Skin Changes in Pregnancy

Pigment, Hair, and Gland Changes in Pregnancy

Most of the skin changes seen in pregnancy are due to the effects of hormones on various body structures. The effects on the skin may be considered normal and not disease-related. However, these same effects may be viewed as pathologic to the woman who has new skin changes. Some of these changes are permanent, but others are present only during or for a short time after pregnancy.

Pigment Changes
The most common pigmentation change in pregnancy is called hyperpigmentation, or darkening of the skin.

It is believed that higher levels of estrogen, progesterone, and melanocyte-stimulating hormone cause this skin darkening. The latter is a hormone that causes the pigment producing cells, or melanocytes, to make more melanin. Areas that were darker prior to pregnancy such as the areolae, nipples, genital skin, armpits, and inner thighs tend to get even darker. Sometimes a dark line, called linea nigra, forms on the abdomen. Other women experience a darkening of facial skin called melasma.

Hair and Nail Changes
Hair changes in pregnancy can vary from too much to too little. Many women notice more, darker hair on the face, arms, and legs. The same women may also notice a thinning of the hair on the scalp. This condition is known as telogen effluvium and is caused by a shift of these hairs to the telogen, or resting phase. It is during the telogen phase that hairs are shed. This shedding may last from 1 to 5 months but may not stop until 15 months after delivery.

Nail changes in pregnancy include brittleness, groove formation, or a separation of the nail from the end of the nail bed called onycholysis.

Gland Changes
Interestingly, sweat gland function increases during pregnancy except on the palms, while sebaceous gland function decreases. Thyroid activity also increases, probably causing the increase in sweat gland activity.

Diseases that affect the sweat glands such as miliaria (heat rash) and hyperhidrosis (excessive sweating) may get worse during pregnancy. While diseases that affect the sebaceous glands such as hidradenitis suppurativa, may improve during pregnancy. The sebaceous glands on the areolae, Montgomery's glands, enlarge during pregnancy and are noticeable as small brown bumps. Finally, the affect of pregnancy on acne is variable.

Connective Tissue Changes
The most noticeable connective tissue changes in pregnancy are stretch marks, also known as striae distensae or striae gravidarum. Striae occur in up to 90% of pregnant women, usually on the abdomen, but also on the thighs and breasts. There are several factors that determine who gets stretch marks, not the least of which is genetics. Women whose mothers have stretch marks will be more likely to have striae themselves.

Other factors that play a role are hormones such as estrogen and relaxin, and the actual distance the skin must stretch.

Blood Vessel Changes
During pregnancy the small blood vessels and capillaries multiply, and most blood vessels get larger to accommodate a larger blood volume. Therefore, the changes that are seen are related to this effect. Many women notice visible capillaries known as spider telangiectasias or spider angiomas on the face and palms. The palms may also be diffusely redder during pregnancy. The gums are also affected by this increase in blood vessels, and most pregnant women notice that their gums bleed much easier.

The change in larger blood vessels combined with the increased blood volume contributes to the swelling that many women experience. This swelling occurs not only in the feet, but also in the face and hands. Varicose veins occur in 40% of pregnant women because of blood vessel changes and the pressure of the baby on the pelvic veins that drain the legs.

It is also common for women in their second and third trimesters to notice bruising on the legs without a history of trauma. Finally, rapid fluctuations in the size of small blood vessels can cause facial flushing, pallor, hot or cold "flashes", hives, and worsening of Raynaud's phenomenon.

Continue Reading