Skin problems in pregnancy

EVERYONE looks forward to the glow of pregnancy, but sometimes there are drawbacks of unwanted skin problems that arise.

Most of the changes are benign and will go away once the pregnancy is over, but some are more serious and require further investigation and treatment.

Skin problems may be pre-existing (from before the pregnancy), due to the hormones of pregnancy, or directly caused by other complications of pregnancy.

The hormone changes of pregnancy cause the common complaints of stretch marks, hyper-pigmentation (melasma or darkening of the skin in certain areas), hair growth or loss, and nail changes.

Stretch marks are more common in younger women, women with larger babies, and women who are overweight or obese. They usually fade and shrink after delivery, although they do not completely disappear.

Many creams are on the market to fade or prevent stretch marks, but they usually only lessen the appearance of the marks without actually preventing them.

Nearly all pregnant women experience some amount of hyperpigmentation, which usually results in darkening of the skin around the areolae, underarm, genitals and sometimes scars.

The linea nigra (line that runs down the middle of the abdomen) also becomes very prominent. Melasma (mask of pregnancy), however, is usually more cosmetically troublesome for women and is worsened by exposure to sunlight and other ultraviolet radiation.

Wearing broad-spectrum UV skin sunscreens and avoiding excessive exposure to sunlight may prevent melasma from developing or being exacerbated. Women should be reassured, however, as it resolves after delivery in most cases.

However, it may not resolve fully and may recur with future pregnancies or with oral contraceptive use. Increased blood flow from pregnancy hormones can cause redness to the face, palms and other areas of the body, as well as more visible blood vessels.

These changes can also affect the gums and nasal passages, causing bleeding, especially in the third trimester. Most cases are mild and resolve on their own, but women with severe cases should go to the hospital for immediate attention.

Swelling of the legs and the skin of the abdomen is also a common complaint, which should resolve after pregnancy. Pre-existing skin conditions such as atopic dermatitis, psoriasis, and fungal infections, all tend to change during pregnancy.

Most progress or worsen, but some (such as psoriasis), may actually improve during the pregnancy. Close monitoring of these conditions to ensure optimal treatment pre-pregnancy is the best management plan, as more drugs are available to use for treatment.

Sometimes pregnancy itself can cause skin pathology, including conditions such as pruritic urticarial papules and plaques of pregnancy (PUPPP), prurigo of pregnancy, intrahepatic cholestasis of pregnancy and pemphigoid gestationis.

These only occur during pregnancy and are not associated with any other conditions. PUPPP is the most common pregnancy-specific skin condition, most marked in the third trimester, and usually causes a rash with intense itching, commonly in stretch marks on the abdomen.

The disorder is more common with first pregnancies and multiple gestations, and familial occurrences have been reported. It is treated by relieving the symptoms with antihistamines and topical steroids, and thankfully resolves one to two weeks after delivery.

Pemphigoid gestationis causes an itchy rash with blisters on the abdomen and chest area and tends to appear later in pregnancy (second or third trimester).

Unlike some of the other conditions, symptoms can spontaneously improve by the end of pregnancy and resolution may be aided by breastfeeding.

Intrahepatic cholestasis of pregnancy causes very severe itching (usually in the third trimester) without the presence of a rash or other skin lesions.

It may be associated with jaundice (yellowing of the eyes) and causes an abnormal elevation of the liver (enzymes) blood test results.

This condition may have a negative effect on the pregnancy, so the baby has to be monitored more closely, and is usually delivered before the due date.

Skin changes in pregnancy are very common, and most are not serious; however, very unusual appearances or severe symptoms associated with the skin should not be ignored. Have a discussion with your ObGyn if you are unsure about the cause of your symptoms.

Dr Anna-Kay Taylor Christmas is a consultant obstetrician and gynaecologist at the Obs and Gynae Centre, Winchester Business Centre. She can be contacted at drtaylorchristmas@gmail.com or 908- 3263, 906-2265, 325-7362.