Pregnancy is a period that is commonly known for skin changes, some temporary and others more permanent. The increase in hormones responsible for gestation can affect skin, along with tissue expansion and increases in body weight. Not every pregnant woman will experience the same skin issues, but pregnant women likely will experience some change to their normal, pre-pregnancy skin. Some of the more common changes related to pregnancy include acne, changes in moles, melasma or “the mask of pregnancy”, linea nigra, stretch marks, varicose veins, and hair changes. Read on for pertinent information on each of these.
Acne During Pregnancy
You are supposed to be glowing, so why is your face breaking out like a teenager’s? The higher level of hormones in the first trimester can cause an increase in oil and inflammatory markers of the sebaceous unit at the base of the pore. While this may be temporary for some, one out of every two pregnant women will experience acne during their pregnancy.
Unfortunately, pregnancy and breastfeeding are conditions in which a lot of typical acne treatments are not well studied or are contraindicated. Salicylic acid, tretinoin, adapalene, oral tetracyclines, and a myriad of other typical acne therapies (both prescriptive and over the counter) are not recommended during pregnancy. Isotretinoin is a known teratogen (cause of birth defects) and is closely monitored to avoid pregnancy in those patients taking it.
There are some options, however. Just not many. If your acne is pregnancy related, it will likely lessen after delivery and in the post-partum period. After breastfeeding, steps can be taken to reduce any residual inflammation, cysts, or scarring from lesions that occurred during pregnancy. During pregnancy, the topical use of erythromycin, clindamycin, azelaic acid, glycolic acid (an AHA) and lactic acid are often safe to use, if your medical provider recommends them.
Keeping good skin hygiene can help to lessen oil related comedones. Making a point to cleanse your skin after activities causing perspiration and washing with safe but effective face cleansers in the morning and at night can help minimize the oil that promotes acne. Also, keeping your scalp healthy and clean will minimize any mixed type of acne that comes from the overgrowth of normally occurring organisms that thrive in oil rich environments. It is also a good idea to consult your obstetrician or a dermatologist if your acne becomes more severe.
Mole Changes Caused by Hormones
Hormones can affect moles that were present pre-pregnancy, and also cause de-novo (new) moles as a result. Dermatologists can monitor moles during pregnancy and can perform biopsies safely, as well. Significant change in the size of moles is not as common as once thought. Studies have shown it is less common to have benign changes in moles in pregnancy. Any moles that bleed or change in size or pigment, should be assessed by a professional. It is not uncommon to find red mole-like lesions arise during pregnancy and the post-partum period. These are called angiomas and said to be related to hormonal changes, specifically from increased plasma estrogen. Unfortunately, they will not go away after delivery. Once evaluated and verified to be a benign vascular change, cosmetic treatment can lessen or remove them should that be desired.
Melasma: the Mask of Pregnancy
The surge in hormones responsible for uterine expansion, increase in blood supply, and other important body changes to support a fetus can also cause pigment changes that are exacerbated by sunlight. The more common facial areas to experience this change in pigment include the forehead, the bridge of the nose, and the cheekbones. This pigment change is genetically linked and often occurs after the 16th week of pregnancy. Sunscreen applied liberally to the face during sun exposure, wide brimmed hats, and staying out of direct sunlight can help to lessen any pigment development from sun exposure. Options for lightening of pigmented areas after pregnancy can include lightening serums, chemical peels, and lasers specific for melasma.
During pregnancy, melanocyte-stimulating hormone increases. The effects include darkening of the nipples and the lower midline from the umbilicus to the pubis, referred to as linea nigra . This change occurs based on genetics; skin lightens slightly after delivery.
Stretch Marks from Pregnancy
Caused by collagen separation later in pregnancy, striae, more commonly known as stretch marks, can leave irregular linear lines on any areas that expand in size over a short period of time. Common sites for striae include those areas most prone to stretch, including the abdomen, hips, buttocks, and breasts. The uterus increases in size to ten times the non-pregnant weight over the course of pregnancy, which increases tissue expansion.
Genetics, race, and personal history of stretch marks plays a more vital role in the tendency to develop stretch marks than increased body mass and weight gain. If a pregnant woman’s mother had a history of their development, there is more of a chance she, too, will develop them. Lighter complexion individuals have a tendency to form more red/pink stretch marks, whereas darker complexion individuals often develop striae lighter than their typical skin tone.
While nothing will prevent these from occurring with tissue expansion, attempts can be made to fade them after pregnancy. Topical products that induce cell turnover, such as retinoids and alpha hydroxy acids, can help to minimize their appearance. Improvements to the aesthetic appearance of stretch marks are best seen when therapies are done in their early stages of presentation.
Pressure from the enlarging uterus paired with increased size of peripheral veins by progesterone can cause insufficient flow in blood vessels of the legs. As a result, varicosities, or varicose veins, can form. Prevention or lessening of this can be encouraged with leg elevation and compression stockings during pregnancy. Treatment for any varicose veins after delivery of the baby may include sclerotherapy, laser therapy, and other minimally invasive techniques. If the veins are not painful or bothersome, treatment is not necessary.
The estrogen present in higher amounts during pregnancy accounts for more hair being in the growth/active phase, or the anagen phase, giving a more lush and full look to most pregnant women’s hair. In the months after delivery, the hair follicles may catch up with the increased growth phase and have a larger number of hairs in the resting/shedding phase, or telogen phase. During pregnancy, the number of hair follicles in the resting phase (telogen) is decreased by about half and then nearly doubles in the first few weeks postpartum. It is a temporary hair change, as likely the phases will return to normal once they catch up to the internal hormone adjustment.
Skin Disorders Affected by Pregnancy
Skin disorders, such as atopic dermatitis (eczema) and psoriasis, that were present to some extent prior to pregnancy may flare or go into remission during a woman’s pregnancy. Because some of the medications used to treat these conditions are not recommended in pregnancy, it is important to let your physician know you are pregnant if you are on long term therapies to treat these.
While a lot of the listed changes do not seem to be positive, there are a number of pregnant women who experience few bothersome skin issues and more of the positive ones (increased volume of hair, “pregnancy glow”). But if you are among the many that have experienced the lesser desired changes, know you are in good company.