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DELIVERING THE FACTS: PREGNANCY TAKES ITS TOLL ON THE SKIN
SCHAUMBURG, IL (February 9, 1999) - During pregnancy, a woman's body experiences many changes which make her particularly susceptible to skin, hair, and nail disorders. Depending on the symptoms and their severity, these skin conditions can affect the health of both the mother and her baby.
"Skin problems during pregnancy are very common," stated Samantha Vaughan Jones, M.D., St. Peter's Hospital, Chertsey, Surrey, United Kingdom, author of "Pregnancy Dermatoses" published in the February 1999 issue of the Journal of the American Academy of Dermatology. "While simple treatments such as soap substitutes, bath oils, topical steroids, and antihistamines are safe and can be extremely effective at reducing the symptoms of the most prevalent skin conditions during pregnancy, the more uncommon conditions can be dangerous if not diagnosed promptly. These conditions need to be taken seriously -- pregnant women who experience their symptoms should consult their dermatologist."
Common Skin Conditions Of Pregnancy
Pruritus, itching, is one of the most common skin problems that occurs during pregnancy. "If itching persists beyond the first trimester, is severe and interrupts sleep, or develops into a rash, the pregnant woman should see her dermatologist," advised Dr. Vaughan Jones.
Ninety percent of women experience hyperpigmentation during pregnancy. The increase production of melanoctye-stimulating hormone causes the darkening of the skin especially on the nipples and pre-existing moles. In addition, many pregnant women develop linea nigra, a line down the abdomen, in the first or second trimester. While there is no treatment for hyperpigmentation and linea nigra, they usually disappear after pregnancy. "Pregnant women should be especially cautious that they do not confuse hyperpigmentation with a melanoma," stated Dr. Vaughan Jones. "If you have a dark mole, make sure that it is examined by a dermatologist."
High estrogen levels cause 70 percent of pregnant women, as well as women taking oral contraceptives, to develop melasma, the darkening of the face. Melasma is common on the upper cheekbones and worsens with sunlight exposure. If melasma persists after pregnancy, Dr. Vaughan Jones recommends depigmenting creams be used to reduce its appearance.
The increase in steroid level and the stretching of the abdominal wall causes 90 percent of pregnant women to develop striae distensae, stretch marks on the lower abdomen. During pregnancy, these lines are very red, but fade to silvery white after the baby's birth. Striae distensae is also common in adolescents going through puberty and individuals who suddenly gain or lose weight. "While striae distensae can be treated with lasers after pregnancy, it is very difficult to treat and can be permanent," Dr. Vaughan Jones said.
Women may experience other physical changes during pregnancy including brittle nails, hairiness (hirsutism) on the face, limbs, and back, and excessive sweating (hyperhidrosis). In addition, increased sebaceous gland activity often causes acne in the third trimester while increased estrogen levels may cause spider nevi, spider veins of the face, to develop as the blood vessels dilate.
Uncommon Skin Conditions of Pregnancy
Impetigo herpetiformis and intrahepatic cholestatis of pregnancy are two skin conditions that develop only in pregnancy. Treated with oral steroids, impetigo herpetiformis is characterized by red patches of skin with pimples, fever, diarrhea, and vomiting. While it generally occurs in the third trimester and tends to persist until delivery, it may reoccur in a more severe form in subsequent pregnancies. "Pregnant women with impetigo herpetiformis have an increased risk of stillbirth, neonatal death, and fetal abnormalities," reported Dr. Vaughan Jones. "In addition, death can occur from heart or kidney failure. In severe cases, termination of the pregnancy may be required."
Thought to be induced by high levels of estrogen, intrahepatic cholestasis of pregnancy (ICP), or obstetric cholestasis (OC) as it is now known, is another condition that occurs in pregnancy as well as women who subsequently take oral contraceptives. ICP is characterized by severe itching in the third trimester. In addition, jaundice may occur and malabsorption of fat may lead to weight loss and vitamin K deficiency in severe cases. Mild cases can be treated with antihistamines or emollients, but severe cases require other treatments. "Early diagnosis is critical to prevent fetal complications which are particularly seen after 38 weeks gestation," stated Dr. Vaughan Jones. "After this stage, the risk of stillbirth, pre-term delivery, neonatal death, and fetal abnormalities significantly increases and many obstetricians now advocate elective early delivery before 38 weeks."
Polymorphic eruption of pregnancy (PEP), pemphigoid gestationis, prurigo of pregnancy, and pruritic folliculitis (PF) are specific dermatoses of pregnancy which generally occur in the second or third trimester. Each of these dermatoses begins with itching, progresses to a rash, and is usually treated with topical steroids and antihistamines.
PEP, the most common specific dermatosis of pregnancy affecting between 1 in 160 to 300 women, is characterized by itching which begins on the abdomen and subsequently spreads to the breasts, upper thighs, and arms. "It is most prevalent in women during their first pregnancy and is thought to arise because of maternal weight gain although this has not been proven," Dr. Vaughan Jones said. "While its incidence is increased in a multiple pregnancy, recurrence in later pregnancies is unusual."
Pemphigoid gestationis, a rare (1 in 60,000) autoimmune disease, is the most severe of the specific dermatoses of pregnancy and often recurs with increased severity in subsequent pregnancies. Pemphigoid gestationis is characterized by blistering and is often treated with oral steroids. In approximately 10 percent of the cases, the baby may temporarily experience mild blistering. "Women with pemphigoid gestationis have a higher incidence of low birth weight babies, premature delivery, and stillbirth," reported Dr. Vaughan Jones. "In addition, pemphigoid gestationis can be triggered by oral contraceptives and the menstrual cycle, so patients who have had a pregnancy affected by this condition need to be counseled carefully."
The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership over 11,000 dermatologists worldwide, the Academy is committed to: advancing the science and art of medicine and surgery related to the skin; advocating high standards in clinical practice, education, and research in dermatology; supporting and enhancing patient care; and promoting a lifetime of healthier skin, hair, and nails. For further information, contact the AAD at 1-888-462-DERM or www.aad.org.
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