

Understanding the types of acne can help you to identify and manage acne effectively. Consulting with a healthcare provider is recommended for personalised treatment options tailored to your skin concerns and needs. 

Distribution 

The area most affected by postpartum acne is the face – on the chin, jawline, and cheeks. This is due to the high number of subcutaneous glands on the face. However, postpartum acne is not restricted to this area and can also occur on the back, shoulders, neck, and chest. 

Severity 

Postpartum acne varies from person to person, with individual experiences influenced by factors such as a previous history of acne and hormonal fluctuations. 

Symptoms of inflammatory acne may include redness, swelling and tenderness in the areas affected and there may be an increase in oil production on your skin. 

In more severe cases, you may experience scarring, made worse if your symptoms are very inflammatory or you pick or squeeze your acne. 

Some women may experience mild acne which can resolve once hormone levels have settled down, whilst others may need medical intervention to manage their symptoms effectively. Consulting a healthcare professional such as a dermatologist is advised if you are struggling with the severity of your acne. 

Psychological Impact

Having acne during the postpartum period can impact your mental well-being. You may be experiencing feelings of low self-esteem, embarrassment and low self-confidence. postpartum acne is common and will likely clear up without any intervention. However, if your acne persists and is causing distress, there are medical interventions that can assist you. Seeking help from a medical professional can provide solutions to the physical and emotional symptoms of postpartum acne.  

Management 

You may be able to manage postpartum acne yourself, without the help of a medical professional. Possible ways  include: 

1. Cleansing  routines 
2. Moisturising 
3. Wearing SPF daily
4. Stress management techniques 

If you do seek medical intervention, these may include: 

• Topical retinoids 
• benzoyl peroxide
• Oral medications (antibiotics or hormonal therapies) 
• Procedures (chemical peels, laser therapy) 

A medical professional will advise you on what is safe and most likely to work for you. 

Summary

Postpartum acne is usually thought of as temporary, occurring during the period of hormonal changes occurring following pregnancy. Implementing lifestyle modifications, a well-managed skincare routine and in more severe cases, medical intervention can help you to manage the symptoms. When starting a new treatment, however, make sure you seek medical advice, especially if you’re breastfeeding.  

If your acne is severe or affecting your mood, there is help available and it is important that you share these feelings with your friends, family, or a healthcare professional to ensure you get the help that you need. 

To conclude, postpartum acne may occur in the six to eight weeks after giving birth and is caused by a change in hormone levels after pregnancy, stress or genetic factors. There are different types of acne, all varying in severity. It is important to know that you are not alone in the postpartum period and medical help will be available to you if you are struggling with the physical or mental side effects of postpartum acne.