The ESK blog
Pregnancy itch! Is it a thing?
19 August 2024
Dr Anne Thomson
Congratulations mama to-be! Pregnancy is an exciting time as you look forward to expanding your family. Of course, that’s not all that’s expanding, with pregnancy being a time of enormous changes to your body. These changes are designed to help your baby thrive and grow, but they can also cause some unwanted effects. Aches and pains, cankles, insomnia, pregnancy brain, you name it, nearly all body systems are affected. Your skin is no exception, with over 90% of women experiencing at least one noticeable skin change in pregnancy. Anything from acne to pigmentation and, of course, itch. So yes, pregnancy itch IS a thing!
How common is it?
Very common as it turns out, nearly 40% of pregnant women experience itch. Sometimes it’s associated with a rash, sometimes not. It can be a real nuisance, interfering with sleep (as if there weren’t enough pregnancy symptoms conspiring to keep you awake at night!) and impacting your quality of life.
What causes it?
There are a number of known conditions of pregnancy associated with itch, and some that are unrelated to pregnancy. In 61% of cases, we don’t ever find a cause. Many of these are probably (we’re not 100% sure yet) due to hormonal and immune system effects on the skin barrier leading to dry skin.
Is it serious?
There are a couple of conditions that can be potentially harmful to you or bub, so it’s very important that you see your doctor straight away if you develop an itch or a rash whilst pregnant.
The big one to rule out is intrahepatic cholestasis of pregnancy (ICP) which is a condition affecting the liver. It isn’t that common – anywhere between 0.2 to 2% of pregnancies, and whilst it can potentially cause problems for the baby, these risks are reduced if it’s picked up early, treated and closely monitored. It typically starts late in the second or early in the third trimester with an intense itch (without a rash) starting on the belly and classically spreading to the palms of the hands and soles of the feet.
Non-serious (but VERY annoying) causes of pregnancy itch
Polymorphic eruption of pregnancy (PEP): formerly known as PUPPP (doctors love a good abbreviation!) is responsible for around 20% of pregnancy-related itch and causes an intensely itchy red, raised rash that comes on in the third trimester. It starts on the belly, usually in the stretch marks – we think the cause is an immune response to damaged collagen due to stretching of the skin. It’s completely harmless to Mum and bub, the challenge is managing the itch.
Treatment includes a good emollient moisturiser; steroid creams and oral antihistamines that are safe in pregnancy like loratadine or cetirizine can also help.
Atopic eruption of pregnancy (AEP): (the alphabet soup of medical terms continues..) is the most common cause of an itchy rash in pregnancy. It can come on quite early in the pregnancy and starts with a very itchy rash on the arms and legs, particularly the elbows and knees or the backs of the hands/top of the feet. There may be a past history of atopic eczema or hay fever. It’s also perfectly harmless to Mum and baby and usually disappears once the baby is born.
Treatment: As with atopic eczema, an altered skin barrier with dry skin is a major feature, so treatment revolves around avoiding soap and using plenty of emollient moisturiser, with steroid creams and antihistamines also providing relief.
All the rest..
Once you’ve seen your doctor and ruled out a serious underlying cause, you can be reassured that the majority of pregnancy itch conditions have no known (or serious) cause and are most likely due to hormone and immune system-induced changes to the skin barrier leading to dry skin. This means treatment should focus on keeping skin as moisturised as possible and avoiding anything that might aggravate dryness or itch.
Moisturise, moisturise, then moisturise some more!
Look for a good emollient moisturiser that softens and smooths your skin by attracting water into its top layers, rehydrating and improving the skin barrier function. Typical emollient ingredients include wool fat, palm oil, and coconut oil, propylene glycol, jojoba oil and dimethicone.
Skin barrier-building ingredients including niacinamide, ceramides and panthenol haven’t been specifically studied for itch in pregnancy. But they are safe to use so could be worth a try!
B Calm is formulated to support irritable and blemish prone skin while maintaining a healthy skin barrier. Ceramides strengthen resilience, Salicylic Acid exfoliates and calms the skin, and Niacinamide helps regulate oil and reduce the appearance of blemished skin.
B Calm
Featuring:
- Ingredients to support an improved skin barrier
- Helps manage excess oil production
- Supports a clearer-looking skin
Medications
Over the counter antihistamine tablets can help settle down your immune system. Loratadine or cetirizine are safe to use during pregnancy.
Your doctor may offer a prescription for a mild topical steroid cream. They can be safely used in pregnancy too.
Avoid:
Typical itch aggravators like soap, getting too hot and sweaty, dry air and tight clothing. TRY to avoid excessive scratching which can further damage the skin barrier and even lead to skin infections or pigment changes.
The good news is that most cases of pregnancy itch are not serious, can be managed and usually completely disappear once your bundle of joy is born. See your doctor to get it checked out, moisturise as much as you can, and best of luck on your pregnancy journey!
** Please check with your clinician before using any skincare products in pregnancy.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884185/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632889/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8860374/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8646210/
https://pubmed.ncbi.nlm.nih.gov/29480924/
https://www.ncbi.nlm.nih.gov/books/NBK560820/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8860374/
https://pubmed.ncbi.nlm.nih.gov/36075066/
