Skin and Hair During Pregnancy

Overview

During pregnancy, various skin changes occur. Many of these changes are seen so frequently that they are considered normal. Pregnancy can also alter the course of certain preexisting skin conditions or 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 acuminatum may enlarge considerably and may proliferate.

However, it should always be kept in mind that many common skin diseases unrelated to pregnancy should be considered when evaluating a pregnant patient with a skin disorder.

Hyperpigmentation
- Linea nigra
Connective tissue changes
- Striae gravidarum
- Keloids
Vascular phenomena
- Spider telangiectasias
- Palmar erythema
Hair changes
- Telogen effluvium
- Hirsutism
Other findings
- Pregnancy gingivitis
- Pyogenic granulomas
- Erythema nodosum
Specific dermatoses of pregnancy
- Pruritic urticarial papules and plaques of pregnancy
- Pruritus gravidarum
- Recurrent cholestasis of pregnancy
- Pemphigoid gestationis
Other conditions
- Pruritic folliculitis of pregnancy
- Impetigo herpetiformis

Frequently Seen Skin Changes That Are Considered Normal

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.

Hyperpigmentation

Hyperpigmentation is presumed to be secondary to increased levels of estrogens and melanocyte-stimulating hormone. It frequently manifests as follows:

Darkening of the linea alba (which becomes the linea nigra). There may also be darkening of the nipples and surrounding areolae, as well as darkening of the axillae, thighs, umbilicus, perineum, and external genitalia (Fig. 23.1).
Melasma (for a more complete discussion, see Chapter 14, “Pigmentary Disorders”). The “mask of pregnancy” (formerly known as chloasma) occurs in more than 50% of women. It is worsened by exposure to the sun. Melasma is also seen in women taking oral contraceptives and, on occasion, de novo in women in whom no explanation is obvious.
Darkening of preexisting freckles and nevi.

Connective Tissue Changes

Striae gravidarum (striae cutis distensae related to pregnancy) or “stretch marks.” It is thought that these are caused by the combination of increased adrenocortical activity and rapid tissue growth and distension, which result in tearing of the collagen matrix of the dermis and a weakness 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.
Proliferation and enlargement of skin tags, with some persisting after pregnancy.
Occasional growth of preexisting keloids. For example, this may occur in the scars of an abdominal hysterectomy or a cesarean section (Fig. 23.2). Growth of preexisting keloids is a not-uncommon problem in women of African descent.