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All of the changes your body is going through during pregnancy may give you a beautiful glow. For many expecting moms, pregnancy can cause some challenging skin issues. The good news is the majority of these skin issues are temporary and will disappear after your baby is born. This article examines common skin issues during pregnancy like skin sensitivity, stretch marks, acne, melasma, linea nigra, spider and varicose veins, skin tags, and conditions like PUPPP and ICP. We examine the symptoms, causes, if or how you can prevent them, and how you can safely treat each of these skin issues.

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Pregnancy Glow

Pregnancy glow describes how some expecting mothers have beautiful glowing skin during pregnancy. This glow is due to two factors. The first is increased blood volume, giving your face more color and even appearing fuller. The second is the extra production of oil, which can make your skin appear shiny. All of the changes your body is going through during pregnancy may give you a beautiful glow. For many expecting moms, pregnancy can cause some challenging skin issues.

Skin Sensitivity

Many expecting moms find that their skin is more sensitive during pregnancy.

Symptoms: Skin sensitivity presents as redness, swelling, tenderness, or irritation in response to products, fabrics, or sun exposure.

Cause: This is caused by an increase in hormones during pregnancy.

Prevention: Some expecting mothers choose to cut down on chemicals in products that contact their skin. Only a handful of ingredients are strongly advised against during pregnancy, and some parents choose to be more cautious than others.

Treatment: If you are not experiencing any additional sensitivity and like the products you are using, you may not need to make any changes. To treat skin sensitivity, you want to stop using irritating products and swap them out for more mild formulas. Switching to a more mild or fragrance-free laundry detergent may be helpful. If your skin isn’t loving your usual skin products, ditch those during your pregnancy. You can always resume using them after your baby is born when your skin returns to more of a normal state. Be aware that skincare products labeled “hypoallergenic,” “natural,” or “clean” are only marketing terms and have no legal definition or regulatory oversight. For more information on pregnancy-safe skincare, see this article.

If your skin is more sensitive to sun exposure, wear a hat in the sun, seek shade, and wear sunscreen on exposed skin outdoors.

Stretch Marks

Symptoms: Stretch marks are off-color lines that can appear on your breasts, belly, butt, and thighs. These lines can be pink or reddish and fade to a lighter color than your skin tone. The good news is that stretch marks fade over time.

Cause: Stretch marks happen when the underlying supporting tissue stretches and tears during rapid stretching of your skin. Affected skin may feel tight and itchy. Stretchmarks are common when your belly is expanding faster than your skin can accommodate a growing belly. Genetics plays the most significant part in your susceptibility to stretch marks, which, unfortunately, you cannot control.

Prevention: Besides avoiding excess weight gain during pregnancy, there isn’t much you can do to prevent stretch marks.

Treatment: While stretch marks fade over time, there are no magic creams or oils evidence-based to prevent them effectively. This study evaluated many different topical treatments, and there was no clear evidence that any of them effectively prevented stretch marks.

If you want to massage your belly with coconut oil, vitamin E, or other creams or oils, there isn’t a downside. Massage has been recommended to improve the appearance of scarring, although I could not locate any evidence that massage truly helped with stretch marks. One benefit of using creams or oils is these may relieve itching that often accompanies stretch marks. After your pregnancy, you can talk to a dermatologist about other methods of improving the appearance of stretch marks. This could include interventions like laser treatments.

Acne

Symptoms: Acne appears as small tender bumps on your skin when follicles get plugged with oil or dead skin cells. These bumps can be red or may have a whitehead or blackhead. It is most common on the face but can also appear on your chest, shoulders, and back.

Cause: Acne can be caused by many things, including hormones, bacteria, inflammation, and skin sensitivities. During pregnancy, increased progesterone hormone production increases your skin’s production of oils. This can clog pores and allow bacteria to build up.

Prevention: If hormones are wreaking havoc on your skin, there isn’t much you can do to prevent it during pregnancy. Developing a good skincare routine will benefit your skin now and for years to come, regardless of whether you are experiencing acne.

Treatment: Treating acne is tricky because there are many causes and some, like increased hormone production during pregnancy, are out of your control.

Some acne treatments are not safe during pregnancy. You should be cautious about vitamin A compounds and retinoids during pregnancy and avoid some specific ones. The oral medication, Isotretinoin, is strongly associated with congenital disabilities and should not be taken during pregnancy. The American College of Obstetricians and Gynecologists states that the amount of medication absorbed by the body from topical retinoids is low. However, it is generally recommended that you avoid the use of these medications during pregnancy. ACOG also advises against other prescription acne medications during pregnancy, including hormonal therapy and tetracyclines.

My go-to resource for skincare is Caroline Hirons, an internationally recognized esthetician, and skincare expert. If you want to learn about how to take care of your skin, her book Skin Care breaks down what different ingredients do, how to care for your skin, and how to find the right routine and products for you. While Caroline Hirons doesn’t specifically address skin care during pregnancy, she is an excellent resource for everything from acne to anti-aging. Here is Caroline’s cheat sheet for acne.

Since everyone’s skin is different, there is no one perfect treatment for acne. Fortunately, some things may help clear up your skin.

Cleanse your face twice a day and after a sweaty workout. If you wash your face too much, it can dry out your skin and cause more oil production. You may want to avoid alcohol, soaps, and foaming washes that can break down your skin’s acid mantle. Mineral oils can contribute to breakouts. Natural plant-based oils will not clog pores. Opt for non-foaming cleansers and balms.

Touching your face throughout the day transfers oil and bacteria from your hands. You may also want to wash pillowcases more frequently. As tempting as it may be, don’t squeeze breakouts. This will only make them worse.

If you want to use acne-specific treatments, ACOG states that over-the-counter products containing topical benzoyl peroxide, azelaic acid, topical salicylic acid, and glycolic acid may be used to treat acne during pregnancy. If you have any questions about ingredients in skincare products, please run them by your dermatologist, doctor, or midwife.

Melasma

Symptoms: Melasma presents as darker patches of skin on your forehead, cheeks, nose, or upper lip.

Cause: Like many skin issues during pregnancy, melasma is caused by an increase in estrogen, which can increase your body’s production of melanin. Melanin is what gives your skin, hair, and eyes their color.

Prevention: There is no way to prevent melasma, but you can take steps to make sure you do not make it more pronounced.

Treatment: Sun exposure tends to darken these spots. You can wear a hat to shade your face from the sun or try to stay out of the sun. If you are outdoors, wear sunscreen.

If you do get these dark patches, they will go away after your baby is born. Skin lightening products that contain hydroquinone or vitamin A compounds may not be recommended during pregnancy. Hydroquinone has a very high absorption rate, 35-45%, compared to 1-2% in most skincare products. This is only available with a prescription in the United States. There are also cautions around products with vitamin A compounds, and the American College of Obstetricians and Gynecologists generally recommends that you avoid using these medications during pregnancy. 

Linea Nigra

Symptoms: Linea nigra is the name for the dark stripe that can appear down the center of your belly during pregnancy. This usually occurs in the second trimester and may get darker as you get closer to your due date.

Cause: The exact cause of this is unknown, so of course, we blame hormones. The leading theory is due to a melanocyte-stimulating hormone from the placenta.

Prevention: There is no known way to prevent the linea nigra from appearing on your belly.

Treatment: Unfortunately, there is no treatment for this. The good news is that it will go away after you have your baby.

Spider Veins and Varicose Veins

Symptoms: Spider veins are tiny red or bluish veins that most often appear on your legs but can also show up on other parts of your body. Other than changing the appearance of your skin when they are visible, they are painless. Varicose veins are more prominent, protruding veins. Varicose veins have the potential to be uncomfortable for some women who experience them. Hemorrhoids are varicose veins that appear in your rectum.

Cause: Several factors during pregnancy cause spider and varicose veins. Your blood volume can increase up to as much as 50% during pregnancy. As your uterus grows, it can put additional pressure on your veins in the lower half of your body, especially in your legs. This causes your veins to work extra hard to circulate that additional blood volume to your body. On top of this, progesterone can relax your blood vessels.

Prevention: Like stretch marks, spider and varicose veins are mainly hereditary. The good news is that you can do some things to treat them if they do show up.

Treatment: Anything that promotes blood flow can improve the appearance of these veins. You may want to avoid standing for long periods or sitting with your legs crossed. You can prop up your feet to improve blood flow in your legs. The position you sleep in can impact blood flow. Sleeping on your left side can minimize pressure on a vein called the vena cava. This means the deoxygenated blood from the lower half of your body can flow easier to your heart to be replenished with oxygen.

Exercise also improves blood flow and has many benefits during pregnancy. It is also essential to eat a healthy diet that includes plenty of fiber and be sure you are taking a high-quality prenatal vitamin. Staying hydrated can also help with the swelling that can exacerbate spider and varicose veins.

You may also want to try wearing compression stockings. These support hose put mild pressure on your legs, with the most pressure on your ankles and decreasing pressure as they move up your legs. You want to be careful that they are not cutting off any circulation, but these may make the work your veins have a little bit easier.

Spider and varicose veins should go away in the months after you have your baby. If you find that they do not, you can discuss procedures, like laser treatments, with your doctor or dermatologist.

Skin Tags

Symptoms: Skin tags are small skin-colored growths that usually pop up in folds of skin where friction occurs. Some common locations these happen are under your arms, on your neck, or beneath your breasts. These growths are benign but can be aesthetically bothersome. They are not painful unless you catch them in jewelry on your neck or knick them with a razor when shaving your armpits.

Cause: The cause of skin tags is hyperactive skin growth. These can be hereditary and be caused by hormonal changes and weight gain. There is evidence that skin tags are associated with hypertensive disorders during pregnancy.

Prevention: Unfortunately, there is no way to prevent skin tags.

Treatment: These may shrink in size or disappear in the months after you have your baby. If they are still present and you wish to remove them after your birth, there are over-the-counter remedies and tools available. I was unable to locate evidence of their effectiveness. If you consider using any over-the-counter product during pregnancy, please run it by your doctor or midwife first. Plus, remember, they may go away on their own after your pregnancy.

Dermatologists advise against removing them yourself to avoid the risk of skin irritation, infection, bleeding, or scarring. A dermatologist can remove them by surgically cutting, cauterizing, or freezing. This is typically not covered by health insurance since it is considered a cosmetic procedure.

There are also some DIY skin tag removal methods, but I could not track down any evidence of their effectiveness. Most of these involve drying out the skin tag until it falls off and take the consistent application for days, weeks, or longer. Some common remedies are to use tea tree oil or apple cider vinegar. As long as these don’t irritate your skin, there is unlikely no downside of trying this.

Skin Conditions

In addition to some of the temporary skin issues that can happen during pregnancy, some skin conditions with more severe symptoms can occur. These are PUPPP and intrahepatic cholestasis of pregnancy (ICP).

PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy)

PUPPP stands for pruritic urticarial papules and plaques of pregnancy or PEP in the UK (polymorphic eruption of pregnancy). This is the most common skin condition in pregnancy. Studies show the incidence is 0.5% of single pregnancies, 2.9 to 16% in twin pregnancies, and 14 to 17% in triplet pregnancies. PUPPP is most common with first-time mothers and doesn’t tend to show up in subsequent pregnancies.

Symptoms: This presents as a rash that is bumpy and itchy. PUPPPS typically shows up in the third trimester and usually first appears in stretch marks on your belly. On your stomach, it surrounds your navel. It can spread to your arms, thighs, butt, and essentially your whole body from your belly. This rash does not show up on your belly button or your face. Although this can be uncomfortable, it does not increase the risk for adverse outcomes for you or your baby.

Cause: We don’t know why PUPPP happens and exactly what causes it, and there are several theories. One theory is that when your skin stretches and stretch marks form, the damage to the connective tissue exposes antigens within collagen that could elicit an allergic-type reaction. This could explain why the rash first shows up in stretchmarks. Another theory is that DNA from your baby migrates to other parts of your body, and your skin has an inflammatory response. This also could be caused by hormones since high levels of progesterone are found in patients with PUPPP.

Prevention: Since we do not know the cause and PUPPP is not hereditary, there is no known way to prevent it.

Treatment: Thankfully, PUPPP does disappear after birth. If the symptoms are bothersome during pregnancy, there are some remedies to treat it. Topical corticosteroids and oral antihistamines are typically prescribed to alleviate the itching associated with PUPPP. Since this condition usually shows up in the third trimester, your baby is less vulnerable to substances that could interfere with their development.

There are several antihistamines considered safe during pregnancy. Also, a review on the safety of topical corticosteroids in pregnancy found no associations between mothers’ use of topical steroids of any potency and type of delivery, congenital disabilities, premature births, or low Apgar score. There is some evidence indicating a relation between low birth weight and maternal use of potent or very potent topical steroids, especially when high doses are used in pregnancy, which may warrant more research.

If you prefer not to take corticosteroids or antihistamines, some natural remedies may help with PUPPS. There are no studies on the efficacy of these methods, but there also is not a downside to trying them. Some mothers with PUPPP find cool baths helpful. You could also try adding oatmeal or baking soda to the tub. Applying a cold compress to your skin may alleviate itching. You may find relief in applying aloe vera or lotion to your skin and wearing light cotton clothing.

ICP (Intrahepatic Cholestasis of Pregnancy)

Intrahepatic cholestasis of pregnancy is a complication caused by a reduced flow of bile down the bile ducts in the liver, which causes some bile to leak into the bloodstream. The prevalence of ICP varies widely based on countries and ethnic groups and can range from anywhere between 0.1% to 15.6% of pregnancies. It is most common in South Asia, South America, and Scandanavia, and is more common in twin pregnancies.

Symptoms: This build-up of bile acids in the bloodstream can cause a persistent itch, most often in the palms of your hands or the soles of your feet. It is also possible for it to spread to your belly. This is characterized by severe itching with no rash present. Usually, this occurs in the third trimester, then disappears after you have your baby.

Other than the itching, which can be very uncomfortable, there are no risks to the mother. Unfortunately, this condition does increase risks for some adverse outcomes for your baby.

Talking to Your Doctor or Midwife

The majority of skin issues present in pregnancy are temporary with no risks to you or your baby. There are exceptions, like ICP, and if you notice any concerning changes or have questions, please bring them up with your doctor or midwife. If you are worried, do not wait until your next prenatal appointment. Contact your doctor or midwife sooner. If you are treating any condition with over-the-counter medications, run them by your doctor or midwife first.

Thank you to the amazing companies that have supported this episode.

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