Beyond the maternal glow. Common pregnancy-related skin problems

By Dr. Shafeeqah Fakir
MBChB (UCT) FC Derm (SA),Dermatologist and currently practices at Melomed Tokai

Skin-related conditions in pregnancy can be classified as either physiological (hormone related); pre-existing (present before pregnancy), or those conditions that are specific to pregnancy. Fortunately, most of these ailments resolve postpartum and only a small percentage require medical treatment. Here is a list of the most common pregnancy-related skin concerns.

Physiological

Stretch Marks Stretch marks develop in up to 90% of pregnant women by the third trimester. Pregnancy causes your skin to stretch faster and more than usual, particularly in the abdomen, breasts and thighs. Hormonal factors affect the skin’s elastic fibres and together with rapid stretching, induces thinning of the skin. Initially, they may appear as reddish or purple lines or bands. After pregnancy, they gradually fade and become silvery white. Very little evidence supports the use of stretch-mark cosmetics. Instead, avoiding rapid weight gain, and basic skin care such as moisturising, may minimize their appearance.

Melasma
Areas of your skin appearing darker is often one of the first signs that you’re pregnant. Up to 90% of expecting moms find that their nipples and surrounding skin darken. Other pigmented areas such as moles and freckles may darken too. Not to worry though, as these changes often lighten with time. Brown or grey patches of pigmentation on the forehead, cheeks and neck are known as chloasma or melasma. Caused by normal pregnancy-related hormonal changes, the condition is exacerbated by sun exposure. Wearing a broad-spectrum sunscreen with a sun-protection factor of at least 30, wearing sun-protective clothing, and limiting exposure to sunlight, are paramount. Although melasma often fades within three months of the baby’s birth, one in ten women find that the patches persist. The use of a tinted foundation may be useful in camouflaging the patches and medical therapy can be prescribed postpartum.

Linea Nigra
The linea nigra is a vertical, hyperpigmented (darkened) line that appears down the middle of the abdomen. The brownish streak is usually 1cm in width, crosses the navel and is induced by normal hormonal changes. Usually, the pigmentation appears around the fifth month of pregnancy and disappears several months after delivery.

Skin Tags
Skin tags are common, soft, flesh-coloured growths that primarily affect the eyelids, neck, armpits and under the breasts. These growths are benign (not cancerous) and will not affect the fetus. Persistent skin tags can be removed via a simple procedure by your doctor postpartum.

Spider Veins
Changes in oestrogen production, normal to pregnancy, can cause dilation, proliferation, and congestion of blood vessels. These vascular changes primarily affect the face, neck and arms during the first and second trimester and regress postpartum.

Pre-existing
Acne
Hormonal stimulation increases the production of sebum – a waxy, oily substance that can clog up your pores, leading to inflammation and breakouts. Pregnancy-related acne often resolves postpartum and is not as severe. Not all acne therapy is safe during pregnancy. Unsafe options include isotretinoin (a form of vitamin A), tetracyclines and hormonal therapies, which increase the risk of birth defects and growth deformities. Safer options include topical azelaic acid, benzoyl peroxide (Benzac) and salicylic acid. Cleansing with a mild cleanser and lukewarm water; not picking pimples; keeping the hair out of the face; using oil-free moisturisers and cosmetics and removing make-up before bed will help remove excess oil, prevent clogging of pores, and accelerate healing of existing blemishes. marks. The cause of the ailment is unclear, and it is neither contagious nor harmful to the mother or the foetus. Common associations include multiple and first pregnancies. PEP usually resolves spontaneously one to two weeks after birth.

Atopic Dermatitis and Psoriasis
Existing atopic dermatitis and psoriasis may improve or worsen during pregnancy. It is recommended that certain oral and topical medication is stopped before pregnancy and consultation with your doctor is advised to adjust management. Pregnancy-specific skin problems are abnormal skin concerns that require medical therapy.

These conditions include:
Polymorphic eruption in pregnancy
Polymorphic eruption of pregnancy (PEP) is the most common pregnancy-specific skin problem. The disorder affects 1% of all pregnancies during the second and third trimester. Extremely itchy, red patches develop on the abdomen, in and around stretch marks. The cause of the ailment is unclear, and it is neither contagious nor harmful to the mother or the foetus. Common associations include multiple and first pregnancies. PEP usually resolves spontaneously one to two weeks after birth.

Atopic eruption of pregnancy
Atopic eruption of pregnancy is a common, itchy, eczematous disorder occurring in women who have an atopic background. The disorder has a rapid response to treatment and is harmless to both mother and foetus.

Pemphigoid gestationis
Pemphigoid gestationis is an autoimmune condition, characterised by intensely itchy, urticarial-like eruptions that form blisters on the abdomen during the second or third trimester.

Intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy is a pregnancy-induced liver disorder that presents in the third trimester as severe itching without any skin signs. There is increased risk of premature delivery, low birth weight and intrauterine foetal demise.