Skin changes during pregnancy

Skin changes during pregnancy

 

Skin darkening

Particularly the nipples and a line from the pubis to the naval, the so-called linea nigra. Areas of facial pigmentation, which is called chloasma, is also common. The reason for these changes is the increase in melanocyte stimulating hormone (MSH) oestrogens and progesterone. This pigmentation will usually naturally fade post-partum. To reduce facial pigmentation, women should wear a factor 50 sunblock, a wide-brimmed hat and sit with their back to the sun.

Facial flushing

Increased oestrogen dilates facial vessels giving that healthy pregnancy glow. Some women, however, find that the flushing leaves prominent capillaries and can exacerbate the skin condition, rosacea. It may be necessary for them to see a GP to prescribe some topical treatments. Again, this should settle post-partum.

Skin itching

Most women experience some dryness and itching, particularly in the third trimester when the skin is stretched. Usually a good moisturiser is all that is needed. Sometimes, a prescription for an antihistamine or a topical steroid may be needed, depending on severity.

Striae gravidarum

Stretch marks occur in around 90% of pregnancies to some degree,1 beginning at around 24 weeks. The combination of mechanical stretching and hormones are implicated in changing the underlying collagen. At first, they appear red and prominent, then usually fade to silver atrophic lines. Topical stretch mark creams and oils can soothe the skin and reduce the redness. Less commonly, women develop skin dermatoses specific to pregnancy. It is important that these are diagnosed and managed appropriately, so it may be appropriate for the woman to see her GP who will refer her to a dermatologist.

Pruritic urticarial plaques and papules of pregnancy (PUPP)

This is a distinctive pruritic (itchy) eruption in pregnancy that usually begins in the third trimester, most often in a primigravidae. There is no risk to the fetus. Typically, the pruritus develops on the abdomen, commonly (50%) within the striae.2 The lesions are urticated and sometimes vesicular. The buttocks and thighs are often affected. The face, breast and palms are rarely involved.

Treatments include antihistamines, potent topical and rarely oral steroids, which usually relieve symptoms within 48-72 hrs.

Pemphigoid Gestationis

A rare autoimmune dermatosis that usually develops after 14 weeks, but can develop post-partum. Itching usually develops around the umbilicus and then an urticated rash (like hives) often with plaques, and sometimes tense blisters, develops. The condition is usually treated with oral prednisolone. Careful monitoring of mother and baby is vital as there is a link to premature birth and 5-10% of new-borns can have a rash for the first six weeks. A recurrence can be triggered with oestrogen medication, and rarely, menstruation.

Intrahepatic Cholestasis of pregnancy

This is usually seen in the third trimester. The mother complains of intense itching, often of the extensor surfaces, palms and soles, with no skin rash, except sometimes excoriations (scratches) are seen. Rarely, she may be jaundiced. Bloods tests show raised bile acids and sometimes a raised bilirubin and alkaline phosphatase. Careful monitoring is essential as the fetus can be affected, and sometimes early delivery is advised. Treatment is with ursodeoxycholic acid.

Pruritic folliculitis of pregnancy

This is a rare dermatosis affecting around one in 3,000 pregnancies (0.2% of all pregnancy dermatoses). A wide spread follicular eruption with papules and pustules appears on the shoulders, chest and back. It may persist until two months post-partum. Washing with a gentle antiseptic wash may help.

 

  1. The truth about pregnancy stretch marks. Available at: www.webmd.com/baby/features/stretch-marks.
  2. Bergman et al. Pruritus in pregnancy. Can Fam Physician. 2013(12): 1290-1294.

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