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D​​​uring your pregnancy​, many changes can occur on your skin. These changes are related to the surge of female hormones (estrogen and progesterone) to the skin pigments, blood vessels, glands and your immune system. These changes can be physiological or present as skin disorders. 

The following are seen during pregnancy and improve after delivery. 

Pigmentation 

You will notice that the color of the nipples, genitalia skin and the centre of your tummy darken. Pre-existing freckles and “moles” darken. A dark blemish can appear on your cheeks, forehead, nose and chin called melasma (“pregnancy mask”). ​

Here, the melanin deposits are increased in the superficial and middle of the skin. Fortunately, the pigment resolves after delivery. 

Many women normally have a faint white line (called linea alba) running from their navel to the center of the pubic bone. In the second trimester, this linea alba may darken to be visible. This line is now called linea nigra. In some women the line extends upward from the navel as well. The linea nigra is darker in darker skinned women and usually lightens several months after delivery. 

There is another condition with localised pigmentation on the armpits and groins called acanthosis nigricans whereby the skin is thickened and dark. 

Stretch Marks 

The stretching and distension of the tummy causes the skin to split. These split lines are called striae gravidarum. 

These are purplish wavy lines, which appear on the tummy, breasts, thighs and groin. After delivery, they become paler in colour but the striae remain as permanent scars. 

Blood Vessel Changes 

Changes related to blood vessels appear as redness of the palms known as palmar erythema; venous varicosities of the legs, vascular lumps on the gums, and “spider nevi” or proliferation of blood vessels on the face and chest. 

The increased volume of blood also causes the cheeks to take on an attractive blush because of the many blood vessels just below the skin’s surface. On top of this redness, the increased secretions of the oil glands give the skin a waxy sheen. Many see this as the “pregnancy glow”. 

An increase in the varicose veins may occur in the vulva and vagina at the end of second or third trimester. This may cause a sensation of “heaviness” in the groin. 

Hair and Nail Changes 

You seem to have a bigger volume of hair on your scalp. This is because the increased estrogen supports a longer life cycle of your hair. Unfortunately, the increased hair is shed after delivery, and most women are quite upset by the hair lost, which are seen as clumps on the basin as they shampoo their hair. The loss can last three to six months. 

In addition, hair can increase on your face, back and legs. Your nails can become brittle and split at the ends. 

Acne during Pregnancy 

Most women sweat more as their sweat glands become more active. Especially​ in the third trimester, the oil glands become active and you can develop pimples or acne​. 

Skin Rash during Pregnancy 

The skin becomes very itchy and this is distressing. It is due to the impaired transport of bile to the liver and the bile circulates in your body. 

Some skin diseases get worse during pregnancy. These are eczema​, psoriasis, acne, and lupus erythematosus and candidia (fungal) infection of the vagina. 

Tips on Skin Care during Pregnancy 

  • ​​Use a broad spectrum sun block on your face each day, to prevent the pigment from further darkening. Avoid the hot sun. 

  • While mild soap is recommended during pregnancy, moisturising soaps are better. Do not use bubble baths or scrub your skin daily. 

  • A moisturiser with a sun block is helpful. The SPF factor or sun protective factor needs to be at least 15 to 20. 

  • The tummy needs an enriching physiological moisturiser and be supported with special maternity panties. Most women continue to wear their normal panties but these don’t support the distending skin. The splits would be less, if these special maternity panties were worn. You need to exercise to keep the abdomen muscles strong. Exercise ​also reduces stress incontinence. This is a condition where urine leaks out when you cough or sneeze hard. Seaweed wraps and massages are not proven to help. 

  • Keep your body clean, as you will feel sweaty and hot but limit baths to once a day only. Keep your hair clean with a daily mild shampoo. 

  • See your doctor if you have bad eczema, as you may need steroid creams but a low potency will have to be prescribed as steroids may thin your skin, if applied in excess. 

  • Ensure you take vitamins and calcium. Some types of psoriasis get worse with low calcium in your body. 

  • Bad acne can be treated with antibiotic lotions, for example, erythromycin or clindamycin lotions. Do not use tretinoin (Retin-A) cream during pregnancy, as it is known to cause multiple malformations in the baby. 

  • Reduce intake of foods with a lot of yeast if you have fungal genital infection, like pau, wheat noodles or cakes. 

  • Have adequate sleep. Adequate exercise helps the skin to glow. Cosmetics are kept to the basics like sun block, moisturiser, mild cleansers. 

  • Above all, be happy and do not overeat like you are eating for two​. The excess fat gained can be difficult to get rid off later. 

  • Moisturisers help to decrease the itch. A physiological moisturiser is useful. Try not to use paraffin on the skin, as this ​​can clog the skin pores. Chlorpheniramine tablets can be taken to relieve the itch. 

Tips on Skin Care after Delivery 

As there are at least three months of postpartum care for the working mother and a much longer time for mothers who are not working, you need to get your skin back to normal. 

  • ​​Exercises may tone up your abdomen and reduce the striae. 

  • Low potency vitamin A cream will help improve the scars in the tummy. As you will be tired looking after the child, try to get enough sleep and do allow others to help with looking after the child. You need to be well rested and happy. 

  • The breasts may be sore from the baby sucking too vigorously on the nipple. Allow the child to suck properly on the areolar area as well. Clean the nipple area and moisturise them. 

  • ​Continue to use a sunblock and a lightening cream called hydroquinone cream to clear the melasma. 

  • Continue to use moisturisers on your body daily, especially after the bath. 

  • For excessive hair loss, you can use minoxidil spray on your scalp. 

  • For any remaining acne, you can use topical antibiotics, oxy cream and a vitamin A cream in the evening. 

  • Should you or your baby develop any skin rashes, consult a doctor. 

  • Use a silicone gel sheet or silicone cream on your cesarean section wound to reduce the chance of keloid formation (overgrowth of fibrous tissue at cesarean wound).​  

Safety of Makeup and Skin/Hair Care Products during Pregnancy 

Exposure to certain environmental agents during pregnancy can lead to birth defects, abnormal fetal growth and pregnancy complications. For most skin and hair care products, the evidence of harm during pregnancy is not established. Not all products have been studied adequately in pregnancy. 

Chemicals from certain skin and hair care products can be absorbed through the skin and into the bloodstream. Thus, if you want to protect your developing baby from unnecessary chemical exposure, especially during the first trimester when critical organ systems are developing, you may want to avoid using these products while you are pregnant. 

Products such as shampoos, hair sprays, soaps, lotions and deodorants have not been shown to be harmful during pregnancy. Using these products are generally safe. 

It is also not known if the chemicals used in artificial nail products are safe for use by anyone, whether you’re pregnant or not. Nail removers contain ingredients that are extremely toxic if ingested. Avoid prolonged inhalation of fumes from nail products. ​​

Tattoos during Pregnancy 

Body art, which includes piercing, tattoos and permanent make-up, has various health risks. The risks most relevant to pregnancy include the safety of the dyes and the possibility of infections or allergic reactions. Because the skin is punctured for all body art procedures, there is a risk that a local infection could develop at the puncture site. 

There is also a small risk that blood-borne infections could be transmitted, such as HIV or hepatitis B​ or C, from improperly disinfected body art tools. With a tattoo or permanent make-up, ink is injected into the second layer of skin. 

The safety of this ink is unknown. Some inks are approved for skin application as cosmetics, but their safety when injected into the skin has not been thoroughly studied. ​


Acknowledgement

Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.