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, and of course, also in her skin. These changes are very common and many of them are physiological, meaning they occur due to pregnancy and therefore disappear when it ends.

Why do these changes occur and what are they?

During pregnancy, there is a new endocrine organ, the placenta, which besides nurturing our baby, is responsible for producing 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 colour.

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. The origin of chloasma or melasma is an excess of melanin in the epidermis and dermis, determined by a series of hormonal, genetic, and environmental factors, as well as cumulative sun damage to the skin. Therefore, daily sun protection with broad-spectrum SPF 50+ sunscreens is key throughout the year, with consistency being particularly important during periods of higher sun exposure. Melasma is usually treated with topical depigmenting treatments, such as hydroquinone, kojic acid, azelaic acid, and tranexamic acid, which are often combined with retinoic acid or glycolic acid to enhance their penetration and therefore their effectiveness. Peels or chemical exfoliations andmicroneedling can also be used, and in specific cases, they are combined with a type of laser therapy, to promote the depigmentation of melasma.

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 depending on your condition, different treatments will be recommended.

Stretch marks during pregnancy

A high percentage of pregnant women, between 77 and 90%, develop stretch marks, especially from the sixth month onwards. They are lines of atrophied skin resulting from a rupture of the dermis under an intact epidermis.

Initially, they appear as linear tracks between 1 and 10mm wide, which are pink or reddish-purple in colour, slightly depressed when touched, and over time they become pearly white. 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, today with new laser systems, it is possible to improve the process and appearance of stretch marks.

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, there are changes in the hair renewal cycle and the number of anagen follicles increases, so less hair is lost each day. However, after childbirth, a compensatory effect occurs, known as postpartum telogen effluvium. It usually begins 2 to 3 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", especially in the shower. It is important not to be alarmed by this loss, to understand that it is a physiological process that is difficult for us to stop, and to understand that all these hairs that fall out will grow back in a few months. If the situation persists for more than two or three months, it is advisable to consult a specialist dermatologist to rule out any other reason explaining the hair loss or the development of a type of alopecia.

Other skin changes

• It is also common for spider veins to appear, which are reddish, tree-like elevations mainly on the chest, hands, arms, and face. Most disappear several months after childbirth, but if they persist, they can be easily removed with laser or intense pulsed light.
• In some women, due to genetic predisposition or hormonal factors, the increased abdominal pressure caused by uterine growth, and the history of having had other pregnancies, varicose veins appear in the legs and also haemorrhoids in the anal region.
• 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, and if not, we can easily remove them in 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 diagnose and treat them properly, as some require stricter monitoring of pregnancy to ensure the baby's well-being.