Motherhood is something most women look forward to. Having a child of your own is an innate sense of belonging for you as a mother. However pregnancy gives rise to immense number of changes in the body. Most of it is related to the hormonal changes the mother goes through when she is pregnant.
Pregnancy is a physiological state that is associated with specific skin changes and modification of existing skin rashes. Various hormonal, immunological and haemodynamic factors that are specific to pregnancy influence the status of the skin.
The skin changes in pregnancy constitute a group of skin conditions that occur due to interaction of multiple process in the body during pregnancy. Skin problems in pregnancy may be physiological, some skin diseases are aggravated or improved during pregnancy and some skin lesions are specific to pregnancy.
The physiological(hormonal) skin problems due to pregnancy
Physiological changes are not considered as abnormal skin changes, they are just benign skin changes which cause cosmetic distress to the patient. Hormonal, metabolic and immunological factors contribute to physiological alterations in pigmentation, vessels, moles, hair and nails.
The common physiological skin problems we come across are-
Hyperpigmentation (dark skin)
Hyperpigmentation or dark skin is one of the common and early signs of skin changes in pregnancy. Changes in the hormonal profile during the pregnancy is the primary cause of pigmentary changes. Pigmentation is more evident in the areas of genitalia, perineum, areolae, axilla and inner thighs. There will be hyperpigmented lines in the centre of abdomen longitudinally as well.
Chloasma often termed as mask of pregnancy is nothing but presence of brownish pigmentation of the face, it is seen in 45-75% of pregnant women making it quite common. Freckles, birth marks and scars tend to darken and enlarge. pigmentation gradually fades after delivery but in some women the resolution of the colour is incomplete. Sun protection and reassurance is all that is needed. However topical creams are avoided in pregnancy and can be used after delivery.
Stretch marks (striae)
Many a times, the gross distension of abdomen are responsible for red-blue depressed streaks and later evolve into linear depressions seen on abdomen and breasts called stria distensa (stretch marks). Risk factors include familial predisposition, history of striae, excess weight gain during pregnancy.
Preventive management of these stretch marks using creams containing vitamin E, cocoa butter, aloe vera lotion and olive oil is controversial and not effective however post delivery treatment options include laser and topical tretinoin.
Other changes –
We see many physiological vascular changes like swelling of face, hands and feet, redness of hands, varicosities of legs. However, most of these changes revert back to normal post delivery.
Changes in the hair –
Around 3-12% of pregnant women are seen having changes in their hair. Hormonal changes during the pregnancy have the potential to increase or decrease the hair growth. However in most cases, hair fall is seen post delivery. You must be thinking when will your hair grow back right?
Well, usually post your pregnancy, it takes from 3-12 months. There might be excessive hair growth of body hair and hirsutism due to hormonal imbalance in pregnancy.
Changes in the nails –
Nail growth increases during pregnancy. Brittleness of nails may be seen often. Reassurance is all that is needed for these benign physiological problems.
Diseases modified by pregnancy
Many preexisting dermatoses may be exacerbated or ameliorated by pregnancy. Knowledge of these conditions is important to forewarn the patient and to prepare for the upcoming complications, if any. For many mothers, immunity is suppressed during normal pregnancy and this makes them prone to infections.
Candidiasis is quite common and is found to be the most common cause of white discharge in the vagina. Other infections which are harmful for the baby during childbirth are herpes, chicken pox and genital warts. It is very important that pregnant women with preexisting skin problems consult the dermatologist and know about the progression of their skin problems. If the skin diseases are exacerbated in pregnancy the treatment options depend on severity and occurrence of the lesions.
Pregnancy specific dermatoses
These are heterogenous group of inflammatory skin diseases specific for pregnancy. Most of these conditions resolve spontaneously post delivery but few are associated with fetal complications. Pregnancy specific dermatoses we come across are pemphigoid gestationis, atopic eruption of pregnancy, polymorphic eruption of pregnancy and intrahepatic cholestasis of pregnancy. Almost all of them present with pruritis and a skin eruption of varying severity.
There are many kinds of rashes which appear as a pregnancy skin problem and have an adverse affect on your baby.
Most skin rashes which might affect the fetus are very rare. Maybe a 1 in 300 and can go upto 1 in 50,000 births. However, it is essential and important for you to visit your dermatologist immediately in case you notice any symptoms.
It is best to consult dermatologist if you have severe itching and skin rashes to avoid fetal complications.
Acne in Pregnancy
Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit and is characterized by blackheads, papules, pustules and nodules that can cause scarring and psychological distress.
For women who are planning to have a child or who are pregnant, this condition can be particularly bothersome given the physiological changes that comes with it. Along with this, the unpredictable nature of acne during this time is often bothersome. Acne often improves during the first 3 months of pregnancy but may worsen during the third trimester due to hormonal imbalance resulting in increased sebum production. Patients with a history of acne are more prone to developing acne during pregnancy.
Management of acne in pregnant patients can be challenging because many widely used and effective therapeutic options are contraindicated or not recommended. Depending on the severity of acne the dermatologist will prescribe safe treatment modalities.
Are skin problems an early sign of pregnancy?
Skin changes are seen in more than 90 percent of pregnant women . We frequently hear about pregnancy glow, mask of pregnancy, stria, pimples break out from women who are pregnant. These all are the changes occurring due to hormonal imbalance. Skin changes are definitely seen in most pregnant women but probably not a early sign of pregnancy.
Itching in pregnancy is fairly common and can be due to various reasons like dermatoses of pregnancy, physiological conditions or even associated with the liver, kidney or thyroid. Itching is more common on abdomen, particularly in the last trimester. The cause of itching should be identified and then treated accordingly.
Pregnancy and skin problems – A cause for depression?
You might have heard of depression during pregnancy.
There are certain situations, maybe your health or even your baby’s health along with the cocktail of hormones working in your body which can contribute to the phase of depression during pregnancy.
All mothers would love and wish for a perfect pregnancy, even you would. Who wouldn’t? Free of all these complications and other hormonal changes which affects your external body.
Itching can be sufficiently severe and may affect your sleep cycle and quality of life. This might lead to or worsen depression, if already present. In some even the physiological skin changes especially pigmentation during pregnancy can affect the quality life. Reassurance, proper evaluation and symptomatic treatment is required.
Can skin problems in pregnancy risk fetal life?
Pregnancy specific dermatoses has been linked to stillbirth, premature birth, meconium passage, fetal distress, delivery by caesarean section and postpartum haemorrhage. Pregnant women with infective conditions like genital warts, chicken pox or herpes infections should consult the dermatologist for further evaluation and management to avoid infections in
How to fight skin problems during pregnancy and When do skin problems during pregnancy clear up?
Firstly, do not fight alone. Visit us at Ambrosia Clinics and we will fight for you and with you.
Secondly reassurance and counseling of the patient needs to be done. Pregnant women are cautioned against using any over the counter medications for pigmentation and other changes.
A previous history of skin problems should always be elicited and any therapy of a pre-existing skin condition should be modified after consulting the dermatologist. Most skin conditions resolve postpartum and only require symptomatic treatment. Liberal application of topical emollients and antihistamines should be advised in pregnancy associated pruritus.
However, there are specific treatments for some conditions. Proper evaluation and monitoring is recommended for patients with specific skin problems of pregnancy.
When to consult a dermatologist?
- The most common skin problems during pregnancy observed in India are pruritus and pigmentary changes
- Diagnosis of most of the skin problems during pregnancy can be made by careful understanding the history and local examination of the skin.
- If you have any pre-existing dermatosis, even topical medications, should be stopped after consulting with dermatologist.
- If itching or skin rashes are severe you can immediately consult a dermatologist for further evaluation and management.
It is not easy dealing with pregnancy, when it comes to motherhood. It is a task which you need to be ready for, take adequate precautions and make adequate preparations for as well. However, dealing with pregnancy skin problems is something we at Ambrosia Clinics excel at so if you are soon to be a mother and in fear of skin problems, book an appointment with us and we will make sure nothing comes in between you and your baby.
About the Doctor:
Dr. Sindhuri Reddy
Dr. Sindhuri Reddy specializes in clinical and cosmetic dermatology and dermatosurgery. Her continuous thrive to be updated in recent advances of skincare gives her a unique insight and approach to skincare. She has an MBBS and MD from NTR University of Health sciences and has done observership at Mayo clinic , USA . She has several academic publications to her credit. Her areas of special interest are acne scars, hair transplantations and lasers.