When I was pregnant, the most noticeable change in my skin was the dark line that ran through the center of my basketball-size stomach from the belly button to the pubic bone. It was very straight, natural looking, and, as it turned out, completely common.
But the appearance of this dark line (or hyperpigmented linea nigra, as it is called) took me by surprise. Like most pregnant woman, I was acutely aware of many of the changes taking place in my body: the extra pounds, the curve of the abdomen, the enlarged breasts. But I didn’t know that pregnancy could cause changes in the skin.
But it makes sense. The body goes through so many changes during pregnancy that it stands to reason that the skin, the body’s largest organ, is also affected. “Many of the normal physiologic changes that occur in the skin during pregnancy are related to hormonal changes such as the increase in estrogen and progesterone,” says Iris Aronson, MD, associate professor of dermatology at the University of Illinois at Chicago. Besides the normal skin changes of pregnancy, there are also a number of skin conditions that are unique to pregnant women.
The Normal Skin (and Hair) Changes of Pregnancy
As many as 90% of pregnant women experience some form of hyperpigmentation, or darkening of the skin, in specific areas of the body, according to Dr. Aronson. Besides the linea nigra, it is also common for dark areas of the body to become darker, such as the nipple and areola (the circular area that surrounds the nipple). The skin on the face may also darken, creating a “mask of pregnancy,” as it’s called.
The hair also changes during pregnancy. Some women experience an increase in hair growth during the first trimester. This growth typically occurs on the face, but also on the abdomen, legs, arms, and back. Dermatologists say this happens because the proportion of growing hair to resting hair is increased during pregnancy, mainly because of hormonal changes in the body. Some women experience hair loss on the head between 2 and 4 months after the baby is born. “It can take up to several months after pregnancy for the hair to get back to its normal growth to loss ratio,” Dr. Aronson explains.
Skin Conditions Related to Pregnancy
Several skin conditions are known to crop up during pregnancy. One of the most common is referred to as pruritic urticarial papules of pregnancy (PUPP). It often begins with small bumps that form in the stretch marks on the stomach. This then becomes a rash that can spread to the rest of the stomach, thighs, arms, and buttocks. Although most cases occur in the third trimester, it can flare up anytime during pregnancy. The rash is irritating for moms-to-be because it causes itching. Topical medications are often prescribed when the itching is very uncomfortable. Although the rash is not known to affect the baby, Dr. Aronson recommends monitoring the fetus with weekly nonstress tests.
Cholestasis of pregnancy may cause such severe itching that a rash created by scratching develops. The intense itching is caused by a buildup of bile acids. If a woman has intense itching during pregnancy, a physician will often perform a bile acid study to determine if this minor liver problem is the culprit.
Cholestasis of pregnancy disappears postpartum, but it can come back in subsequent pregnancies. Because cholestasis of pregnancy is associated with increased complications, women with the liver disorder and resulting rash may be closely monitored.
Herpes gestationis is a rare skin condition that is believed to occur in one in 50,000 pregnancies. Although it is called “herpes,” it is not related to the herpes virus. It most commonly begins in the second or third trimester, but it can start as early as the second week of pregnancy or as late as the postpartum period. The rash usually begins in or around the belly button, but it can also appear on the arms or legs and spread to the abdomen and thighs. Herpes gestationis can look like PUPP, but it differs in that the rash can form blisters. Once diagnosed, herpes gestationis is likely to occur again in later pregnancies. Some studies have found that the skin disorder causes babies to be born smaller than normal.
Medications for Pregnant Women
As most pregnant women know from their obstetrician, it’s a good idea to limit medications during pregnancy, especially during the first trimester of pregnancy, since this is when more of the baby’s development occurs. A physician will only prescribe medication for a skin condition if the rash or the itching makes the woman very uncomfortable. “Treating a pregnant woman can be difficult since we don’t want to harm the mother or the baby,” says Dr. Bridget Tooome, a dermatologist in private practice in Cherry Hill, New Jersey. If a woman is uncomfortable, over-the-counter antihistamines or low-dose topical cortisone can be prescribed. For severe cases, low-dose oral steroids are given.
Article By: Judith Zimmer, Medical Writer