Dermatology During Pregnancy

Toyin Falola
September 20, 2021

While plenty of the skin problems that pregnant women face cause distress, most luckily are not harmful to you or your baby. Pregnant women should be alert to when skin problems become a truly concerning problem that may indicate a deeper problem.

Skin conditions happen to a lot of pregnant women. Acne, rosacea, stretch marks, rashes, and flushing are things women may encounter. Melasma even is nicknamed "the mask of pregnancy” because it is often triggered by pregnancy hormones.  

Whether a woman develops a skin condition during pregnancy or already had one before getting pregnant, her big question becomes, “What treatments are safe to use?”

While the prevailing cultural wisdom — and even some opinions in the medical establishment — might make it seem like you need to forego treatment out of an abundance of caution for the baby, this is a short-sighted and unfair view. There are lots of treatments that are safe to use when you’re pregnant and can really help get you feeling better.  Of course, this should all be done with the guidance of your obstetrician and a board-certified dermatologist.

Common pregnancy skin problems

Acne

Acne is by far the most common skin-related complaint of pregnancy women—up to 42% of pregnant women get acne. Some treatments are definitely not safe and should be avoided, including Accutane, isotretinoin, tazarotene, and spironolactone among others. Safe options include the topical version of the antibiotic clindamycin, azelaic acid, benzoyl peroxide in limited amounts, and salicylic acid. Some of these can be found over-the-counter, but it is best to consult with a dermatologist before starting any treatments.

Stretch marks

Stretch marks are caused by the rupturing of collagen and elastin as the skin grows or shrinks quickly; hormones also affect their development. They are permanent and while they fade considerably with time, there are treatments that can make them less noticeable.

Rosacea

Rosacea is a skin condition that causes flushing, blushing, small red or pus filled bumps and visible blood vessels in the skin of the face. Some women might develop rosacea or see their pre-existing rosacea worsen during pregnancy. While some rosacea treatments aren’t suitable for pregnancy, a dermatologist should be able prescribe multiple treatment options that are safe to use.

Rashes

Women can get rashes that cause dry, red, irritated and itchy skin. Over-the-counter moisturizing creams, anti-itch lotions, and soothing oatmeal baths may help. These treatments can help sooth mild rashes, though pregnancy-induced rashes can get more troublesome. For example, dyshidrotic eczema will give you uncomfortable itchy fluid filled small blisters on your hands and feet. If you need an evaluation and potentially a treatment for something like this, your dermatologist will likely be able to prescribe an option that’s safe for pregnancy.

Melasma

Melasma is a common skin condition that causes pigmented grey-brown patches to appear on the cheeks, nose, chin, above the upper lip and the forehead; they are typically symmetric.  Women are more likely to get melasma. Melasma often develops and worsens during pregnancy likely due to hormonal changes. It can be hard to treat, especially during pregnancy as some lightening creams such as, hydroquinone, are not safe to use. One of the most common treatments is sun protection-- using broad spectrum SPF 30+ sunscreen, wearing wide-brimmed hats when outdoors, seeking shade are key.  Using gentle skin care products on the face is also important as facial irritation may worsen the pigmentation. Melasma can fade on its own. If note, seeing a board-certified dermatologist to discuss various treatment options can help.

PUPPP

Pruritic urticarial papules and plaques of pregnancy (PUPPP) is an extremely itchy rash that typically occurs in the third trimester or immediately after birth. It is the most common dermatologic condition occurring in pregnancy. The rash starts with small bumps around stretch marks on the stomach that spreads which may develop into patches of raised skin (plaques). Ruling out other potential causes of rashes in pregnancy, and treatment should be done in consultation with a physician.  

When to worry

While plenty of the skin problems that pregnant women face cause distress, most luckily are not harmful to you or your baby. Pregnant women should be alert to when skin problems become a truly concerning problem that may indicate a deeper problem.  

Some worrisome signs and symptoms are:

  • Rash that won’t go away, spread, or worsen over time
  • Full-body itching
  • Fluid-filled blisters all over your body
  • Swelling of your hands or feet  

If you start experiencing any of these issues, see your doctor immediately.  

A dermatologist’s advice  

As a dermatologist who often treats the skin problems of pregnant women, I have some standard advice I often give:

  • Moisturize your skin every day with a thick over the counter fragrance-free moisturizer
  • Practice excellent sun protection
  • Use hypoallergenic , gentle skin care products
  • See a board-certified dermatologist when needed
  • And finally… be kind to yourself

While caring for your unborn child is a serious job, it’s not one that requires you to sit in discomfort or embarrassment by neglecting to search out safe treatments for skin problems. There are many safe options out there, and a trained dermatologist will be able to help you pinpoint the one that’s right for you.

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