I asked a former classmate who is now physician specializing in dermatology, for the lowdown on all those funky skin changes that occur during pregnancy, not the least of which is acne. And of course, while you’re pregnant it’s much harder to find a safe treatment. He was able to give a recommendation that you can find over the counter, as well as some solutions to ask your dermatologist about.
Dennis A Porto, MD | DennisAPorto.com
Pregnancy is beautiful. Your body remodels to make room for a new life. This new life grows with you and is born already in love with the mother it has never seen. During pregnancy, your body and your skin change. Some changes are expected and welcome, others less so. I hope that you can use this as a guide on your nine-month journey.
Normal skin changes in pregnancy can be divided into pigmentary changes, hair changes, vascular changes, and connective tissue changes. Almost all pregnant mothers will notice darkening pigmentation, at least in certain areas of the body. Most women will notice darker nipples. Up to 75% will develop a light brown vertical line called linea nigra that extends from the sternum through the belly button. While these causes of darkening usually resolve completely, melasma (common dark patches on the face in pregnancy) tends to be persistent. Many pregnant patients will notices that their moles become darker. While not alarming, it is important for any mole changes to be evaluated by a dermatologist. Although very rare, skin cancers during pregnancy do happen. In fact, pregnancy is a higher risk time for skin cancer.
Hair tends to grow thicker and darker in pregnancy. You will be able to grow your hair longer than before you were pregnant due to changes in the hair cycle that control the maximum hair length. You may also notice unwanted hair growth on the face, chest or elsewhere. This will go away after your pregnancy. Many mothers will notice thin hair about three months after delivery due to a phenomenon called telogen effluvium (TE). TE commonly occurs after any stressful event (psychological or biological) and is characterized by hair shedding. Your hair may come out in clumps when combing or you may find hair on your pillow in the morning. While a dermatologist can help, rest assured that TE will resolve and your hair will return to normal. Unfortunately, it can sometimes take a year to regain the normal thickness of your hair.
There are important vascular changes as well. Almost all women will notice swelling in their legs. Most women don’t do anything to treat this, although leg elevation and compression stockings can help. Sometimes, varicose veins can develop in swollen legs and this can be prevented with compression stockings. Your dermatologist might notice subtle changes like new tiny red vascular spots called spider angiomas or a slight reddening of your palms. These are both due to the presence of high estrogen levels during pregnancy and will diminish when your estrogen returns to normal.
Women often worry about developing stretch marks (also called striae) on their abdomens during pregnancy. Striae are unavoidable. Almost 90% of pregnant women will develop striae. There are numerous cosmetic products that claim to prevent striae. These have been studied extensively and do not work. If you are one of the many women who develops striae, see a cosmetic dermatologist for treatment after delivery. Using various vascular, ablative, and non-ablative lasers, we can make striae fade to the background.
A final concern that many women have is treating acne during pregnancy. Many young women have acne and it may improve or worsen during pregnancy. Unfortunately, there are very few options for treating acne during pregnancy. Women who could become pregnant should stop all acne medications. Even over the counter products can be unsafe. The three treatments that are regarded as safe are: azelaic acid washes, clindamycin lotions, and erythromycin lotions. Other oral medicines like doxycycline and minocycline are absolutely unsafe. If you have taken Accutane, you should be off the drug for at least one to two months before attempting pregnancy. If you plan to breast feed, you will need to talk to your obstetrician about whether to restart your acne medications.
With this knowledge, you should be cool and confident for your journey through pregnancy so that you can focus instead on your own wellbeing and the new life that you are bringing into the world. I’m happy that I could help along the way!
Dr. Porto mentioned that most of the options he recommended for acne during pregnancy are prescription only, but you can find some lower strength over-the-counter non-prescription azelaic acid products, like this one he sent me.