Congratulations! Being pregnant is such an exciting time of your life, waiting to meet your new family member! But apart from the exhaustion, sore boobs and nausea, you might also get some unwelcome skin problems;

Pigmentation

Dark spots, the line that runs from belly button to the bikini line and pigment patches are caused by an increase in the skin’s natural pigment, melanin that happens during pregnancy. All of this will generally fade naturally after you give birth. 

How to combat it;

You can wait it out or

  1. Be scrupulous with wearing a broad spectrum sunscreen from sun up to sun down 365 days a year. A hat will help too
  2. Depigmentation is complex but there is evidence for Vitamin B3, AHAs, vitamin C and vitamin A (which is off the table for pregnant women- see below) all have evidence. 

Acne

Up to 42% of pregnant women suffer from acne and 90% of these women had acne before they got pregnant often after a reasonable period of decent skin. Believe it or not we still don’t know exactly why it happens. There are theories about hormone levels, changing bacterial microbiome on the face and altered immune system. But they remain theories at this point. 

How to combat it;

The basics

  1. Cleanse your skin with a gentle cleanser. Avoid facial scrubs, astringents or toners and masks, that can tend to irritate your skin, and make your acne worse. Pat your skin dry gently, don’t rub your face too hard with a towel!
  2. Don’t pick or squeeze pimples. That’s just a recipe for infection and possibly scarring.
  3. Avoid greasy moisturizers, sunscreens, and foundation that block pores and create a paradise for bacteria and zits. Use oil free products, sometimes labelled “noncomedogenic”, which means they are less likely to cause acne.

Treating acne in pregnancy is often fraught because so many of the products we usually recommend for acne can’t be used in pregnancy (see below). Here are ingredients you can use: 

  1. Antibiotics applied directly to the skin 
  2. Azelaic acid 
  3. Niacinamide 
  4. Alpha Hydroxy Acids
  5. Benzoyl peroxide (liked by some but it can dry out the skin and get all over your pillow case and sheets so I am NOT a fan!)
  6. Blue-violet or red light phototherapy might be useful additions

Acne treatments to avoid during pregnancy

There are lots of acne treatments that must be avoided. Spironalactone (a type of diuretic),  hormonal treatments, oral antibiotics (specifically tetracyclines, co-trimoxazole and fluoroquinolones,) and both oral Vitamin A (retinoids) and vitamin A skincare products should be avoided.

Itch

Lots of people feel itchy when pregnant. There are a few causes. But one we doctors worry about is intrahepatic cholestasis of pregnancy which happens in 1 in 1000 pregnancies. This is a liver disorder where bile builds up in the liver, damaging the liver. It tends to happen in the third trimester of pregnancy and often leads to severe itching. It can also be very harmful for your baby. For this reason I think all women with a new itch in pregnancy must see a doctor. 

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References;

  1. https://www.acog.org/en/Womens%20Health/FAQs/Skin%20Conditions%20During%20Pregnancy
  2. https://www.aad.org/public/diseases/acne/derm-treat/pregnancy
  3. https://pubmed.ncbi.nlm.nih.gov/26957383/
  4. https://pubmed.ncbi.nlm.nih.gov/23657872/
  5. https://pubmed.ncbi.nlm.nih.gov/28070633/ 
  6. https://www.aad.org/public/diseases/acne/derm-treat/pregnancy
  7. https://piel-l.org/blog/wp-content/uploads/2014/02/tto-del-acne-y-embarazo.pdf 
  8. https://rarediseases.info.nih.gov/diseases/9804/index
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