Mums-to-be are sometimes affected by sudden skin changes during pregnancy. From itching to acne, these can start as early as the first trimester. In this issue, Dr Mark Tang, Consultant Dermatologist, The Skin Specialists and Laser Clinic, takes a look at common skin problems among pregnant women.
During pregnancy, your skin may begin to change right before your very eyes. As your body changes and ramps up the production of hormones including estrogen and progesterone, your skin can develop a sudden new glow on your face or you will notice pinkish, reddish streaks on your stomach. Your hormone changes is closely linked to your skin. You may wake up to a few blemishes, darker patches on your skin or even a dark line down your tummy. Many skin changes in pregnancy are “normal” and “expected” though these may affect different women in varying degrees.
Your body secrets more progesterone and estrogen to maintain the physical changes of pregnancy and support your baby’s development. For example, estrogen stimulates the melanocytes, causing darker patches on your skin as they secrete more pigment. Progesterone tightens the pores, making it easier for sebum to become trapped and cause acne.
During pregnancy, a woman’s blood volume will increase by 50%, which means that there is more blood circulating to the body’s tissues, including the face. This causes the “pregnancy glow”. Also, pregnancy hormones cause the sebaceous glands to produce more sebum, which can make the skin appear oily or shiny. Good skin care can keep the extra oil from becoming a problem.
Mask of Pregnancy
On the face, it’s common to have a diffuse, brown pigmentation over the cheeks and nose called melasma or the “mask of pregnancy”. Melasma causes dark splotchy spots to appear on your face, on the forehead and cheeks and are a result of increased pigmentation due to pregnancy. While most of these skin darkening conditions will lighten after delivery, melasma on the face may persist in up to 20% of women.
To prevent “mask of pregnancy”, wear a scarf or wide brimmed hat to protect your face from the sun. At this time, your skin is extra sensitive, and the sun increases your chances of these dark spots showing up on your face. Improve this condition by avoiding the sun, using sun block. A good tip would be to use a good sunscreen that is at least SPF 30 whenever you plan on being outside.
Sometimes, your face is more sensitive than before, or may react differently to a particular brand of cosmetics even though you have been using it for some time. Your usual choices of cosmetics can make your skin feel itchy or dry. These symptoms vary in individuals. In fact, a woman might have skin problems all throughout her first pregnancy and then none at all during her second.
Another common skin change is hyper pigmentation or darkening of the skin. As pregnancy progresses, there is gradual darkening of the nipples, genitalia, armpits, inner thighs and stretch marks. Most women will also develop a brown line that appears on the lower abdomen between the naval and the pubic bone known as linea nigra, which translated from Latin means ‘black line’. This is more common in women with darker skin tones. The line is always there, but it is usually not noticeable because it is light. Hormone changes associated with pregnancy cause the line to darken in some women, typically around the fourth or fifth month. This line will fade on its own after the baby is born.
Another common condition is the appearance of stretch marks over the abdomen. This is related to the sudden distension of the abdomen in late pregnancy, which results in disruption of collagen fibres in the dermis of the skin. Initially reddish purple in colour, these stretch marks gradually fade with time, leaving whitish or atrophic lines.
The most important piece of advice is to keep the tummy skin well moisturised and supple throughout pregnancy. This will reduce the onset and severity of the stretch marks. After delivery, laser treatment may help in severe cases.
Itchy Red Rashes
Sometimes, women develop pregnancy related skin diseases, usually manifesting as itchy red rashes, hives and eczema. A common condition is known as pruritic urticarial papules and plaques of pregnancy (PUPPP) which starts around the tummy and can look like a very severe skin allergy with intense itch. PUPPP is itchy, reddish, raised patches on the skin that will go away after delivery.
Other common skin changes include increased flushing and sweating of the skin, swelling or edema of the legs and hands, and enlarging skin tags or growths over the neck, armpits and chest. Varicose veins of the legs are also common in late trimester and can be prevented by leg elevation, compression stockings, simple exercises and rest.
An important point to remember is that one should seek medical attention immediately if there are blisters, vesicles or pus-filled boils on the skin, as this can sometimes indicate a serious rash or infection in pregnancy.