CHENNAI: Pregnancy is a period where many physical changes take place in a woman’s body. These changes are very evident in 90 per cent of women. These can be classified into three categories.
Physiologic skin changes (normal skin changes)
Pre-existing dermatoses affected by pregnancy (skin diseases modified by pregnancy)
Specific dermatoses (skin diseases only during pregnancy)
Most of these conditions do not cause any harm either to the mother or to the baby, and resolve on their own as the pregnancy progresses. But it is important to sort these out from conditions that are likely to cause problems. Many of these may resolve on their own after delivery. But in some situations, special attention is necessary for the mother and baby. Therefore, whatever the difficulty, it is advisable to consult the doctor and ensure proper treatment.
Physiologic changes
These changes are common
Pigmentary changes: Due to hormonal activity, the body becomes darker in colour, it starts from the nipples and genital areas. Moles and scars may darken and enlarge. Discolouration of the whole body may also occur during this period. A black line along the middle of the abdomen called Linea nigra appears during and disappears after pregnancy. Discolouration of the face during pregnancy can be called Chloasma, Melasma or mask of pregnancy. It is seen in 45% to 75% of women. Stretch marks are seen in 90% of women. It starts appearing during the sixth or seventh month. Skin tags appear on the neck, face and chest, but most go away after delivery. If not, it can be treated with caution. Most of the pigmentation subsides within a year. Kindly abstain from using OTC products during pregnancy and lactation.
Hair changes
The hair growth rate is high during pregnancy. It gets shiny and thick during this period without much hair loss. But in one to three months after giving birth, all the hair that did not fall out for so long begins to fall. This can last for a period of three to 12 months. There is a chance of an increase in facial hair growth during pregnancy.
Changes in the nail
Nail breakage and fungal infection are more likely during this period.
Changes in blood circulation
Blood flow to the skin increases during pregnancy. Red moles and marks may appear. The palms of the hands may become red and inflammation of the gums may also happen.
Variation in the glands
Sweating is more common during pregnancy. Therefore, heat rash and fungal infection can occur. Overactive sebaceous glands can cause acne and dandruff.
Skin diseases during pregnancy
Diseases specifically associated with pregnancy
Atopic eruption: People with allergies or a history of allergies in their family may develop itchy rashes on the face, neck, chest and folds. These difficulties can arise from the first trimester of pregnancy. This condition also returns in subsequent pregnancies.
Prurigo of pregnancy
An itchy rash appears on the body, legs and abdomen. Scaling may also appear. It sometimes lasts for three months after pregnancy. It is seen in the second and third trimesters. This condition has also been seen in subsequent pregnancies.
Pruritic folliculitis of pregnancy
Multiple follicular papules and pustules occur on the shoulder, back, arms, chest and abdomen. This goes away after 1-2 months of pregnancy. Pruritus is not a defining feature, despite its name.
Polymorphic eruption of pregnancy
It is mostly seen in women who are pregnant for the first time. It is commonly seen in those with multiple foetuses and those who are overweight. It appears on the abdomen, fingers and thighs. Pustules and rashes appear and they disappear in two weeks of postpartum.
Dermatitis herpetiformis or Pemphigoid gestationis
It is usually seen in the last months of pregnancy or immediately after delivery. Red rashes and pustules start from the abdomen and affect the whole body. But the rash is not seen on palms, face, oral cavity and genitalia. It affects the growth of the fetus and causes premature delivery.
Intrahepatic Cholestasis of Pregnancy (Pruritus Gravidarum)
It can be caused by an increase in the amount of bilirubin in the blood. Sudden itching of the palm and soles which may spread to the whole body followed by rashes. This condition may adversely affect the foetus.
The writer is a consultant dermatologist at SUT Hospital, Pattom
DISEASES MODIFIED BY PREGNANCY
Many pre-existing conditions may be exacerbated or ameliorated by pregnancy. Pre-pregnancy skin diseases, especially fungal infections, can increase during this period. Monitoring of mother and baby is essential in people with connective tissue disorder (SLE, Scleroderma). However, the intensity of psoriasis decreases during pregnancy.