This woman should be treated with azelaic acid cream. Women of childbearing age need special consideration, as treatment of some of the most common diseases, including acne, involves the use of teratogenic medications. The FDA pregnancy safety category of all medications should be considered when prescribing to women who are pregnant, breastfeeding, or trying to conceive. Several commonly used systemic and some topical dermatologic drugs are contraindicated for use in pregnancy. Azelaic acid cream is rated pregnancy category B and is the safest of the listed acne therapies. Acne is a chronic inflammatory skin condition characterized by open and closed comedones (blackheads and whiteheads, respectively) and inflammatory lesions, including papules, pustules, or nodules. Androgens stimulate increased sebum production, so pregnancy-associated hyperactivity of the hypothalamic–pituitary–gonadal axis can trigger acne exacerbations. This patient has mild comedonal and inflammatory acne, and topical treatment is preferred; however, it is important to consider the safety of topical acne treatments during pregnancy. Topical erythromycin can also be used to manage acne, since it is a pregnancy category B medication.

Doxycycline is rated pregnancy category D and can cause defects in the formation of teeth and bone in the fetus. Both tazarotene and tretinoin are topical retinoids and have been rated as pregnancy category X and D, respectively. They should not be used during pregnancy.