What is it?As your pregnancy progresses you’ll probably experience some changes in your skin, which can materialize in pretty different ways but are generally related to the same underlying cause. Most of the skin changes you might experience are related to some dramatic increases in levels of various hormones throughout pregnancy. These hormone changes play incredible roles in the transformation your body is undergoing, but often lead to skin changes that you might not love. Some of these changes are often anticipated (like the possibility of stretch marks), and others are unexpected (like acne or melasma). Most skin changes during pregnancy are temporary, though, and typically resolve in the postpartum period. In the meantime, there are things you can do to manage and keep your skin feeling its best.
Types of skin changes
Common: Stretch Marks
Stretch marks are estimated to affect 50-90% of people during pregnancy and can appear on your belly, breasts, butt, and thighs as the supportive tissue under your skin rapidly stretches during pregnancy.Stretch marks are especially common during the third trimester when the belly tends to expand faster than your skin can accommodate.
What can I do about them?
There isn’t much you can do to prevent stretch marks, despite the robust market of products suggesting you can. Genetics and other factors (including stress levels, chronic use of steroids, and conditions like Cushing’s syndrome) appear to play a role in an individual’s risk of stretch marks, and products commonly touted as treatment for stretch marks (including olive oil, cocoa butter, and various other topicals have either not been shown to impact occurrence of stretch marks, or have low-quality and inconclusive research. However, there are things you can do to provide relief and comfort while your skin is going through these rapid expansion periods. Using oils and rich moisturizers, sometimes with reapplication throughout the day, can be soothing on your skin, especially since initially skin often feels tight and itchy and uncomfortable.
Common: Pregnancy “Glow”
Some people say that pregnancy brings out a rosy, dewy glow in their skin, commonly called “pregnancy glow.” For some people this is a real thing, typically caused by two factors:
- Increased blood flow: Your body's blood volume increases by 50% throughout pregnancy, which can increase circulation and lead to a rosier complexion.
- Increased oil production: Certain androgen hormones increase during pregnancy, which can increase oil production. Sebum (the skin's natural oils) can make your face appear slightly shiny or dewy.
Acne is common during pregnancy, and is most likely the result of fluctuating hormone levels. Progesterone, estrogen, and androgens can all cause acne, but androgens appear to play the biggest role because they increase your skin's oil production which can clog pores and lead to breakouts.
- During pregnancy acne can appear anywhere on your body, but it's most common on the face, chest, back, and shoulders.
- The severity of acne during pregnancy can vary from person to person. Some people may only experience a few mild breakouts, while others may have more severe acne.
What can I do about it?
Many common acne treatments are off-limits during pregnancy, so the main thing you can do to reduce acne is develop good skin care practices. If you experience pregnancy acne, consider taking these steps:
Tips to prevent acne and calm flares:
- Wash your face twice a day (and after exercising) using a mild cleanser and lukewarm water. Washing your face more often than that or using products with harsh ingredients like alcohol may dry out your skin and increase oil production.
- Avoid scrubbing your face or using harsh exfoliants, which can actually work to aggravate acne.
- Avoid touching your face with your hands or phone, as this can transfer oil and bacteria and potentially exacerbate acne. You can also periodically wipe down your phone screen as well.
- Avoid picking or squeezing acne, as that can cause inflammation and possible infection.
- Wash your pillowcases and sheets frequently. This reduces your skin’s contact with potentially acne-causing bacteria, oil, dirt, and hair product residue, which can clog pores.
Treatments that are not safe for pregnancy
- Vitamin A compounds like topical retinoids
- The oral medication isotretinoin
- Hormonal therapy such as oral contraceptives
- Oral tetracycline antibiotics
Common: Skin Sensitivity
Many people find their skin is more sensitive during pregnancy. You may notice increased redness, swelling, tenderness, or irritation in response to products, detergents, fabrics, jewelry, or sun exposure. You may even react to products you’ve been using for years.
Heightened skin sensitivity is thought to be caused by increased hormones during pregnancy, which may impact the immune system and its response to potential irritants. However, autoimmune-related skin conditions such as psoriasis have actually been shown to improve during pregnancy.
What can I do about it?
If your skin isn’t irritated or inflamed, you don’t need to make any changes. If it is, then it’s time to switch up your routine. Skin irritants differ from person to person, but consider the following tips to keep skin calm and clear:
- Consider choosing fragrance-free products to minimize sensitivity. Ask a dermatologist about hypoallergenic skincare and makeup products that may be less irritating. Note that the term “hypoallergenic” is not regulated, so seek recommendations from a professional and avoid relying on labels alone.
- Switch to a fragrance-free laundry detergent for your clothing, sheets, and bath towels.
- Decrease sun exposure by wearing hats and protective clothing and applying sunscreen to exposed skin.
- Consider using a mineral-based sunscreen. These contain ingredients such as zinc oxide or titanium dioxide that sit on top of your skin and physically block the sun instead of being absorbed.
Melasma or chloasma (sometimes called the “mask of pregnancy”) is a condition in which dark patches and freckle-like spots appear on the skin of your forehead, cheeks, nose, or upper lip. Melasma is most likely to appear on the face because that’s the area most commonly exposed to sunlight, and sunlight is known to trigger melanin production. This type of hyperpigmentation can occur in up to 20% of pregnant individuals, and it may worsen during summer months when sun exposure typically increases.
Like many skin issues experienced during pregnancy, melasma is caused by an increase in hormones — specifically progesterone, estrogen, and melanocyte-stimulating hormone — which increase the production of the skin pigment melanin by cells called melanocytes.
What can I do about it?
There is no way to completely prevent melasma from occurring, but you can take steps to prevent it from becoming severe. Because exposure to sunlight makes melasma worse, avoiding prolonged sun exposure and using broad-spectrum sunscreen may help. If dark patches appear on your face, they will typically fade after giving birth. Drugs commonly recommended for treating melasma in non-pregnant individuals (including tretinoin, hydroquinone, and corticosteroids) are not safe during pregnancy, but may be used postpartum if your melasma remains. Melasma typically fades naturally after giving birth, and with treatment disappears within a year.
Common: Linea Nigra
Linea nigra appears as a dark vertical line down the center of your belly during pregnancy. Specifically, it refers to the darkening of the linea alba, a thin fibrous tissue that runs down the abdomen. Not everyone will experience this, but if you do, it usually develops during the second trimester and may get darker as you get closer to your due date.
Similar to melasma, linea nigra is a form of skin hyperpigmentation that is believed to be caused by increased levels of progesterone, estrogen, and melanocyte-stimulating hormone. Sun exposure may also intensify or darken linea nigra.
What can I do about it?
This is considered one of the hallmarks of pregnancy, and there’s really nothing to do about it because it fades in postpartum. If it bothers you and you want to reduce its prominence, try to minimize sun exposure and use broad-spectrum sunscreen on the abdominal area.
Common: Spider veins and varicose veins
Spider veins are tiny red or swollen bluish veins that often appear on your legs but can also appear on other parts of your body, such as your face, neck, and arms. They change the appearance of your skin when they’re visible, but they’re painless.
- The greater volume of blood your body carries during pregnancy—and the increased pressure it puts on your blood vessels— may contribute to spider veins.
- Your growing uterus puts pressure on your blood vessels, particularly the veins in the lower half of your body. This pressure forces veins to work extra hard to circulate blood, which can result in the formation of varicose veins.
- Additionally, pregnancy hormones such as relaxin can relax your blood vessel walls and make them more vulnerable to the effects of this increased pressure.
What can I do about it?
Anything that promotes blood flow may improve the appearance of these veins. Here are a few ways to boost your circulation throughout the day.
- Avoid sitting or standing for long periods and sitting with your legs crossed, which promotes spider veins even when you’re not pregnant.
- Compression socks put mild pressure on your legs — with the greatest pressure on your ankles — to support upward blood flow through your veins with pressure. Avoid ones that stop immediately below your knee if you have swollen calves, as that can impact circulation.
- Regular exercise, even short walks throughout the day, can improve blood flow and promote overall health during pregnancy.
- Drink plenty of water. Staying hydrated helps make blood thinner and easier to circulate.
- If you have hemorrhoids (varicose veins in the rectum), ensure you consume plenty of fiber and fluids to promote regularity since constipation can worsen this condition.
Rare: Rash of hive-like bumps (PUPPP)
Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) is a rash identified by itchy, hive-like bumps that first appear on or near the stretch marks of your expanding belly and can then spread to your thighs, butt, breasts, and arms. It occurs in about 0.5% - 0.63% of pregnancies and typically develops in the third trimester. PUPPP rashes are most common in first-time pregnancies or when you’re carrying multiples. While this skin condition can be extremely irritating, it’s harmless to you and your pregnancy and usually resolves by six weeks postpartum.
- The exact cause of PUPPP is unclear, but several theories exist. One is that when the skin stretches, damage to the connective tissue can trigger an allergic type reaction. This could explain why the rash first appears in stretch marks.
- Another theory is that DNA from your baby migrates to other parts of your body, and your skin has an inflammatory response.
- Patients with PUPPP often have high levels of progesterone, so hormones may also play a role.
What can I do about it?
There is no way to prevent PUPPP because the definitive cause is unknown, but it typically goes away two to three months after giving birth. If the symptoms are bothersome during pregnancy, certain solutions are considered safe during pregnancy and may provide relief.
- First-line treatment is typically emollient and topical corticosteroid creams. Research suggests there is no association between typical-strength corticosteroid creams and adverse outcomes for your pregnancy.
- For significant itching and irritation that interferes with your quality of life, your healthcare provider may recommend an oral antihistamine. There are several antihistamines considered safe during pregnancy.
Tips to soothe a PUPPP rash
The following natural remedies and strategies may also soothe a PUPPP rash, although there is no official research on their effectiveness:
- Taking cool baths or showers
- Taking baths with oatmeal or baking soda
- Applying cold compresses to your skin
- Applying aloe vera or fragrance-free lotion
- Wearing loose cotton clothing to avoid further irritation
Severe itching on palms, feet and abdomen (ICP)
Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder in which the normal flow of bile acids from the liver to the gallbladder and intestines is impaired. This causes bile acids to build up in the liver and eventually leak into your bloodstream, which causes severe itching but no rash. Itching initially occurs in the palms of your hands and soles of your feet but can also spread to your belly. Some research suggests that nausea and vomiting may also be more severe among people with this condition.
ICP is most common in the third trimester among people of South Asian, South American, and Scandinavian ancestry and goes away once you give birth. ICP can increase the risk of pregnancy complications, so appropriate monitoring by your healthcare team is important. Your healthcare provider may recommend induction of labor before your scheduled due date, depending on your blood work.
What can I do about it?
There is no known way to prevent ICP. Because it can cause potential complications for your pregnancy, it should be closely monitored by your healthcare provider. Be sure to mention any new itching during your visits. Your doctor may also prescribe a medication to improve liver function and reduce levels of bile in the blood, which can also reduce itching. Topical anti-itch creams may offer some relief. A healthcare provider can determine whether you should use topical medications and at what dose and frequency. Typically, ICP resolves within six weeks after birth.
When should I be worried?
Most skin issues that occur during pregnancy aren’t serious and carry no risk to you or your baby. There are exceptions, however — like intrahepatic cholestasis of pregnancy (ICP) — and if you notice any concerning changes or have questions, bring them up with your healthcare provider as soon as possible. Don’t wait until your next prenatal appointment. If you treat any condition with over-the-counter medications, you should always check with your healthcare provider first to avoid potential complications. Many skin changes will disappear or stop progressing after you give birth. However, some skin changes, such as stretch marks, may be permanent. If they bother you, talk to a dermatologist about methods to treat them, minimize their appearance, or remove them.