Ask the Dermatologist: Pregnancy Skin Problems

Pregnancy means glowing skin, right? Maybe for a lucky few of us. For many women, pregnancy can mean anything from teenage-level breakouts to dry, flaky skin. There’s also something called the “mask of pregnancy,” which sounds like something out of a horror film. So, we asked our in-house dermatologist Dr. Kara Shah of Kenwood Dermatology the following question on behalf of a newly pregnant Cincinnati Mom:

I’m 9 weeks pregnant and my skin is a mess. I’m breaking out like a teenager and itchy all over. What other pregnancy skin problems can I expect during these 9 months – and what can I do about it?

It is not at all uncommon for women to experience a multitude of skin changes during pregnancy. While some women report glowing skin and luxurious hair and nails during pregnancy, for many the changes are less glamorous. Hormonal, physiologic, metabolic and immunologic changes during pregnancy are responsible for many of the skin changes that are commonly seen.

One of the more common skin disorders that can develop or worsen during pregnancy is acne. An increased in androgenic hormone levels results in an increase in sebum (oil) production. Using gentle skin-care products created for acne-prone skin can be helpful. Discuss with your healthcare provider which acne medications are safe for use during pregnancy. Common topical medications that are safe for use during pregnancy include benzoyl peroxide, salicylic acid, and glycolic acid.

There are several pregnancy-related skin disorders that occur only in pregnant women and are believed to be mediated by changes in the function of the immune system. Pruritic and urticarial papules and plaques of pregnancy (PUPPS), also known as polymorphous eruption of pregnancy, is one of the more common skin disorders seen during pregnancy; it is a benign condition that results in an itchy, hive-like rash that usually develops during the third trimester of pregnancy and resolves shortly after delivery. Prurigo of pregnancy, also known as atopic eruption of pregnancy, is another rash that can present during pregnancy as itchy, red bumps. Itching (pruritus) is very common during pregnancy and usually benign; it can be treated with emollients, avoidance of heat exposure/sweating, a cool environment, and use of topical corticosteroids, antihistamines and other topical treatments such as mentholated cream. Severe itching, however, may be a sign of a more serious condition, intrahepatic cholestasis of pregnancy; this condition results from impaired liver function and requires medical attention for diagnosis and appropriate treatment.

Physiologic skin changes that are common during pregnancy include hyperpigmentation and melasma (the ‘mask of pregnancy’), telangiectasias (broken capillary blood vessels), and striae gravidarum, those annoying stretch marks on the abdomen and other areas where the elastic fibers in the skin have been damaged due to rapid growth and weight gain. Routine use of sunscreen and avoidance of too much sun exposure can minimize the development of melasma. Unfortunately, there is little evidence that stretch marks can be easily prevented or treated once they have appeared; most will fade with time. Development or worsening of varicose veins is also common during pregnancy and results from a combination of factors: hormonal changes, increased blood volume, and decreased blood return from the legs. Easy steps that you can take to minimize the appearance of varicose veins include regular exercise, use of support stockings, and elevating your legs when possible.

Finally, common skin disorders that can either improve or worsen during pregnancy include psoriasis and eczema. While many treatments for these skin conditions are safe to continue during pregnancy, you should discuss your current treatments with your doctor to determine whether they may be safely continued during your pregnancy.

Luckily for most women, the common skin changes noted during pregnancy are a minor annoyance and quickly forgotten after delivery!

Ask the DermatologistDr. Shah was previously the Director of Pediatric Dermatology at Cincinnati Children’s Hospital, and prior to relocating to Cincinnati, she was the Clinical Director of Pediatric Dermatology at the Children’s Hospital of Philadelphia. Motivated to provide more personalized and specialized dermatology services, she started Kenwood Dermatology in 2016, where she focuses on providing expert skin care to children, adolescents and young adults. While she enjoys caring for patients with a variety of skin concerns, her special interests include hemangioma and other birthmarks, melanocytic nevi (moles) and melanoma, psoriasis, acne, atopic dermatitis/eczema, hair and nail disorders, and genetic skin diseases.

Among her many achievements, she was recognized by Cincinnati Magazine as a Top Doctor in 2016.

Dr. Shah serves on the medical advisory boards for the Foundation for Ichthyosis and Related Skin Types and the National Psoriasis Foundation. She is also on the Scientific Advisory Council for Naevus Global and is a Councilor for the International Society for Pediatric Wound Care. Dr. Shah is board-certified in General Pediatrics, General Dermatology, and Pediatric Dermatology.

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