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The skin in pregnancy
All skin conditions may arise in pregnancy, and pre-existing conditions may worsen or improve. Treatments must also account for the health of the unborn baby, and advice sought if safety is uncertain.
The skin during pregnancy
The changes in the skin during the pregnant state can be categorized as physiological changes due to endocrine effects, the effects of stretching, and the effects of the alteration in immune function of pregnancy on skin disease. Some dermatoses are pregnancy-specific and some are exacerbated by pregnancy.
Normal physiological effects arise in most pregnancies, and are consequences of the endocrine changes. These effects include pigmentary alterations, hair and nail changes, vascular proliferation and sebaceous gland activity.
Pigmentary changes
Generalized, mild hyperpigmentation is common in pregnancy but may be accentuated in specific sites including groins, flexures and especially in the abdomen midline (linea nigra). Melanoocytic naevi may also darken and sometimes enlarge. Hyperpigmentation generally recedes postpartum, but some changes e.g. vulvar melanosis may persist. Melasma is also common and exacerbated by sun exposure ( Chapter 42 ). Hypopigmented, pinkish, linear changes are frequently noted in later pregnancy, and their location at sites of enlargement on the breasts, thighs and abdomen has led to the name ‘stretch marks’ (syn. striae gravidarum). Histologically, the dermal elastin and collagen fibrils are disorganised and likely contribute to the weakened tensile strength. Over time the lesions fade to eventually become pale, often shiny, atrophic linear changes (striae alba) that are permanent. Despite widespread use of emollients and oils to reduce striae during pregnancy, little evidence exists that this is effective.
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