Skin Conditions During Pregnancy

Many women notice changes to their skin, nails, and hair during pregnancy. Some of the most common changes include the following:

• Dark spots on the breasts, nipples, or inner thighs

• Melasma—brown patches on the face around the cheeks, nose, and forehead

• Linea nigra—a dark line that runs from the navel to the pubic hair

• Stretch marks

• Acne

• Spider veins

• Varicose veins

• Changes in nail and hair growth

Some are due to changes in hormone levels that happen during pregnancy. But for most skin changes health care professionals are not sure of the exact cause.

Dark spots and patches are caused by an increase in the body's melanin—a natural substance that gives color to the skin and hair. The patches are called melasma or "the mask of pregnancy."

To help prevent melasma from getting worse, wear sunscreen and a wide-brimmed hat every day when you are outside. The sun's UV rays can reach you even on cloudy days.

Dark spots and melasma usually fade on their own after you give birth. But some women may have dark patches that last for years. If melasma does not go away, you can talk with a dermatologist about treatment options. Dermatologists are specialists in skin conditions.

As your belly grows during pregnancy, your skin may become marked with reddish lines called stretch marks. These marks occur when the skin stretches quickly as the fetus grows. By the third trimester, many pregnant women have stretch marks on the abdomen, buttocks, breasts, or thighs. Sometimes the marks are faint. Sometimes they can be quite dark.

There are many products on the market that claim to prevent stretch marks. There is no proof that any of these treatments work. Using a heavy moisturizer may help keep your skin soft, but it will not help get rid of stretch marks. Most stretch marks fade after the baby is born, but they may never disappear completely.

Many women have acne during pregnancy. Some already have acne and notice that it gets worse during pregnancy. Other women who may always have had clear skin may develop acne while they are pregnant.

If you get acne during pregnancy, take these steps to treat your skin:

• Wash your face twice a day with a mild cleanser and lukewarm water.

• If you have oily hair, shampoo every day and try to keep your hair off your face.

• Avoid picking or squeezing acne sores to lessen possible scarring.

• Choose oil-free cosmetics.

Over-the-counter (OTC) products containing the following ingredients can be used during pregnancy:

• Topical benzoyl peroxide

• Azelaic acid

• Topical salicylic acid

• Glycolic acid

If you want to use an OTC product that contains an ingredient not on this list, contact your obstetrician–gynecologist (ob-gyn).

Some prescription acne medications should not be used while you are pregnant:

• Hormonal therapy—Several medications that block specific hormones can be used to treat acne. Their use during pregnancy is not recommended due to the risk of birth defects.

• Isotretinoin—This drug is a form of vitamin A. It may cause severe birth defects in fetuses, including intellectual disabilities, life-threatening heart and brain defects, and other physical deformities.

• Oral tetracyclines—This antibiotic can cause discoloration of the fetus’s teeth if it is taken after the fourth month of pregnancy and can affect the growth of the fetus's bones as long as the medication is taken.

• Topical retinoids—These medications are a form of vitamin A and are in the same drug family as isotretinoin. Unlike isotretinoin, topical retinoids are applied to the skin, and the amount of medication absorbed by the body is low. But it is generally recommended that use of these medications be avoided during pregnancy. Some retinoids are available by prescription. Other retinoids can be found in some OTC products. Read labels carefully.

If you are concerned about which products to use to treat your acne, talk with your dermatologist and ob-gyn. Together you can decide which option is best for you.

Hormonal changes and the higher amounts of blood in your body during pregnancy can cause tiny red veins, known as spider veins, to appear on your face, neck, and arms.

Spider veins are most common during the first half of pregnancy. The redness should fade after the baby is born.

The weight and pressure of your uterus can decrease blood flow from your lower body and cause the veins in your legs to become swollen, sore, and blue. These are called varicose veins. Varicose veins can also appear on your vulva and in your vagina and rectum (usually called hemorrhoids). You are more likely to have varicose veins if someone else in your family has had them.

In most cases, varicose veins are a cosmetic problem that will go away after delivery.

You cannot prevent them, but there are some things you can do to ease the swelling and soreness and prevent varicose veins from getting worse:

• Be sure to move around from time to time if you must sit or stand for long periods.

• Do not sit with your legs crossed for long periods.

• Prop your legs up on a couch, chair, or footstool as often as you can.

• Exercise regularly—walk, swim, or ride an exercise bike.

• Wear support hose.

• Avoid constipation by eating foods high in fiber and drinking plenty of liquids.

If a tender, red spot appears on your leg, it should be checked by your health care professional.

The hormone changes in pregnancy may cause the hair on your head and body to grow or become thicker. Sometimes women grow hair in areas where they do not normally have hair, such as the face, chest, abdomen, and arms.

Your hair should return to normal within 6 months after giving birth. In the meantime, it is safe to use tweezing, waxing, and shaving to remove unwanted hair during pregnancy.

About 3 months after childbirth, most women begin to notice hair loss from the scalp. This happens because hormones are returning to normal levels, which allows the hair to return to its normal cycle of growing and falling out. In most cases, your hair should grow back completely within 3 to 6 months.

Some women find that their nails grow faster during pregnancy. Others notice that their nails split and break more easily. Like the changes to your hair, changes that affect your nails will ease after birth.

Some uncommon health conditions can arise during pregnancy and cause skin changes. These include the following:

• Pruritic urticarial papules and plaques of pregnancy (PUPPP)

• Prurigo of pregnancy

• Pemphigoid gestationis

• Intrahepatic cholestasis of pregnancy (ICP)

In PUPPP, small, red bumps and hives appear on the skin later in pregnancy. The bumps can form large patches that can be very itchy. These bumps usually first appear on the abdomen and can spread to the thighs, buttocks, and breasts.

It is not clear what causes PUPPP. It usually goes away after you give birth. In the meantime, your health care professional may prescribe anti-itch medication to help with the itching.

With prurigo of pregnancy, tiny, itchy bumps that look like insect bites can appear almost anywhere on the skin. This condition can happen anytime during pregnancy. It usually starts with a few bumps that increase in number each day. It is thought to be caused by changes in the immune system that occur during pregnancy.

Prurigo can last for several months and may even continue for some time after the baby is born. It is usually treated with anti-itch medication applied to the skin and other medications, such as antihistamines and corticosteroids.

Pemphigoid gestationis is a rare skin condition that usually starts during the second and third trimesters of pregnancy or sometimes right after childbirth. With this condition, blisters appear on the abdomen, and in severe cases, the blisters can cover a wide area of the body. It is thought to be an autoimmune disorder. Sometimes the condition returns during future pregnancies.

There is a slightly increased risk of pregnancy problems with this condition, including preterm birth and a smaller-than-average baby. There is also a small chance that your baby will have similar blisters at the time of birth. These blisters are usually mild and go away within a few weeks.

If your health care professional diagnoses pemphigoid gestationis after checking your blisters, you and your fetus should be monitored closely during the last part of pregnancy. Your health care professional may also give you medications to control the outbreak of blisters and help relieve your discomfort.

ICP is the most common liver condition that happens during pregnancy. Bile is a substance that is made in the liver. Bile travels from the liver to the small intestine, where it is used to break down fats in food. In ICP, this flow of bile is blocked and the components of bile are deposited in the skin.

The main symptom of ICP is severe itching in the absence of a rash. Itching commonly occurs on the palms of the hands and soles of the feet, but it can also spread to the trunk of the body. It is typically worse at night.

Symptoms usually start during the third trimester of pregnancy and often go away a few days after childbirth. But ICP can happen again in future pregnancies.

If your health care professional diagnoses ICP after doing blood tests, you and your fetus should be monitored closely during the third trimester. Close monitoring is needed because ICP may increase the risk of preterm birth and other problems, including, in rare cases, stillbirth. In some cases, your ob-gyn may recommend an early delivery to help reduce the risk of stillbirth. You may also be given medication to help control severe itching.

Women who already have certain skin diseases, such as atopic dermatitis and psoriasis, may see their conditions worsen or improve while they are pregnant. The changes are different for every woman and every pregnancy.

If you have any type of skin disease, let your ob-gyn know of any changes in signs or symptoms during your pregnancy. You should also review any medications that you take to treat your condition with your ob-gyn to make sure they are safe to use during pregnancy.

For conditions that cause itchy skin, using an over-the-counter anti-itch cream may help provide relief. You also can try the following tips:

• Wash with mild, fragrance-free soaps.

• Add uncooked oatmeal or baking soda to your bath.

• Place a cool, wet cloth on the area to ease the burn.

• Use a heavy moisturizer on your skin twice a day.

Antibiotic: A drug that treats certain types of infections.

Autoimmune Disorder: A condition in which the body attacks its own tissues.

Bile: A substance made by the liver that helps digest fats.

Hormone: A substance made in the body that controls the function of cells or organs.

Immune System: The body’s natural defense system against viruses and bacteria that cause disease.

Linea Nigra: A line running from the belly button to pubic hair that darkens during pregnancy.

Melasma: A common skin problem that causes brown to gray-brown patches on the face. Also known as the “mask of pregnancy.”

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women's health.

Preterm: Less than 37 weeks of pregnancy.

Rectum: The last part of the digestive tract.

Stillbirth: Birth of a dead fetus.

Trimester: A 3-month time in pregnancy. It can be first, second, or third.

Uterus: A muscular organ in the female pelvis. During pregnancy this organ holds and nourishes the fetus.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Vulva: The external female genital area.