Pregnancy is an exciting and transformative time, involving an array of physical changes. In addition to the growing abdomen housing the developing fetus, one of the more visible physical manifestations of pregnancy are skin changes. Many think of pregnancy as generating that “special glow,” which does occur for some women, due to the increased blood flow and hormonal changes that are characteristic of pregnancy. However, there are numerous other, and sometimes less welcome, effects pregnancy can have on skin. Understanding these skin changes and how to manage them can help women maintain healthy skin throughout pregnancy.
One of the most common skin changes in pregnancy is new or worsening acne. This is likely due to hormone shifts and increased androgen levels in pregnancy, particularly in the first trimester. Some simple lifestyle measures to manage acne include using a gentle cleanser once or twice daily, washing hair frequently to avoid excessive exposure to natural oils, and using oil-free cosmetics. Over-the-counter acne treatments that can be used include products that are applied topically containing small amounts of azelaic acid, glycolic acid, salicylic acid or benzoyl peroxide. Gentle exfoliation with alpha hydroxy acids can be used as well. Certain acne treatments, both over-the-counter and prescription, should be avoided in pregnancy as they can be absorbed systemically and may be harmful to the developing fetus.
Skin treatments that should not be used in pregnancy include hormone therapy, isotretinoin (vitamin A), oral tetracyclines (a type of antibiotic), topical retinol, and hydroquinone. It is actually recommended to stop use of products containing retinol a few months before pregnancy, if possible. Overall, skin can be more sensitive in pregnancy and therefore sticking to gentle skin care products while avoiding products with harsh chemicals is ideal for skin health.
Another skin change women may experience in pregnancy is melasma, also known as “the mask of pregnancy.” Women may notice a change in pigmentation or dark patches on their skin, which is due to increased amounts of melanin in the body. Melanin is a natural substance that is responsible for the color in skin and hair. In order to prevent or lessen melasma, pregnant women should avoid excessive exposure to direct sunlight and be sure to use sunscreen with SPF 30 or higher as regularly as possible. It is important to remember that the sun’s UV rays can be strong and penetrate the skin even on cloudy days!
The linea nigra is a dark vertical line that extends over the lower abdomen during pregnancy, and is also due to increased melanin levels. The linea cannot be prevented but in most cases will disappear or fade within a few months post-childbirth.
One dreaded effect pregnancy can have on skin is the development of red, darkened lines known as “striae gravidarum” or stretch marks. This occurs due to the rapid stretching of skin as the body is making space for the growing baby. There is no known treatment that has been proven to prevent or resolve stretch marks, but use of massage oils or moisturizing products containing shea butter, coconut oil and vitamin E may help reduce the appearance of these lines. Keeping the skin well moisturized by maintaining adequate oral hydration and applying the above-mentioned products frequently will help support the skin as it stretches to accommodate the pregnancy. And beginning this skin regimen as early in pregnancy as possible is key!
Certain vascular phenomena that women are prone to in pregnancy can also manifest on the skin, such as “spider veins” or varicose veins. Spider veins are a collection of tiny superficial blood vessels that appear red or purple on the skin surface and are due to increased circulating blood volume in pregnancy. These are usually flat and not painful. Varicose veins are larger bulging veins that often occur on the lower half of the body. These are thought to be secondary to the weight and pressure of the uterus, leading to slower blood flow from the lower extremities. They may also be related to increased laxity of veins in pregnancy, due to hormone changes.
Varicose veins can be sore and tender. Some women may have a genetic predisposition to the development of varicose veins. Though they cannot be prevented entirely, certain measures can stop them from worsening. Wearing compression stockings, avoiding standing or sitting for extended periods of time, engaging in a regular exercise routine, and keeping legs elevated when sitting or lying down, are all important ways to prevent aggravation of varicose veins.
While many of the skin changes during pregnancy are common and physiological, there are certain skin conditions that can be pathological and warrant medical attention. A detailed review of these conditions is beyond the scope of this article, however it is important to acknowledge that certain skin symptoms should lead to further evaluation. For example, severe itching, generalized over the whole body or specific to palms of the hands and soles of the feet, could be reflective of a liver condition called intrahepatic cholestasis of pregnancy. Development of a new rash, skin irritation, swelling, blisters or painful skin lesions may be manifestations of other skin conditions in pregnancy, including PUPPP, prurigo, pemphigoid gestationis, or certain viruses. These symptoms should be assessed in a medical setting.
Pregnancy is a time of significant change in a woman’s body, and the skin is no exception. By understanding the common skin changes that occur and following a skincare routine tailored to each individual’s needs, skin health and its “glow” can be maintained throughout pregnancy.
Pregnant women should always consult with their OB or dermatologist with regard to which products are safe for use in pregnancy, or if any concerning symptoms arise. With the right care, the pregnant woman can embrace the beauty of her pregnancy and feel confident in her skin.
Dr. Leora Joel is a board-certified OB/GYN who has been in practice since 2017. She is a strong believer in supporting women’s birth choices to achieve the birth they desire. She is a physician at Maternal Resources, a thriving boutique style practice, with offices in Hackensack, Jersey City, Hoboken, Howell and NYC.
