Skin issues in pregnancy are very common. In fact, it is estimated that up to 90% of women will experience some form of pregnancy related skin condition by the end of their pregnancy (I know I have). Changes in skin colour on areas of the body, growths and new stretch marks are amongst the most common. So how can we know what is normal? Does it go away? And what can be done to treat some of these problems? Let’s discuss!
So once the initial excitement of pregnancy sets in…the reality then appears! So many women love pregnancy and get a true ‘glow’….some of us not so much! Now at 32 weeks here’s a little of my (not always so glow-filled) skin journey…
Skin changes in Pregnancy - a dermatologists diary
The first joy - Pregnancy Induced Acne!
I have suffered acne most of my life, and required multiple courses of medication. I have learnt to manage it pretty well with skin care and treatments, mainly only getting the odd whopper around my period and if I have been too undisciplined to lay off the chocolate. So I guess it was no surprise (and I was really dreading it!) that I developed full blown cystic acne in the first trimester!
I got huge painful cysts around the jaw, mouth cheeks and even neck and back! They would resolve and leave redness for months. Lucky for COVID I was able to cover it with a mask. Not much you can do to prevent these buggers, but I did get lots of LED and the odd Vbeam laser burst to hasten resolution. Sometimes I just HAD to squeeze them as they were so painful (which I do not advise, as in pregnancy it seems the healing is impaired and the ones I mutilated have left me with marks on the skin)
But I also experienced another more unfamiliar type of acne on the forehead - comedomal acne. This came was tiny little blackheads under the skin. These are couldn't attack as they were too small, so I basically was in the clinic every week having extractions with Alanna and Lily which REALLY helped. We did Pyruvic Acid chemical peels frequently, which really helped the congestion clear and new ones stop coming. I was anal about my home skin care routine too which I think helped.
Haha, I have seen millions of these on my pregnant patients, but geez, when it actually happens to you it is confronting!! These seemed to start in the second trimester. Mostly they have appeared on my belly in the areas of biggest growth, but also flat brown ones on my arms and legs. And I am pretty fair so they are quite noticeable.
Sometimes they get itchy and I accidentally scratch them off. I will wait to treat these until after baby as they just regrow. Note: melanoma is the most common cancer in pregnancy so make sure you get a dermatologist to check you out if you are concerned about any changes.
Tiny little red dots that are becoming quite raised have sprung up all over the place in the third trimester. Especially on the growth areas such as boobs (which have gone exponential!) and the belly. Also on the thighs and legs. These I know are harmless and will disappear with one zap of the Vbeam laser postpartum.
No one warned me about this! I thought I had everything lasered off for good years ago….but clearly the pregnancy hormones don’t remember I did! Hair grows lovely and lush on the scalp, but also lovely and lush in areas you don’t want a lush forest (like stomach and 'down below!’)
I had to find someone to do a wax (which I haven’t done since I was 18!) Laser on those areas for hair removal is NOT recommended in pregnancy.
Plus I cannot be subjecting my poor obstetrician to that! Wonder if it will all fall out the like the scalp postpartum….will keep you posted.
Leg Veins - ugh! they are forming before my eyes! Big red vessels on the thighs and knees from the increased pressure of carrying this baby load, and working on my feet all day.. Not sure there is a lot one can do to prevent these but I do wear compression gear wherever I can (I like the Active Truth and SRC leggings) I also noticed big veins on my chest and boobs, and some on the belly. When its all over I will look at laser or sclerotherapy for these (my mum got nasty ones in pregnancy so I really had no hope!)
So this is just the START of the pregnancy skin realities. Ill came with more on stretch marks, melasma, wrinkles and any other things that literally ‘just pop up’. Oh and on that elusive glow…if I ever get it!
Skin changes in Pregnancy - more changes that might catch you by surprise
Dark patches on the face
Dark spots or patches appearing in pregnancy on your face, chest and arms can be alarming. This is not one of the pregnancy symptoms you see in movies, and most people don’t know about it until they are pregnant themselves.
Melanin is a natural substance produced by your body and is responsible for giving colour to your skin and hair. Levels of melanin increase during pregnancy. When it's produced in excess, usually due to hormonal imbalance, it causes patches of discolouration. These patches are often referred to as melasma, or "the mask of pregnancy".
Melasma can range in severity from mild to severe. It can cause symptoms like brown, blotchy, flat-topped patches on the face, chest and upper arms. These patches are often darker than the surrounding skin and are sometimes accompanied by redness or swelling. If you are experiencing this, you are one of the 15-50% of women that are affected by this condition. These changes are not usually painful and they cause no physical harm but it can really affect your self confidence (and that’s the last thing you need when you’re riding the pregnancy rollercoaster!).
Good news though is that most of these patches fade within a few months of giving birth. Occasionally when they don’t fade, there are treatment options you can discuss with a trusted dermatologist.
I know that may seem far away, so what can you do in the meantime to prevent symptoms of melasma from getting worse? Well, the sun’s UV rays aggravate melasma so it is important to take measures to protect yourself from the sun when pregnant. Wearing a good quality sunscreen, avoiding direct sunlight at peak times, between 10am-2pm, and wearing a wide-brimmed hat when outside will help keep symptoms from intensifying.
Many of you will know what stretch marks are. The scientific term is Striae Gravidarum. They are very common in adolescence and of course, during pregnancy where around 43-88% of women experience them.
Stretch marks are usually narrow and streak-like, and can be different colours depending on your skin tone. They start off a reddish colour (stria rubrea) and occur when the skin stretches rapidly as the baby develops.
As much as we try to avoid them, many women have stretch marks on the abdomen, buttocks, breasts or thighs by the third trimester. One of the first signs of stretch marks is an itchiness around an area where the skin is becoming thinner, for pregnant women this is usually felt on their stomach. Hormonal changes during pregnancy can also affect the skin and make it more susceptible to developing stretch marks.
The intensity of the marks can vary, with some being faint while others being quite dark. Stretch marks are more likely to appear if weight gain during pregnancy is above average or a woman has a well grown baby on board.
I bet you’ve all heard the myth that cocoa butter prevents stretch marks and vitamin E gets rid of them. These claims are sadly not backed by research. There is some evidence to suggest that massage and silicon gels might prevent them (no harm in trying right?). Hopefully, in the future more research is done.
Stretch marks are technically a type of scarring so they don’t go away. Don’t worry though, they do fade to a white colour (striae albea). There are also a few dermatological treatments that can be done to fade stretch marks post birth such as laser therapy, chemical peels and microdermabrasion.
Nail changes in pregnancy are so common. Most of my friends have told me that their nails were brittlle, chipping or peeling. I even had someone who was lucky enough to get stronger nails!
These changes can be caused by an increase in the hormone androgen. Androgens also cause hair changes in pregnancy, such as increased oil production, growth, thickness, drier and oilier hair.
Looking after your nails is important. Now I know what you’re all thinking, is there anything that can help your nails remain intact? Keeping them short if brittle can prevent painful breakages, wearing gloves when cleaning dishes to avoid damaging them further, file down any part of the nail that can get caught and look out for colour changes. When nails are weak or broken they are more likely to invite fungal infections. If you notice anything strange, see your GP for more advice.
FAQs I get asked about skin and pregnancy
Can rosacea be brought on from pregnancy?
The answer is probably. There is evidence to suggest that hormonal changes during pregnancy can trigger rosacea, though more research is needed in this area. Pregnancy can also exacerbate pre existing rosacea.
What can you do for rosacea when pregnant?
There are a few known effective options out there for rosacea. The problem is that not all options are safe in pregnancy. Retinoids, tetracycline antibiotics, antiandrogenic contraceptives and dapsone are not recommended for use during pregnancy.
Like many conditions in pregnancy, it can be tricky to find something that works when usual options aren’t safe. Luckily, there are a few experts out there who can help women find the right treatment for their situation. Some treatment options available include topical drying compounds, surgical drainage, and topical and systemic antibiotics and corticosteroids. The best approach to managing this condition is a multidisciplinary one, involving early diagnosis, shared obstetric and dermatology care, and emotional support.
Is the Vbeam laser safe to use in pregnancy?
Yes, Vbeam laser treatment during pregnancy is safe for both mother and baby. If you're pregnant and interested in getting a Vbeam laser treatment done, it's important to go to a certified laser treatment center to get the procedure safely.
What is the most common cancer in pregnancy?
Melanoma is the most common cancer in pregnancy. Due to many women experiencing changes in skin pigmentation during pregnancy, many have a delay in diagnosis. It is important for women to get their skin checked by a professional during pregnancy to avoid late diagnosis.
Does Melasma go away after giving birth?
Most of the time melasma fades or disappears after giving birth. However, some women have darker patches that take a while to fade or stay after giving birth. In those cases, a consultation with a dermatologist to discuss treatment options can be arranged.
Is chloasma and melasma the same thing?
The main difference between melasma and chloasma is that melasma is a skin condition that can affect anyone and causes brown or blue-grey patches, while chloasma only affects pregnant women and causes dark brownish patches.
Melasma is a common, harmless skin condition that causes dark patches on the face. It is normally caused by exposure to the sun. When cholasma condition occurs in pregnant women, it is known as a mask of pregnancy. Chloasma is brought on by the hormonal changes occurring during pregnancy.
Why does my skin change in pregnancy?
Many skin changes during pregnancy are due to hormone level changes and stretching of the skin throughout pregnancy and breastfeeding. However, for the majority of skin changes, the exact cause is unknown to health care professionals.