Cutaneous Manifestations of Pregnancy

OVERVIEW

During pregnancy, hormonal shifts may result in physiologic alterations in the skin, hair, and nails. Many of these changes are seen so frequently, that they are considered to be normal. Pregnancy can also alter the course of certain preexisting skin conditions and systemic diseases that have cutaneous involvement, for example:

Systemic lupus erythematosus and scleroderma may flare.
Acne may improve, or it may worsen.
Dyshidrotic eczema may appear de novo, or a flare-up of preexisting lesions may occur.
Condylomata acuminata may enlarge considerably and may proliferate.

It should always be kept in mind that common skin diseases unrelated to pregnancy should also be considered when evaluating a pregnant patient with a skin disorder.

PHYSIOLOGIC CHANGES DURING PREGNANCY

Hyperpigmentation

Distinguishing Features

Darkening of the linea alba which then becomes the linea nigra (Fig. 23-1)
Darkening of the nipples and surrounding areolae, as well as darkening of the axillae, thighs, umbilicus, perineum, and external genitalia, may occur
Melasma (see also Cheeks). The “mask of pregnancy” (formerly known as chloasma) occurs in more than 50% of women during pregnancy. It is worsened by exposure to the sun
Darkening of preexisting freckles and nevi

Connective Tissue Changes

Striae gravidarum (striae cutis distensae related to pregnancy) or “stretch marks” are caused by the combination of increased adrenocortical activity and rapid tissue growth and distention, which results in the tearing of the dermal collagen matrix and a weakening of elastic fibers. Typically, striae are reddish pink to violaceous linear atrophic bands that are located on the abdomen, hips, buttocks, and breasts. The striae are permanent, but the purplish color fades with time (Fig. 23-1).

Proliferation and enlargement of skin tags, with some persisting after pregnancy.

Growth of preexisting keloids. This may occur in the scars of an abdominal hysterectomy or a cesarean section (Fig. 23-2).

Figure 23-1 Linea nigra and striae gravidarum.

The linea alba darkens during pregnancy, but the normal color usually returns after delivery. In contrast, although the purplish color of striae gravidarum fades over time, the striae themselves are permanent.