Physiological Skin Changes in Pregnancy

Physiological skin changes occur in women during pregnancy (Table 28.1). Patients require reassurance regarding the benign nature of these changes. For example, in telogen effluvium (see Chapter 25) the hair will re-grow a few months post-partum. Some changes may persist and may later require treatment to improve the cosmetic appearance. For example, spider naevi (Figure 28.1) may be treated with pulsed dye laser and melasma (Figure 28.2) with depigmentation treatment (topical hydroquinone, tretinoin and hydrocortisone), sunblock and advice on sun protection.

Skin Lesions in Pregnancy

The vast majority of skin lesions that change or occur during pregnancy are benign (Figure 28.3) and do not require any active treatment. The differential diagnosis of a rapidly growing lesion during pregnancy is either a pyogenic granuloma or a malignant melanoma, although these are not specifically ‘pregnancy-related’.

Pyogenic granulomas (Figure 28.4) commonly occur on fingers, but can develop at any body site. Usually, there is a history of a preceding injury followed by the development of a nodular lesion that bleeds on contact. Pyogenic granulomas are treated by curettage of the lesion followed by cautery of the base of the lesion.

Malignant melanoma (Figure 28.5), although rare, is one of the most common malignancies presenting during pregnancy and may metastasise to the placenta and fetus. A melanoma may arise from a pre-existing naevus or develop de novo at any body site. Clinically suspicious lesions should be completely excised promptly for a histological diagnosis (for details on melanoma see Chapter 35).