About Pregnancy and Changes in the Skin

Pregnancy brings major changes to a woman’s body. As the baby grows, the secretion of the hormones estrogen and progesterone increases sharply, the volume of blood circulating through the body rises, and the workings of the immune system are partly weakened so that the body does not reject the baby, which is essentially foreign.

With these changes, an existing skin condition may improve or worsen, and skin conditions specific to pregnancy may also appear. These tend to settle down on their own after childbirth, but you cannot simply endure them throughout a long pregnancy, and when your body is already having a hard time, having your skin out of sorts as well can be quite dispiriting.

At the same time, when it comes to treatment, the side effects of medications, and especially their effect on the baby, must be considered. When skin symptoms appear, we recommend consulting a dermatology specialist under the supervision of your obstetrician.

Main Skin Conditions Likely During Pregnancy and After Childbirth

From here, we explain skin conditions commonly seen during pregnancy as well as postpartum skin troubles.

Pruritus gravidarum (itching of pregnancy)

During pregnancy, strong generalized itching without any rash can appear; this is called pruritus gravidarum. It can also occur in association with cholestasis, in which case it is characterized by itching of the hands and feet that becomes worse at night in particular.

When cholestasis is suspected, there are concerns about effects on the fetus, so prompt contact with your obstetrician is needed. (More often, it may be your obstetrician who detects this condition.) In dermatology, while considering side effects and effects on the baby, we ease symptoms using topical agents such as steroids and moisturizers and oral antihistamines.

Treatment: topical (moisturizers, steroids), oral (antihistamines)

Prurigo of pregnancy

In early to mid-pregnancy, small red bumps appear on the arms, legs, and trunk, accompanied by strong itching. Scratching them open can cause bleeding or scabbing. It often occurs in second and subsequent pregnancies, and some women get it with every pregnancy. There is no effect on the fetus. It is a condition that often improves and resolves on its own after childbirth. Treatment centers on topical steroids and moisturizers, with oral antiallergic medication and, when symptoms are strong, oral steroids; but because long-term oral steroids pose a side-effect problem, they are kept to a short period.

Treatment: topical (moisturizers, steroids), oral (antihistamines, steroids)

Polymorphic eruption of pregnancy (PUPPP, PEP: pruritic urticarial papules and plaques of pregnancy)

In late pregnancy, hives-like redness and bumps with strong itching appear, centered on areas where stretch marks form, such as the abdomen, buttocks, and thighs. They can spread to the arms, legs, and trunk, but do not appear on the navel. It is said to be especially common in first pregnancies and multiple pregnancies.

There is no effect on the fetus, and it often resolves on its own within a few days after childbirth. Treatment, while considering side effects and effects on the baby, consists of topical steroids and moisturizers and oral antiallergic medication.

Treatment: topical (moisturizers, steroids), oral (antihistamines)

Pemphigoid gestationis

Also called herpes gestationis. It is an autoimmune skin condition in which red patches and blisters with strong itching suddenly appear from the second trimester onward.

Autoantibodies are formed against a structure called the “basement membrane” at the bottom of the epidermis, making the skin prone to separating and forming blisters.

It typically begins around the abdomen and spreads to the arms, legs, and trunk. It is common in older pregnant women and recurs and worsens with each pregnancy. Rarely, the newborn or a low-birth-weight baby may show symptoms, but these fade on their own in a short time. Care needs to be provided in cooperation between dermatology and obstetrics.

Treatment centers on topical and oral steroids, with antihistamines added for itching. Symptoms often gradually settle down after childbirth.

Treatment: topical (steroids), oral (steroids, antihistamines)

Pyogenic granuloma (granuloma of pregnancy)

Triggered by a minor injury, or with no identifiable cause, a red, raised growth can form on the fingertips, lips, gums, and the like. This is a benign vascular lesion called a pyogenic granuloma. It can occur even when not pregnant, but during pregnancy the increased hormone estrogen makes this growth more likely. It sometimes shrinks and disappears on its own after childbirth, but it can also bleed heavily and be a nuisance, in which case it may be treated by freezing with liquid nitrogen, surgical excision, burning off with an electric scalpel, or vaporizing with a carbon dioxide laser.

Treatment: no treatment, liquid nitrogen cryotherapy, surgical excision, cauterization with an electric scalpel, vaporization with a carbon dioxide laser

Postpartum telogen effluvium (postpartum hair loss)

Hair normally follows a rhythm that repeats a growth phase of several years in which the hair grows, a regression (catagen) phase of two to three weeks in which the hair shrinks back, and a resting (telogen) phase of several months in which it stays put; this is called the hair cycle. During pregnancy, hormones lengthen the growth phase, but a few months after childbirth the hair all enters the resting phase at once, so hair shedding increases. It improves on its own over about 6 to 12 months and in most cases does not require treatment.

Hypertrophic scars and keloids after a cesarean section

After a cesarean section or an episiotomy, the redness of the scar may not fade and may instead thicken and become raised. If it stays in the shape of the original wound it is a hypertrophic scar; if it spreads beyond the area of the original wound into an irregular shape with itching or pain, it is called a keloid.

Treatment uses topical steroids (ointments, creams, or tapes) and local injections. As self-pay options, pulsed dye laser (V Beam II) irradiation or botulinum toxin injection (not possible while breastfeeding) may also be performed.

Learn more about hypertrophic scars and keloids

Learn more about the pulsed dye laser (V Beam II)

Treatment: topical steroids or local injection, pulsed dye laser, local botulinum toxin injection