Is this Supposed to be Happening?
A message from Dr. Diane Chiu:
As a recent new mother, I experienced first-hand the numerous skin changes that occur during pregnancy. Even though my dermatology training prepared me for what to expect, I was still surprised by the rapid nature of these changes! Prenatal OB-GYN visits focus on the health of the mother and her growing baby, as they should, leaving little time to discuss the mother’s relatively benign skin changes. It is for this reason that I decided to include information to help educate new and expectant mothers about the normal skin changes of pregnancy, and also to provide information about available treatments.
Skin Changes and Pregnancy
Congratulations! Now that you’re pregnant, you may begin to notice a variety of changes in your skin. Some are positive, like glowing skin, thicker hair, and stronger nails. Other changes are not as welcome, like stretch marks and broken blood vessels. Unfortunately, the positive effects of pregnancy may disappear after delivery, and some of the negative ones may be long-lasting. The good news is, there are many treatment options available to mothers today.
This is a beautiful time in your life, and your face often shows it. Increased blood flow and hormonal changes cause your glands to release more oil. This process creates what we recognize as the “glow” of pregnancy.
Because of the hormonal changes and increased oil production, acne may appear or worsen during pregnancy. Many acne medications are not safe for you now. Talk to your health care provider before attempting to treat acne. Fortunately, acne tends to improve in the second or third trimester even without treatment.
Hair and Nails
Most women’s nails will grow more quickly and their hair will thicken during pregnancy. Unfortunately, it is also normal for this extra hair to shed a few months after delivery in a condition called telogen effluvium. The shedding can last for several months, and may leave you thinner than before pregnancy. If you plan to breastfeed, continue to take your prenatal vitamins and maintain healthy iron levels, as this will lessen the hair loss.
Skin growths tend to increase during pregnancy. Skin tags are small fleshy bumps that protrude from the skin in areas where friction occurs (around the neck, armpits, breasts, and groin). Aging spots, also known as seborrheic keratoses, are crusty, barnacle-like lesions that can occur anywhere on the body. Although they are completely harmless, these growths do not resolve on their own, and may be removed for cosmetic reasons. New moles may also develop during pregnancy. If there are any that concern you, particularly ones that are rapidly growing, darkly colored, irregularly shaped, or bleeding, contact your health care provider immediately.
Melasma is a patchy, brown discoloration of the face (especially on the forehead, upper cheeks, and upper lip) also known as the “mask of pregnancy.” For women experiencing melasma, diligent use of SPF 30 (or higher) sunscreen is recommended, since the condition tends to darken with sun exposure. Melasma usually fades after delivery, but if it persists, options for treatment include bleaching creams, chemical peels, and laser therapy.
Hormonal changes may cause areas of the body that are relatively dark (nipples, labia, and inner thighs) to become darker. They may lighten somewhat after delivery, but often will remain darker than before pregnancy.
During your second trimester, you may also develop a dark line that runs from the navel to the top of the pubic area. This is called linea nigra and should fade after delivery.
Moles and freckles may also become darker with pregnancy. If you notice a mole or freckle that changes significantly in shape, color, or size, contact your health care provider right away.
Dilated Blood Vessels
The increased blood flow during pregnancy may cause dilated blood vessels, or “spider veins,” to appear on the face, body, or legs. Small bright red or purplish bumps called cherry angiomas are also common. Both of these conditions tend to disappear after pregnancy, but if they persist, possible treatments include laser therapy or sclerotherapy.
Some women develop bulging, bluish leg veins called varicose veins. Varicose veins, which are frequently hereditary, appear or worsen as a result of increased blood flow during pregnancy. They can cause aching, burning, and swelling of the legs. You can minimize your risk of developing varicose veins and relieve uncomfortable symptoms by wearing support stockings, not standing for long periods of time, and propping your feet up while at rest. If varicose veins persist after pregnancy, ask your health care provider about treatment options.
Stretch marks often appear during pregnancy, especially towards the end when rapid weight gain is common. They start off as slightly depressed streaks that are pinkish, reddish, or purplish in color, and have a different texture than normal skin. With time, these streaks tend to fade to a silvery white color.
There is no guaranteed way to prevent stretch marks. Moisturizing creams and vitamin C are said to help, although there is no clinical data to support this. When started soon after delivery, laser treatments have been shown to be effective in lessening the appearance of stretch marks. Retin-A may also be beneficial, but is not recommended during pregnancy or breast feeding.
Itchy Skin and Rashes
Hormonal changes and stretching of the skin may cause dryness and itching, especially during the second and third trimesters. Avoid bathing with very hot water, and use gentle cleansers such as Dove soap or Cetaphil. It’s especially important to apply an unscented moisturizer immediately after bathing, and as needed throughout the day, to keep your skin well hydrated.
Pruritic urticarial papules and plaques of pregnancy, or PUPPP, are itchy red hive-like bumps that usually occur during the third trimester of first-time pregnancies. PUPPP may be uncomfortable, but it is not dangerous, and disappears after delivery. Severe itching late in pregnancy could also be a sign of a liver problem called cholestasis. Cholestasis, which may be harmful to the fetus, is associated with nausea, vomiting, fatigue, loss of appetite, or jaundice. If you experience a severe itch that is not relieved by moisturizing and/or over the counter anti-itch creams, contact your health care provider immediately.
Saggy Skin and Tummy Pooch
After delivery, your abdominal skin tone and texture may be noticeably changed. The belly can develop a little “pooch,” and the skin can experience a loss of elasticity, causing it to appear wrinkly or saggy. In general, the abdominal area may feel more “doughy” than before. Exercise may help, but not completely. Depending on the severity, treatment options include non-invasive laser therapy, and more aggressive treatments including liposuction and tummy tuck.