What changes occur in the skin during pregnancy? Why do these changes happen?

Pregnancy is a very special and unique time for a woman. But it is also a time when she experiences changes in her body, including, of course, her skin. These changes are very common, and many of them are physiological, which means they occur during pregnancy and then disappear once it is over.

Why do these changes occur and what are they?

During pregnancy, a new endocrine organ, the placenta, develops and produces a series of hormones to which the body must adapt.

Most women, especially those with dark skin and hair, notice a general increase in melanic skin pigmentation. Around the third month, the nipples, areolas, and vulva darken. In addition, the midline of the abdomen that runs from the mons pubis to the navel also darkens, forming the linea alba which ranges from light to dark brown in color.

Chloasma

Melasma, or chloasma in the case of pregnant women, is a hyperpigmentation in the form of darker spots that appear mainly on the forehead, cheeks, and upper lip.

It is relatively common in pregnant women, although it also appears with the use of oral contraceptives. Chloasma, also known as melasma, is caused by an excess of melanin in the epidermis and dermis, which is determined by a combination of hormonal, genetic, and environmental factors, as well as cumulative sun exposure. Therefore, daily sun protection with broad-spectrum SPF 50+ sunscreens is essential throughout the year, with consistency being especially important during periods of increased sun exposure. Melasma is typically treated with topical depigmenting agents such as hydroquinone, kojic acid, azelaic acid, and tranexamic acid, which are frequently combined with retinoic acid or glycolic acid to increase penetration and thus effectiveness. Peels, chemical exfoliants, and microneedling can also be used, and in some cases, they are combined with laser therapy to promote melasma depigmentation.

It is a condition that requires a combination of specific dermatological treatments to control hyperpigmentation and maintain the result. Some of these treatments may be contraindicated during pregnancy, so different treatments may be recommended based on your condition.

Stretch marks during pregnancy

Stretch marks appear in a high percentage of pregnant women (77-90%), particularly after the sixth month. They are lines of atrophied skin resulting from a rupture of the dermis under an intact epidermis.

They begin as linear tracks ranging from 1 to 10mm wide, pink or reddish-purple in color, slightly depressed when touched, and gradually turn pearly white over time. They usually appear around the navel and abdomen, hips, thighs, and breasts. For them to develop, there needs to be a genetic predisposition, a clear impact of hormones in situations of pregnancy and puberty, which is a time when stretch marks also appear in many young people, and skin stretching. Once established, there is no effective topical treatment. However, with today’s new laser systems, stretch marks can be improved in both process and appearance.

What happens to our hair?

Many women notice that their hair looks much healthier during pregnancy and perceive their hair to be denser, thicker, and shinier.

These changes in the hair are due to hormonal variations during pregnancy. In this case, the hair renewal cycle changes, and the number of anagen follicles increases, resulting in less hair loss per day. However, after childbirth, a compensatory effect occurs, known as postpartum telogen effluvium. It usually begins two to three months after giving birth and lasts for several weeks. It can lead to very alarming hair loss, and many mothers tell me in consultations that their hair falls out “in handfuls” in the shower. It is critical not to be alarmed by this loss, to recognize that it is a physiological process that we cannot control, and to understand that all of the hairs that fall out will grow back in a few months. If the problem persists for more than two or three months, it is recommended that you see a specialist dermatologist to rule out any other causes of hair loss or the development of alopecia.

Other skin changes

• Spider veins, which are reddish, tree-like elevations, are also common, appearing primarily on the chest, hands, arms, and face. Most fade away several months after childbirth, but if they persist, they can be easily removed with a laser or intense pulsed light.
• Varicose veins in the legs and hemorrhoids in the anal region develop in some women due to genetic predisposition or hormonal factors, increased abdominal pressure caused by uterine growth, and a history of previous pregnancies.
• Skin tags or soft fibromas frequently appear from the second half of pregnancy, especially in the armpits, neck, and inframammary fold. Some disappear after childbirth; if not, we can easily remove them during consultations.

Finally, there are a series of dermatoses or specific skin diseases of pregnancy. They appear in a small percentage of women, and are mainly prurigo gestationis, pemphigoid gestationis, and polymorphic eruption of pregnancy. It is important to accurately diagnose and treat them, as some necessitate stricter pregnancy monitoring to ensure the baby’s well-being.