Skin and pregnancy

Skin changes are well-accepted and expected effects of pregnancy Before, you jump the gun and start calling it a disease, you should know that most of these new observations are directly related to the physiological changes that are taking place in your new body

When these skin disorders occur, the first thought that enters the mind of most pregnant mothers is whether any of these skin problems will be transferred to the developing fetus in any adverse way. Fortunately, most of the common skin diseases seen in pregnancy are of no risk to the mother or baby and are simply the marks of motherhood and a tolerable inconvenience.

The common aggravating condition chloasma (the mask of pregnancy) or bad acne, does send some women to the dermatologist. However, depending on your hormones and skin condition, you may not suffer from these problems. Some women develop rashes and some are completely unaffected. If you have had a long-term acne condition, you may be surprised to find that it clears up during pregnancy. Also, having a rash during your first pregnancy does not automatically mean that the rash will return for subsequent pregnancies.

Acne, eczema and psoriasis
Many skin conditions such as psoriasis, eczema and acne are modified by pregnancy In some cases, the rashes do not show up in a genetically predisposed individual until a pregnancy occurs. Even in these cases, the impact of the pregnancy on the skin condition is unpredictable, basically, the glands beneath the skin work overtime in a pregnant body, causing oil-producing glands to become more productive and sweat glands to overwork, causing the mother to perspire more.

According to the American Academy of Dermatology, psoriasis is a chronic genetic skin disorder characterised by raised thickened patch of red skin covered with silvery-white scales that can affect any part of the body. While psoriasis tends to improve during pregnancy, it can flare out of control after delivery.

Rosacea, the red acne-like rash on the face, tends to worsen during pregnancy. This is because the increase in blood volume that peaks during the second trimester and tends to bring more blood to the skin, giving the highly vascular areas like the face a rosier appearance.

Pruritus gravidarurn
Pruritus or itching, is by far the most common dermatosis seen, it usually begins in the later stages of pregnancy. It is widely accepted that the sluggish flow and retention of bile salts that occurs in pregnancy, is the cause of the itch.

Usually centred around the abdomen, the itch may spread to the limbs in severe cases. 'Me condition occurs from the first trimester and may persist right up to delivery. According to Doctor Herbert Goodheart, MD, in the Journal of Women's Health, this condition is often thought to possibly be a variation of PUPPP without lesions.

Treatment involves use of itch-reduction measures such as cooling the skin, applying anti-itch lotions and oral antihistamines, if the itch is severe. Pruritus gravidarum does not have any adverse effect on the baby or on the progress of the pregnancy, however, it may recur with subsequent pregnancies or if the woman takes certain oral contraceptives.

Polymorphic Eruption Of Pregnancy (PEP)
According to the National Skin Centre, one in 300 pregnant women develop this itchy skin disease. The onset of the rash is usually in the third trimester, especially from the 35th week onwards. On the average, the rash will last for up to six weeks, usually clearing within two to three weeks after delivery. However, in some women, the onset of the rash may be delayed till a few days after delivery.

The term polymorphic means 'many forms' and this aptly describes the appearance of the rash. It usually occurs over the abdominal stretch marks as itchy, red spots or lumps, much like hives. It then progresses to the legs and arms. As a rule, the face and upper trunk are not involved. It may take the form of red patches, papules (spots), vesicles (small water blisters) or dry, red, scaly patches (eczema?like). The itch is usually quite intense.

Treatment is with the use of cold compresses, steroid creams and oral antihistamines. More severe cases may require short courses of oral steroids. PEP itself does not harm the mother or baby

Pruritic Urticarial Papules
Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a common dermatosis of late pregnancy. This common rash is characterised by small red bumps and hives that can cause slight to severe itching. It typically shows up during a woman's third trimester and usually disappears after delivery. While it is not dangerous to mum or baby, the itching can be very annoying, it usually starts on the abdomen and can extend to upper thighs, buttocks and chest.

PUPs is usually treated topically with soothing ointrments, oatmeal baths and calamine lotion. When itching makes a woman too uncomfortable, she can ask her doctor about antihistamines safe for use during pregnancy

Chloasma
If you wake up one morning and find yellow or brown patches on your face, you are most probably suffering from chloasma. These skin pigmentation changes on the face especially the forehead, nose, and cheeks are termed chloasma, or the "mask of pregnancy." According to co-author of "Dermatoses of Pregnancy", dermatologist, George Kroumpouzo, MD, PhD "Chloasma has been reported in up to 70 percent of pregnant women and causes an increase in pigmentation that occurs almost exclusively in sun?exposed areas." This can sometimes include the forearms as well.

These skin splotches will gradually fade after delivery, and darker women tend to experience chloasma more because of the increased levels of estrogen and progesterone that stimulate pigment?producing cells.

Dermatologists encourage the use of proper sunscreen as well as treatment with lightening agents, chemical peels and tretinoin. Some women opt for laser treatments after delivery.

Should I feel threatened?
Common pregnancy-related skin changes pose no health problems. But other conditions, such as skin cancer, could bring about skin discoloration in anyone, pregnant or not. Consult your caregiver if you notice any changes in the colour or size of a mole, or if changes in skin pigmentation are accompanied by pain, tenderness, or redness.

Most skin changes during pregnancy are benign but in rare cases, severe itchiness in your third trimester -- known as cholestasis of pregnancy- could be a sign of a serious liver problem. The itchiness may be accompanied by nausea, vomiting, loss of appetite, fatigue, and jaundice. Call your doctor or immediately if you have any of these symptoms.

Source: Motherhood Magazine