Pregnant? Shouldn't your skin be glowing?

While some women seem to develop a glow about them when they are pregnant, others are not so fortunate. Your skin is the largest organ in your body, so it’s no surprise that it undergoes changes when you are pregnant. Most skin changes in pregnancy are mild, or even harmless, and will resolve once you have given birth. 

Acne, eczema or psoriasis may worsen in pregnancy. On the positive side psoriasis often improves and acne can also improve in the third trimester. If you had these conditions before you were pregnant, it is a good idea to see your GP or dermatologist when you discover you are pregnant, to review your treatment.

This article touches on some of the skin changes that women may experience when they are pregnant:

• itchy dry skin
• stretch marks
• mask of pregnancy
• linea nigra
• spider veins
• obstetric cholestasis
• pyogenic granuloma
• pruritic urticarial papules and plaques of pregnancy (PUPP)
• pemphigoid gestationis.

Itchy dry skin

Your skin has to stretch to accommodate your growing baby. In addition, hormonal changes in your body can make your skin drier and more sensitive. Eczema is a common cause of itchy, dry skin in pregnancy. In pregnancy, it may start or worsen due to changes in the way the immune system works. 

• Try having a shower instead of a bath and reduce the number of times you bathe.
• Keep cool as much as possible, as overheating can aggravate the itching.
• Substitute your soap or shower gel for a soap-free cleanser.
• Wear soft, smooth clothes and avoid wool, which can irritate already itchy skin.
• Use a moisturising lotion, cream or ointment to protect your skin.

Other causes of itchy skin can be PUPP or obstetric cholestasis (see below).

Stretch marks

Stretch marks happen when the skin’s middle layer - the dermis - is stretched a long way, quickly, or over a long period of time. Developing stretch marks may be hereditary so it can be helpful to know if your mother or grandmother had them. They will fade over time, but you may wish to try using creams or oils to minimise their appearance.

Some people argue that, if you are going to get stretch marks, you will get them regardless of what you put on your skin. If you decide you want to use a stretch mark product, you should start doing so long before they appear and check it is safe to use in pregnancy. Areas to focus on are your abdomen, breasts, legs and arms.

Mask of pregnancy

Also known as melasma or chloasma, the mask of pregnancy is a blotchy, brownish area that appears on the face. Chloasma can have a number of causes and pregnancy is just one of them. It comes on slowly during pregnancy and may fade with time after giving birth. 

If you develop skin pigment changes on your face:

• try to stay out of the sun as much as possible  
• use a high sun protection factor (SPF) sunscreen year-round  
• use mild cleansers to reduce any drying or irritation.

Linea nigra (dark line down your abdomen)

Linea nigra - simply meaning ‘dark line’ - this harmless mark of pregnancy does not appear on every woman’s stomach. It is more likely to show in women with darker skin. 

Linea nigra usually occurs around the second trimester of pregnancy, when the muscles in the abdomen stretch and separate slightly to accommodate a woman’s growing bump. A pigment called melanin marks appears where the separation has occurred. The line generally disappears within a few weeks of giving birth.

Spider veins or angiomas

When pregnant, your body pumps more blood around your body to meet the needs of you and your baby. That can place the blood vessels under some strain and cause some of the smallest vessels – the capillaries – to leak or burst, resulting in a small area of fine red or purple lines. 

The most common place for spider veins is on the face, an area more likely to be exposed to extremes of temperature. Although spider veins fade with time, you can minimise them by protecting bare skin from very hot or very cold conditions.

Obstetric cholestasis

A rare liver condition in pregnancy, known as obstetric cholestasis, is identified by intensely itchy skin. The itchiness is most common on the palms of the hands and soles of the feet but can spread to the rest of the body. There is no rash but other symptoms can include dark-coloured urine, pale stools and jaundice or yellowing of the skin. You may feel generally unwell or lose your appetite. If you experience these symptoms you should consult your lead maternity carer or GP. 

Pyogenic granuloma

About 5% of pregnant women develop a benign skin growth called pyogenic granuloma. The most common place is in the mouth, although one may also appear on the head, neck, upper trunk, hands or feet. Starting as small, red, brown or blue-black spots the size of a pinhead, these lumps grow quickly over a few days or weeks. They can grow to 2cm in diameter or, less commonly, as big as 5cm. 

While it is noncancerous, a pyogenic granuloma can be unsightly, uncomfortable and can bleed profusely if knocked. This type of skin growth generally disappears after the baby is born. If not, it can be removed. This is also an option while you are pregnant, if it is causing you problems.

Pruritic urticarial papules and plaques of pregnancy (PUPP)

This long name refers to a condition that is thought to result from rapid stretching of the skin. Another name for it is polymorphic eruption of pregnancy. 

More common in first-time mothers and those carrying more than one baby, the condition usually comes on in the third trimester. Small, itchy, red bumps usually start near the stretch marks around your belly button. They may have a white halo around them. Gradually, they join up to form raised patches and may spread to your thighs, buttocks, arms and legs.

Your lead maternity carer or GP will be able to advise you on treatment, which may include a cream or ointment to protect the skin, a steroid cream or an antihistamine.

PUPP usually disappears once your baby is born.

Pemphigoid gestationis

Pemphigoid gestationis is a rare skin condition associated with pregnancy. It has also been called herpes gestationis, although it has nothing to do with the herpes virus. It is caused when your immune system begins to react against your own body tissue.

The condition usually begins in the second or third trimester with itchy, red bumps – a bit like hives – around the belly button. The rash spreads to other parts of the body, including the trunk, legs and arms. Fluid-filled blisters or raised red patches form after two to four weeks. 

In most women, the rash disappears once her baby is born. In a few cases, it flares up with future pregnancies, menstrual periods or oral contraceptive use.

If you have these symptoms you should talk to your lead maternity carer or GP, who may refer you to a dermatologist.

Original material prepared by everybody and kindly reviewed by dermatologist Dr Julie Smith, April 2009. (With thanks to ‘everybody communities’ members ‘Angela’ and ‘anonymous’ for the use of their photos of stretch marks and linea nigra.)