Although skin changes in pregnancy may be a cause of concern for the expectant mum, most are perfectly normal physiological responses, dermatology expert Julie Van Onselen offers reassuring advice on some common ones:
Pregnancy causes a variety of skin changes, which, in the majority of cases, are a normal physiological response. Existing inflammatory skin conditions, such as eczema and psoriasis, can also change in pregnancy, sometimes improving and sometimes deteriorating.
Any healthcare professional seeing a mother during her pregnancy needs to provide her with an explanation of visible skin changes during pregnancy to offer reassurance and suggest measures to improve skin comfort.
It is also important for the health professional to know which skin changes are normal physiological changes and which may be a dermatosis specific to pregnancy. Normal skin changes in pregnancy can be divided into five categories:
| |
Skin care advice |
Cautions |
| Pigmentary changes |
Melasma: Use sun protection (SPF30) and a sun
hat, as sun exposure will increase melasma. |
Check changing and new moles in
pregnancy. Refer to a dermatologist if
changes are suspicious.
|
| Vascular changes
|
Palmar erythema: moisturise palms with a
medical emollient, keep cream in fridge so it
is cooling.
Gingivitis: diligent oral hygiene, antiseptic
mouth washes after eating and local
anaesethic mouth gels for ulcers.
Varicose veins: support stockings and
elevate legs when resting.
Haemorrhoids: high fibre diet, lactulose, avoid
straining and non-steroidal rectal cream
|
Calf pain should be immediately
investigated as DVT may occur in
pregnancy.
|
| Hair and nail changes
|
Increased facial hair: can be removed with
facial depilatory creams and electrolysis.
|
Investigate and refer women with
hirsutism and acne, developing in second
trimester.
|
| Sweat and sebaceous gland changes |
Increased sweat gland activity: keep cool
and try not to overheat.
|
|
| Connective tissue disruption
|
Stretch marks: can’t be prevented as they
originate in connective tissue; reassure that
they will eventually fade to white
|
|
Changes with existing inflammatory skin conditions
Pregnancy can improve some inflammatory skin conditions but others are unpredictable. Atopic eczema is very variable in pregnancy; in the post natal period, nipple and hand eczema are often exacerbated. Psoriasis often improves in pregnancy but will generally relapse in the post partum period.
Women with systemic lupus ertythematous generally cope well with pregnancy but a few may develop renal problems. Cutaneous lupus does not appear to be affected by pregnancy. Women with scleroderma can often improve, but again renal deterioration with pre-eclampsia and hypertension is a risk of pregnancy.
The health professional has an important role in the provision of skin care in pregnancy. The skin changes discussed in this article are generally normal physiological responses. However, many women will still become anxious about them, and for some they may cause added discomfort in pregnancy. The healthcare professional can provide invaluable support by providing reassurance and skin care advice as well as being aware when a skin change requires further investigation.
To read part 2 of Julie's advice, focusing on skin conditions unique to pregnancy, subscribe to JFHC magazine here.