During pregnancy, your body will go through a multitude of changes. While many of those changes are internal, some are more prevalent physically, including skin conditions that may arise. There are many common skin conditions that can occur during pregnancy and most of them disappear postpartum. Most common skin conditions can be broken down into three categories: hormone-related, preexisting, and pregnancy-specific.
Hormone-Related Skin Conditions
Many skin conditions that women will experience during pregnancy are due to hormonal changes that the body goes through. Pregnant women experience sudden and dramatic increases in estrogen and progesterone, in addition to a number of other hormones. Some of the most common hormone-related skin conditions include hyperpigmentation, stretch marks (or striae gravidarum), vascular changes, and changes to your hair and nails.
Dark patches or spots that appear on the skin are known as hyperpigmentation. Hyperpigmentation is caused by an increase in naturally occurring melanin. Regularly, hyperpigmentation will resolve itself after delivery, but in some cases, it may take several years until it disappears completely. Melasma or “pregnancy mask” is an example of hyperpigmentation that appears as brown spots on different features of the face. Limiting sun exposure during pregnancy can help reduce melasma symptoms.
Stretch Marks (Striae Gravidarum)
Striae Gravidarum, best known as stretch marks, is one of the most common skin conditions associated with pregnancy. Stretch marks affect nearly 8 out of 10 pregnant women. The first sign of stretch marks comes with itchiness as the skin begins to thin. Stretch marks are not harmful and have no medical problems related to them. The most common areas for stretch marks include the stomach area, upper thighs, and breasts. While stretch marks affect almost every pregnant woman, the timing and severity of the stretch marks can differ from person to person. After birth, stretch marks tend to turn a silver or white color, making them less noticeable. There is very limited evidence about whether oils or creams help prevent stretch marks from appearing in the first place.
Changes in the body’s estrogen levels can contribute to vascular changes in pregnant women. Some of the vascular changes related to pregnancy include an increase in blood volume, telangiectasias (or spider veins), and more visible discoloration. Most of these conditions regress postpartum.
As your baby grows, the total amount of blood in your body also increases. Blood plasma increases 40-50%, while red blood cell mass boosts 20-30%. Telangiectasias, or more commonly referred to as spider veins, occur commonly in pregnant women because the increased volume of blood you're carrying creates heightened pressure on your blood vessels. The increase in blood volume, and vasomotor instability, can lead to facial flushing, hot and cold sensations that may lead to bluish skin, and an exaggerated response to cold conditions.
Hair and Nail Changes
Hair and nail changes are very common during pregnancy. Some women either experience an increase or decrease in the growth and production of hair. Many women experience some type of hirsutism, or excessive hair growth, on different parts of their body. While it may be annoying, there is no harm associated with additional hair on the stomach, arms, face, or any other body part. Nails also tend to grow faster during pregnancy. Pregnant women may also experience brittle nails, groove formation, or separation of the nail from the nail bed. Many of these conditions subside after birth, but good nail care is always recommended throughout pregnancy to reduce the severity of these issues.
Preexisting Skin Conditions
Preexisting skin conditions such as acne, psoriasis, and atopic dermatitis, can have unpredictable effects during pregnancy. Acne can oftentimes worsen during the first and second trimesters. This is due to an increase in hormones called androgens. Androgens can cause the skin to grow and produce more sebum, which is an oil-like substance that can clog pores, leading to breakouts. Women who experience breakouts during their menstrual periods are more likely to experience acne while pregnant.
Psoriasis, on the other hand, is more likely to improve than worsen while pregnant. Due to a rise in the hormone progesterone dampening the overactive immune response that triggers psoriasis symptoms, up to 60 percent of women see improvement in their psoriasis during pregnancy.
Atopic dermatitis, also known as eczema, can improve or worsen during pregnancy. According to a study published in The BMJ, eczema flares are the result of different environmental and internal triggers, and pregnancy appears to be one of those triggers. Talking to your clinician about strategies to minimize disease activity at baseline before conceiving can prove beneficial.
Pregnancy-Specific Skin Conditions
There are a few inflammatory skin conditions, or types of dermatoses, which are seen only in pregnant women. Some of the most common pregnancy-specific skin dermatoses are pruritic urticarial papules and plaques of pregnancy (PUPPP), prurigo of pregnancy (PP), intrahepatic cholestasis of pregnancy (ICP), and pruritic folliculitis of pregnancy (PF).
Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
Pruritic urticarial papules and plaques or PUPPP affects less than 1 percent of pregnant women (about 1 in 160 to 300), yet it's the most common pregnancy-specific skin condition. PUPPP first appears as small, raised spots that look like pimples and can grow into larger patches of a hive-like rash. PUPPP can be extremely itchy, but usually resolves itself within a few days after delivery. Those suffering from PUPPP can look to aloe vera gel or an oatmeal bath for calming relief from the itch.
Prurigo of Pregnancy (PP)
Prurigo of Pregnancy has been reported in all trimesters and occurs in approximately one out of 300 pregnancies. Prolonged PP can last for weeks or sometimes months and is viewed as a benign, pruritic papular rash. There is no cause directly related to prurigo of pregnancy and relief can be found with topical steroids or oral antihistamines.
Intrahepatic Cholestasis of Pregnancy (ICP)
Intrahepatic Cholestasis of Pregnancy (ICP) is most commonly seen in the third trimester. ICP is a condition that impairs the release of a digestive fluid called bile from liver cells, leading to impaired liver function. This condition can cause severe itchiness first on the palms of the hands and the soles of the feet, before spreading to other body parts. ICP can disappear after the delivery of the baby once bile flow returns to normal. This condition is associated with a higher risk of premature delivery, meconium-stained amniotic fluid, and intrauterine demise, so careful monitoring is recommended once diagnosed.
Pruritic Folliculitis of Pregnancy (PF)
Pruritic folliculitis of pregnancy is rare in pregnant women and the cause is still unknown. PF is described as papules and pustules on the torso that can then spread throughout the body. Similar to other pregnancy-specific conditions, pruritic folliculitis of pregnancy usually disappears postpartum. PF usually occurs in the second and third trimesters of pregnancy and affects an estimated one in 3,000 pregnancies. However, there is a common occurrence of underreporting pruritic folliculitis because it may be mistaken for acne or microbial folliculitis.
Other Changes That Come with Pregnancy
Your skin isn't the only thing that changes with pregnancy, your body weight, nutritional needs, and mental health all go through changes while pregnant. Growing a healthy baby while staying healthy yourself requires you to be responsible for your nutrition, weight, and fitness.
Have Additional Questions About Skin Conditions During Pregnancy?
Dr. Errick Y. Arroyo, MD is a physician at Kansas City ObGyn. He received his medical degree from the University of Kansas School of Medicine and has been practicing for more than 20 years. He is married and has two teenage daughters.