Monique Rainford

A pregnancy lasts for about 40 weeks of a woman's life. For most of us, being in any particular situation for almost an entire year is a significant length of time I sometimes minimise some of my patients' concerns about their skin conditions, such as acne in pregnancy, if you are prone to certain skin conditions in pregnancy, a year is a long time not to look like yourself. I would still recommend delaying treatment for certain skin problems but understanding some of these problems may relieve some of the anxiety when not only your body changes but your skin and face.

Women may already have skin diseases (dermatoses) that can be affected by pregnancy; they may also develop new dermatoses solely because of pregnancy or they may have skin changes associated with the hormones of pregnancy.

Stretch marks

My patients are most often concerned about stretch marks in pregnancy (striae gravidarum). These occur mostly on the belly (abdomen) but also on breasts, buttocks, hips or thighs. Younger women, heavier women, women who gain more weight in pregnancy, and women with larger babies tend to get stretch marks more often.

Genetics also play a role in the development of stretch marks. Unfortunately, none of the lotions, creams or oils such as cocoa butter, olive oil or vitamin E cream usually recommended for stretch marks has been proven to work. Laser therapy is an effective treatment for stretch marks for women with certain skin types.

Darkening of skin

Most women experience hyperpigmentation or darkening of skin during pregnancy. It is more obvious in women with darker complexion and is especially noticeable in areas such as the underarm, genital area and the area around the nipples (areolae). The linea nigra is the darkened line (linea alba) in the middle of the abdomen.

Chloasma or melasma (the mask of pregnancy) occurs when there is darkening of the skin on the face. The condition worsens with exposure to sunlight and other ultraviolet light and, therefore, not only should exposure be avoided but sunscreen is recommended. Most of the times, skin changes resolve without treatment, however, if the problem persists, certain topical medication can be prescribed.

Eczema and acne

Eczema is the most common dermatosis of pregnancy and is usually worse with pregnancy but may improve. Black and Asian women as well as women who smoke are at higher risk of having eczema. It can be treated with moisturisers and topical steroids. Antihistamines can also be used to alleviate the itching.

Similarly, acne may worsen, improve or even develop for the first time in pregnancy. Some types of acne may be treated with topical medications such as benzoyl peroxide or topical antibiotics such as clindamycin or erythromycin. Topical tretinoin sold locally as Retin-A is not recommended in pregnancy. When taken by mouth, isotretinoin, sold as roaccutane, can cause birth defects in the baby.

There are a number of skin dermatoses unique to pregnancy. Many of them involve red rashes with eruptions of various shapes on the skin. Some of them are associated with itching. The most common is called PUPPP (pruritic urticarial papules and plaques of pregnancy) the appearance may be disturbing, it is not harmful to mother or baby and usually disappears by two weeks after delivery.

There are some less common conditions associated with rashes and/or severe itching that may cause risks to the baby so a woman should alert her doctor if she has any symptoms. Like for eczema, the treatment for most of these skin dermatoses of pregnancy consists of antihistamines and topical and sometimes oral steroids.