Skin diseases in pregnancy

Brownish spots develop on the regions exposed to rubbing like the armpits and tights, especially on women with darker skin. The freckles get darker, their number increase and the mask of pregnancy or melasma develops as the effect of UV-light. Moles increase in number, they get bigger and darker.
Palms may get red and spider angiomas appear as the result of hormonal effect on vessels. Varicose veins may cause problems, like swelling or aching legs. These skin conditions usually simply disappear but you should pay attention to them and consult with your physician in case of the changing moles for instance.

Special skin diseases related to pregnancy

These diseases are more often during pregnancy or occur only during pregnancy but that is the only thing they have in common.

Atopic eruption of pregnancy

This is by far the most common disorder. It is an eczema-like disease; the skin is extremely itchy, red and scaly. Sometimes the pre-existing eczema gets worse but it can occur for the first-time, too. It usually starts early, in the first trimester of pregnancy, only 25% starts in the third trimester. Itchy smaller-bigger nodules (prurigo) or itchy folliculitis may appear mainly on the limbs. It is a harmless condition though annoying because of itchiness but doesn’t affect the embryo.
Basis treatment is essential and consists of regular application of emollients mainly with ointments containing urea. Itchiness can be soothed with antihistamines but some of these medications are not applicable in pregnancy. Topical anti-inflammatory creams containing steroids provide effective and secure treatment. Severe cases may require phototherapy (UVB).

Pemphigoid gestationis=herpes gestationis

The name is misleading since this condition is not associated with herpes virus. A rare and special skin disease caused by the circulating antibodies produced during the pregnancy. It starts usually in the third trimester of the pregnancy and it is very itchy. It starts on the abdomen and then it spreads covering the whole body with protruding patches and urticarial papules, later they progress to herpes-like small or bigger blisters. It gets continuously worse till the end of the pregnancy then it resolves within half a year approximately. Rashes may occur on the skin of the newborn baby but they resolve within a couple of weeks. Diagnosis is made upon special histopathological examination of the skin, a consultation with a dermatologist and treatment is required.
Though the disease resolve on its own it will recur during the next pregnancy and may be more severe.

Intrahepatic cholestasis of pregnancy (pruritus gravidarum)

A rare disease that occurs suddenly during the end of second trimester or the start of the third trimester. There are no visible changes on the skin in the beginning but later rashes and ulcerated nodules appear due to intense scratching. The leading symptom is the itchiness of the palm and soles that gets worse in the evening.
It is caused by the increased level of certain bile acids in bloodstream during the pregnancy that causes severe itchiness. When the level of bile acids gets too high they can pass by the placenta and have a deleterious effect on the embryo’s circulation. Diagnosis is made upon the laboratory examination of the blood sample.

Polymorphic eruption of pregnancy (Pruritic urticarial papules and plaques of pregnancy – PUPP)

May be observed during the first pregnancy, usually in the third trimester, right before delivery, the cause is unknown. It starts on the abdomen, usually within the stretch marks (striae) then it spreads over the body. Red, urticarial papules develop. It is an annoying but harmless disease, it is dangerous neither to the mother, nor to the baby. The intense itchiness must be treated but it resolves on its own within approx. 4 weeks after delivery.

What are the differences in the treatment of skin diseases during pregnancy?

Naturally the possible side effects are always considered in case of an expectant mother and medications are applied only in cases strictly necessary.
The most common problem is itchiness that has to be treated since it poisons the expectant mother’s life. First we start with topical medication, with creams and ointments. The skin must be prevented from dehydration so the application of emollients containing urea is recommended. Topical steroids are recommended if necessary naturally upon a consultation with the expectant mother about the possible side effects. In severe cases we must use drugs, mainly steroids and antihistamines that can be used safely even during pregnancy.

Skin diseases affected by pregnancy

Psoriasis

Usually improves during pregnancy then gets worse after delivery. Phototherapy comes into limelight in case of extensive symptoms.

Autoimmune diseases

Close immunologic control is required; certain types may harm the embryo.

Facial dermatitis

Acne gets worse and it has to be kept in mind that the family of retinoids is not applicable during pregnancy. Perioral dermatitis and rosacea may develop on the face causing serious cosmetic problems frequently.

Erythema nodosum

Painful, inflammatory, nodular lesions appear mainly on the legs. It is not a rare disease and may appear not only during pregnancy but also on young women who are not pregnant. If it is not painful so there is no need for special treatment, incidentally topical anti-inflammatory agents may be applied.

Melanomas

Moles are increasing in size especially those on the abdomen or the breasts. 5% of female melanomas develop during pregnancy so it is self-explanatory why close monitoring is required.

Infections during pregnancy

Viral infections may be especially dangerous during pregnancy since they may lead to miscarriage or birth defects.

Herpes simplex

May be more severe if develops during the first pregnancy than in cases of non pregnant women. When a woman has active herpes lesions on her genitals cesarean delivery is required.

Chickenpox (Varicella)

Chickenpox infections may have severe consequences on both the mother and the embryo. Complications of varicella infection include pneumonia and encephalitis in the mother. The infection may cause fetal death in the first 20 week of pregnancy; fortunately it is rare – the incidence is only 1-2%. The exposure to the virus between 5 days before delivery and the first 2 days of his/her life is a serious threat to the newborn baby. Antiviral therapy is required in all of these cases.

Human Papilloma Virus (HPV)

Viral warts may increase in size more quickly and may develop a bleeding tendency. If the baby gets infected during delivery in cases where the mother is infected with HPV type 6 and 11 small warts, papillomas may develop in the baby’s throat. Condyloma’s treatment includes mainly physical methods, e.g. removal with laser or cryosurgery.

B19 Parvovirus

Parvovirus infection’s symptom is the appearance of lacy rashes on the skin (erythema infectiosum), or fever and myalgia. Early infection may cause miscarriage or stillbirth.

Syphilis

The pathogen of lues harms the embryo causing miscarriage and stillbirth. Babies may be born with the symptoms of congenital syphilis. Fortunately it is very rare; a screen test is obligatory during pregnancy and can be cured with antibiotics as long as it is diagnosed.

 

Cosmetic changes related to pregnancy

Melasma (mask of pregnancy, chloasma)

It is also called as chloasma or mask of pregnancy. May appear not only during pregnancy, any hormonal changes (e.g. taking contraceptives or quitting it) can trigger melasma. It is a very common problem – 20% of women taking contraceptives may be affected. Apart from hormonal changes exposure to UV light is the primary contributor to melasma.
Melasma usually fades after the delivery but may leave traces behind. These can be seen on the forehead, the cheeks and above the upper lips. The color may vary from yellowish-brown to really deep black. The existing patches may get darker after sun exposure.

How to treat?

There are three basic rules in the treatment of melasma: Sun protection, careful fading and patience. 50+ SPF sun protection is recommended on the face. The effective depigmentation and fading products contain hydroquinone, azelain acid so dermatologic control is recommended.
Peeling has a beneficial effect in the treatment of pigment patches, particularly specialists familiar with this method may achieve spectacular result with peeling.
Laser treatment is also available but you should ask for information about the possible side effects and the result to be expected during a previous consultation.

Spider nevus (spider angioma)

A very common change that may occur during the pregnancy or independently, and looks like a growth containing small, red, dilated capillaries. If it bothers you it can be removed easily by laser.

Striae (stretch marks of pregnancy)

It appears to some degree on 90% of pregnant women. It is caused partially by the increase of abdomen’s circumference, the weight gain, and partially by a connective tissue disorder due to hormonal changes. They are most likely to appear on the abdomen and breasts, less often on the tights.
When they appear striae are usually darker, reddish-purple and tend to gradually fade to white. They are less and less visible by time but their complete disappearance is almost impossible. Their condition can be improved with several local treatments or peeling methods.
Since the treatment is difficult prevention has to be emphasized. There are a lot of good quality dermatologic and cosmetology product to choose from and a consultation with the dermatologist is also available to prevent later problems.