Pregnancy brings about many changes to the body, and skin is no exception[1],[2]. These changes are completely normal, yet they can sometimes feel overwhelming, especially with the body’s appearance shifting in unexpected ways. The good news? Many of these skin conditions can be managed with the right information and skincare approach. From minor irritations to more noticeable marks, pregnancy skin changes can vary from woman to woman, and a little understanding can make a big difference in feeling comfortable in your own skin.
Hormonal changes are at the heart of many skin conditions during pregnancy. For example, hormones like oestrogen and progesterone are crucial for supporting a healthy pregnancy but also contribute to changes in skin sebum production, elasticity, and pigmentation. With expert guidance, like visiting a dermatologist clinic in Singapore, many women find it easier to manage common skin issues that arise during this unique time. Here’s a guide to some of the most common pregnancy skin conditions and ways to care for your skin safely.
Skin conditions in pregnancy may be broadly divided into three categories:
1. Physiological changes that are normal in pregnancy.
2. Pregnancy specific skin conditions.
3. Pregnancy aggravated skin conditions.
Physiological changes are considered “normal” or expected changes in the skin due to pregnancy related changes in hormones, metabolism and the immune system. These conditions are common and may be expected to resolve after the baby is delivered. While some patients accept the transient nature of these conditions, others may be bothered enough to desire treatment. Some of the most common physiological skin changes in pregnancy include:
Increased Pigmentation
Increase in pigmentation (hyperpigmentation) is the most commonly encountered physiological change in pregnancy. Ninety percent of pregnant women will notice darkening of the skin[4]. This is especially prominent in women who already have darker complexion at baseline. Darkening is also more pronounced around the nipples, private parts, armpits, inner thighs and around the navel button.
The cause of this pregnancy-induced hyperpigmentation is due to a rise in melanocyte-stimulating hormone during pregnancy (melanocytes being the pigment cells in our skin that give it colour).
Common manifestations of increased pigmentation also include development of linea nigra, (“pregnancy line”) that runs vertically down the middle of the abdomen, melanonychia (pigmentation of the nails), and darkening and even increase in the number of moles on the body. The latter may raise concern for melanoma (a type of aggressive skin cancer), but this is rare in pregnancy. If in doubt, get a dermatologist in Singapore to have a look.
Melasma
Also known as the “mask of pregnancy”, this is a condition all pregnant women dread. Up to three quarters of women may develop pigmentation on the cheeks, forehead, neck and forearms, often beginning in the second trimester.
It is important that women continue to apply sunscreen during pregnancy (see our article on Choosing the Right Sunscreen) to reduce the risk of developing melasma. Fortunately, resolution can be expected in most women post-delivery.
For cases that persist, a variety of topical treatments containing hydroquinone, vitamin C, retinoids, etc can be beneficial. Energy devices such as Nd-Yag lasers or radiofrequency microneedling have shown good results in treating melasma. One of the latest therapies include the use of oral tranexamic acid. Patients should not be resigned to the “mask of pregnancy” but seek help from dermatologists in Singapore who can deal with this condition.
Stretch marks (Striae gravidarum)
Stretch marks are perhaps the most universally recognised skin change during pregnancy. These streaky, purple or red marks appear as the skin rapidly stretches, often occurring on the abdomen, breasts, thighs, and hips. Stretch marks develop because the skin is not always able to keep up with the pace of pregnancy-related growth, leading to small tears in the tissue beneath the surface.
While stretch marks can be challenging to prevent entirely, regular use of moisturising creams can help improve the skin’s elasticity. Retinoid treatments are often used for stretch marks but are not safe during pregnancy, so consider discussing post-pregnancy options with your dermatologist for optimal results. The appearance of stretch marks improve over time, and fractional thermolysis using various types of lasers can help to accelerate recovery and get you back into your swimsuit earlier!
Pregnancy specific skin conditions are skin changes that only appear in pregnant women. Some can be easily recognised and managed by your obstetrician; while others may need the attention of a dermatologist.
Polymorphic eruption of pregnancy
(previously known as Pruritic urticarial papules and plaques of pregnancy or PUPPP)
Polymorphic eruption of pregnancy is an itchy rash characterised by raised red bumps that appear within the stretch marks on the abdomen during the last three months of pregnancy. The rash can also spread to the arms and legs. Polymorphic eruption of pregnancy is usually very uncomfortable for the mother due to its intensely itchy nature. However, this condition is not harmful to the baby, and typically resolves upon delivery of the child.
Polymorphic eruption of pregnancy is more common in women experiencing their first pregnancy, having multiple births (e.g. twins) and with a male baby. It is thought that stretching of the skin causes damage to the connective tissue, resulting in an immune response giving rise to the rash.
To relieve the discomfort of polymorphic eruption of pregnancy, there are a few safe, at-home treatments you can try. Oatmeal baths are soothing and can reduce inflammation. Liberal and frequent applications of moisturisers can also be helpful. Antihistamines are available over-the-counter and may be taken to reduce itch. When choosing antihistamines, second-generation (non-sedating) ones are safer, especially those with a longer history of use in pregnancy such as loratadine and cetirizine. If in doubt, always consult a doctor.
If the itch is not controlled with these simple measures, it would be best to consult your dermatologist for other safe and effective recommendations. The doctor will be able to guide you whether topical or even oral steroids at safe doses and durations can alleviate the symptoms. PUPPP usually resolves after delivery, but managing symptoms during pregnancy can help reduce the itch and keep you more comfortable.
Intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy is an itchy condition that often starts around week 28 of pregnancy. It affects around 1 in 170 women in the UK[5].
This itchy condition is due to accumulation of bile acids in the body. Bile acids are normally produced by the liver to help the body digest fat and absorb fat-soluble vitamins. The build-up of bile acids gives rise to intense itch in the skin which is typically not accompanied by any visible rashes. In severe cases, the skin may turn yellow (in a state called jaundice) and one’s stools may turn light-coloured.
Intrahepatic cholestasis of pregnancy is usually diagnosed by blood tests examining the function of the liver and levels of bile acids in the blood.
You need to follow up closely with your obstetrician, as intrahepatic cholestasis of pregnancy can increase the risk of premature (preterm) delivery. Your doctor may also refer you to see a dermatologist to exclude other skin conditions that may be causing itch.
Pemphigoid gestationis
Pemphigoid gestationis is a rare, autoimmune skin condition that affects 1 in 50,000 pregnancies. In this condition, the mother’s immune system develops antibodies against her own skin and attacks it.
Pemphigoid gestationis typically starts as red, itchy patches during mid- to late pregnancy. Within a few weeks, large, tense blisters will form within these red patches. Apart from itch and the alarming appearance of blisters, pemphigoid gestationis can increase the risk of preterm delivery, and bacterial infection of the skin. The abnormal antibodies causing the disease may also cross the placenta, and babies may be born with blisters on their bodies.
Diagnosis of pemphigoid gestationis will usually require a skin biopsy and blood tests to identify the autoimmune antibody, which are performed by a dermatologist. Management of the condition includes steroid creams, and sometimes oral steroids or immunosuppressants (medications that suppress the immune system) if the disease is severe. The dermatologist will usually work closely with your obstetrician to ensure a safe treatment plan for the mother and child.
Many skin diseases can be made worse due to changes in hormones and immunity during pregnancy. Here, we discuss some of the most common dermatologic disorders that may flare up in the pregnant mother:
Acne vulgaris
Acne is one of the most common skin concerns during pregnancy, largely due to increased oil secretion driven by hormonal fluctuations. Pregnancy hormones boost oil production and also lead to clogged pores and breakouts. This is especially the case in the third trimester. Acne may appear on the face, chest and back, and while it can be frustrating, gentle skincare practices can help keep it under control.
Start with a mild cleanser that won’t irritate sensitive pregnancy skin and look for non-comedogenic products to avoid clogged pores. While many acne treatments (such as topical retinoids) are not suitable for use during pregnancy, there are still safe options available. Topical treatments containing ingredients like azelaic acid are generally considered safe.
In severe cases, your doctor may also prescribe oral antibiotics, but not all antibiotics are safe during pregnancy. For example, the most commonly used tetracycline-class of antibiotics (including doxycycline) may lead to yellow staining of the baby’s teeth and should be taken by pregnant women unless absolutely necessary.
Isotretinoin, in normal times a highly effective treatment for acne, is an absolute no-go for women trying to conceive and during pregnancy. Always consult your dermatologist to confirm what’s best for you and your baby.
Atopic dermatitis
Atopic dermatitis, also known as eczema, often flares during pregnancy, though a small percentage of lucky women will see their eczema improve. These changes could be due to hormones making the skin more sensitive, or alterations in the immune system to accommodate the unborn baby in the mother’s womb.Because the condition can vary widely, treatment needs to be tailored to each individual.
For safe atopic dermatitis treatment during pregnancy, try gentle moisturisers and emollients to maintain skin hydration. Ingredients like colloidal oatmeal and shea butter are soothing options. Avoid potential irritants, including heavily fragranced products, and stick to hypoallergenic skincare items. If flare-ups are particularly uncomfortable, consult your dermatologist to explore other safe options that won’t pose risks during pregnancy.
Topical steroid creams are safe in pregnancy if used in a sensible manner. A dermatologist can often help you choose an appropriate strength and amount of steroid cream to apply. Antihistamines may help to reduce itch, and non-sedating second-generation ones such as cetirizine are preferred.
Severe eczema may even require the use of oral steroids for short periods of time, and an experienced dermatologist will be able to gauge the dose and duration necessary to bring the eczema flare under control. Phototherapy is also a safe option during pregnancy for severe eczema.
Psoriasis
Psoriasis is a common, chronic inflammatory skin disease that affects 1 – 2% of the world’s population. It is estimated that more than 40,000 people in Singapore have psoriasis.
Between 10 to 25% of women with psoriasis will notice it becoming worse during pregnancy. Plaque psoriasis is the most common type of psoriasis seen in this group of patients. A unique type of psoriasis in pregnancy is pustular psoriasis of pregnancy (also known as impetigo herpetiformis). This is a rare form of psoriasis that typically appears in the third trimester. Patients present with numerous pustules (small blisters filled with pus) that tend to begin around the armpits and folds of the body and are arranged in a ring-like fashion. These pustules can merge to form large blisters and red patches on the body. Pustular psoriasis may be associated with constitutional symptoms including fever, fatigue and joint pains.
Pustular psoriasis may be mistaken for infections of the skin to the uninitiated, and antibiotics are not effective for pustular psoriasis. Patients with severe pustular psoriasis may need to be admitted to hospital for treatment and monitoring of the fetus. Care will usually be coordinated between your dermatologist and obstetrician. Management of pustular psoriasis in pregnancy can include emollients, intravenous fluid to restore hydration, and specific treatments targeting the inflammation in the skin, such as systemic steroids and cyclosporine. Pustular psoriasis can sometimes be associated with birth complications, and the obstetrician may discuss with the patient whether early delivery is helpful, as pustular psoriasis often improves upon delivery.
While skin changes can feel challenging to manage, rest assured that most will improve post-pregnancy. Meanwhile, adopting a simple and gentle skincare routine can help keep your skin feeling its best. From gentle cleansers to safe topical treatments, there are many options available to support you through every stage of this life-changing experience. It’s always helpful to discuss your options with a professional to ensure they align with your pregnancy health needs.
For compassionate, high-quality dermatology care, consider reaching out to TSN Dermatology, where dedicated professionals can guide you through managing pregnancy skin changes with comfort and confidence.
[1] Jones SV et al. BMJ 2014;348:g3489 doi: 10.1136/bmj.g3489
[2] Kroumpouzos G. Clinics in Dermatol (2016) 34,311-313
[3] Muallem MM et al. Clinics in Dermatol (2006) 24,80-83
[4] Muzaffar F et al. Int J Dermatol 1998;37:429- 31.
[5] https://www.nhs.uk/pregnancy/related-conditions/complications/itching-and-intrahepatic-cholestasis/
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