Common Skin Conditions During Pregnancy and Their Management

Overview

A pregnant woman's body goes through various physiologic and hormonal changes, also reflected on the skin. Some of these skin changes are common, predictable, and considered normal, while others are severe and may lead to complications during pregnancy. Symptomatic treatment is needed to manage various skin problems during pregnancy. Most changes disappear once the baby is delivered. However, specific treatments for some conditions are required.

What Are the Common Skin Conditions in Pregnancy?

Common skin conditions during pregnancy can be categorized into three types:

A. Hormone-Related Skin Conditions:

Due to a surge in hormone levels during pregnancy, many skin changes are observed, most of which are benign and reversible.

Examples include:

1. Striae Gravidarum (Stretch Marks)- Scars that develop on the skin due to stretching, weight gain during pregnancy, or shrunken skin due to extreme weight loss postpartum are known as stretch marks or striae. It is commonly seen during the third trimester of pregnancy in areas of the abdomen, breasts, thighs, and buttocks. Stretch marks have a reddish-purple appearance initially and eventually fade to silver or white over time. Numerous creams, emollients, and oils are used to hydrate the areas with stretch marks. They might fade but never disappear. The postpartum treatment of stretch marks is usually ineffective; laser and prescription creams might help in some cases.

2. Hyperpigmentation- During pregnancy, the production of melanin (a natural substance that gives color to the skin and hair) increases in the body, thus resulting in skin darkening with dark spots and patches on the skin. These spots usually fade after baby delivery but may get retained for many years.

Preventive Measures: Wearing sunscreens and covering skin to prevent exposure to sunlight (ultraviolet radiation) during the day. Hyperpigmentation can recur in successive pregnancies and with the use of oral contraceptives. The changes are more evident in women with a darker complexion.

Affected Areas: The areolae, axillae, genitals, scars, and nevi. Abdominal linea alba darkens to linea nigra during pregnancy.

3. Melasma (Also Known as Chloasma)- Melasma is a type of hyperpigmentation characterized by brown patches on the face, forehead, cheeks, or nose. Extremely common in pregnant women, also referred to as 'the mask of pregnancy.’

Prevention: Avoid exposure to the sun.

4. Hair- Hormonal changes during pregnancy cause an increase in the growth and thickness of hairs. Some women might develop hirsutism (excessive growth of dark or coarse hair in a male-like pattern) on the face, limbs, and back. Hirsutism resolves after delivery, but cosmetic removal may be considered if the condition persists.

After delivery, most women suffer hair loss which may last for several months to years after pregnancy. Complete hair regrowth usually occurs with time, but the hair may not be as abundant as before. In rare cases, male-pattern baldness and hypotrichosis are seen in women.

5. Nail- Nail growth is increased during pregnancy. Nails become brittle and soft; these changes are benign and can be managed by taking good care of nails. After delivery, nails may develop Beau's lines (indentations that run across the nails), which usually resolve without treatment.

6. Vascular Changes- Hormonal changes cause dilation, proliferation, instability, and congestion of the blood vessels. Most of these changes regress postpartum.

Various vascular changes leading to skin conditions during pregnancy are:

• Spider Telangiectasias (Spider Nevi or Spider Angiomas)- small, red veins that affect the face, neck, and arms. The redness goes away after the baby's delivery. It occurs during the first and second trimesters.

• Varicose Veins - Hormonal changes, increased weight, and pressure of the uterus can decrease blood flow from the lower body during pregnancy, causing painful, twisted, and enlarged veins- known as varicose veins. Mainly found in the legs, vulva, vagina, or rectum.

Prevention: Shorter periods of sitting and standing, uncrossed legs while sitting, elevate legs whenever possible, support hose, avoid constipation by maintaining proper fluids and exercise.

• Swelling of the face and eyelids- non-pitting edema.

• Vaginal erythema (Chadwick's sign) and a bluish discoloration of the cervix (Goodell's sign).

• Oral Manifestations: Swollen and bleeding gums or pyogenic granuloma.

• Other Vascular Changes: Palmar erythema, hemangiomas, purpura, petechiae, edema, carpal tunnel syndrome, or varicosities

B. Pre-existing Skin Conditions:

Pre-existing conditions may worsen or improve during pregnancy.

Examples include:

• Atopic Dermatitis (a condition that makes skin red and itchy) - might improve or worsen during pregnancy.

• Psoriasis (a skin disease that causes red, itchy, scaly patches) - usually improves during pregnancy.

• Soft Tissue Fibromas (Skin Tags) - common during pregnancy, typically develop on the neck, chest, back, groin, and under the breasts; usually disappears after baby delivery.

• Fungal Infections- during pregnancy, fungal infections require a longer course of treatment.

• Cutaneous Tumors- like molluscum fibrosum gravidarum and malignant melanoma.

C. Pregnancy Specific Skin Conditions:

Some skin conditions are rare but explicitly associated with pregnancy. Most of these skin conditions resolve postpartum and only require symptomatic treatment.

Examples include:

• Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)- Most common disorder during pregnancy. Characterized by small, red bumps and hives, which may transform to itchy brown patches. These bumps first appear on the abdomen and may spread to the thighs, buttocks, and breasts.

• Prurigo of Pregnancy- These are tiny, itchy bumps that resemble insect bites present throughout pregnancy. The symptoms often get worse with time. This condition may take several months to disappear, even beyond the delivery date.

• Intrahepatic Cholestasis of Pregnancy (ICP)- It is also referred to as Pruritus Gravidarum. During pregnancy, it is the most common liver condition. Symptoms usually start at the third trimester and are characterized by severe itching of the palms of the hand, soles of the feet, or the trunk of the body. There is an absence of any lesions or rashes. This condition usually resolves after childbirth. In severe cases, it may cause preterm delivery or even fetal death.

• Pemphigoid Gestationis- It is a rare autoimmune disorder of the skin that occurs during the second, third trimester of pregnancy or immediately following childbirth. Symptoms include blisters on the abdomen or over a wide area of the body in severe cases. The associated risk of preterm birth or a smaller-than-average baby.

• Impetigo Herpetiformis (also known as pustular psoriasis of pregnancy or PPP) - It is a rare form of skin condition that occurs in the second half of pregnancy. Symptoms include nausea, vomiting, diarrhea, fever, chills, and lymphadenopathy. Medical complications include secondary infections, septicemia, hyperparathyroidism with hypocalcemia, hypoalbuminemia. Systemic corticosteroids and antibiotics are used as treatment.

• Pruritic Folliculitis of Pregnancy-It is characterized by follicular papules and pustules spread throughout the body, typically during pregnancy's second and third trimester. Treatments include topical Corticosteroids, topical Benzoyl peroxide, and ultraviolet B light therapy.

What Is the Treatment of Skin Conditions During Pregnancy?

During pregnancy, the skin conditions are transient and go away by themselves once the baby is born. Due to pre-existing conditions, if a pregnant woman is already taking some medications (steroids), then they must discontinue those medications and re-consult the doctor. If the conditions have severe symptoms, treatment is needed, pregnant women must consult a doctor before taking any medication.

Most of the treatments will provide only symptomatic relief, some of which are mentioned as follows:

• Stretch Marks- Laser or prescription creams.

• Melasma- Prescription creams (Hydroquinone), sunscreen lotions, and some over-the-counter skin care products. Limiting exposure to sunlight.

• Skin Tags- Doctors can remove them off with a scalpel or electrosurgery (burning with an electric current).

• PUPPP- Use topical corticosteroids, wash with lukewarm water, cold compresses or wet clothes to the affected areas, loose and lightweight clothing. Avoid using soap on affected areas.

• Prurigo of Pregnancy- Use of moisturizers and topical steroids.

• Intrahepatic Cholestasis- Medications to stop the itch. Cold baths can also help.

• Pemphigoid Gestationis- Topical or oral corticosteroids.

• Pustular Psoriasis of Pregnancy (PPP)- It is a life-threatening condition. In mild cases, the use of low doses of corticosteroids is done.

• Pruritic Folliculitis- Application of Benzoyl peroxide, moisturizer with menthol, steroid cream or ointment application, and oral antihistamines provide symptomatic relief.

Some natural ways to relieve symptoms during pregnancy-

• Use of scent-free skin products.

• Loose cotton clothing.

• Cold bath.

• Rubbing ice on the skin.

• Oatmeal bath once or twice a week.

• Avoid exposure to sunlight.

Conclusion

Pregnant women undergo so many hormonal, physical, and emotional changes every day. The skin conditions during pregnancy is an addition. As most of these skin conditions are benign and reversible, thus pregnant women must not stress about these conditions. In severe unbearable cases, a doctor should be consulted, and the patient should take only prescribed medication to avoid any mishappening during pregnancy or damage to the fetus.