Why does your skin change so much during pregnancy?
Essentially the increase in hormones, oestrogen and progesterone, blood flow to skin and oil production can give the skin a flushed, more shiny appearance, hence the familiar term ‘pregnancy glow’.
What are the most common skin concerns during pregnancy? Does is change by trimester?
– and what can you do for each concern?
I will break this down into first to third trimester skin concerns:
First Trimester: The sudden change in hormones can I fact often cause some acne in the beginning of pregnancy; this is due to the increasing levels of oestrogen. This often settles as the pregnancy continues but not in all cases. The combination of hormones and UV can start to cause melasma at this stage especially in those with a darker skin tone but is more commonly seen in the second trimester.
Second Trimester: At this stage the blood volume is increasing and as such this increased circulation can start to give the skin that so-called glow. Again, the sebaceous glands are more active and as such skin may be oilier, this may reduce skin dryness and irritation but also can exacerbate an acne-prone skin. It is at this stage melasma can be noticed. The shift in the hair cycle towards the growth stage anagen can start to be seen with thicker, glossier hair. Towards the end of the second trimester stretch marks may be becoming more visible. There is a complex change in the immune system that seeks to protect the mother and foetus, this may see an exacerbation or improvement in some skin conditions. For example, psoriasis commonly improves whereas eczema can be more pronounced, again this is not always the rule. Commonly the increased growth factors can trigger the appearance of skin tags, but these commonly regress after giving birth. Moles may grow and change colour, often getting darker, that said if there are any concerns make sure changes are assessed by a medical practitioner.
Third Trimester: At this point the blood circulation is at its maximum, this increased flow can exacerbate skin issues such as rosacea. There are very specific skin issues to pregnancy including pruritic urticaria plaques and papules of pregnancy (PUPPP). This commonly presents with itchy papules and sometimes blisters that often appear in the abdomen, commonly within stretch marks, they tend to not affect the umbilicus. Rarely there is pemphigoid gestations that appears in 1 in 50,000 pregnancies, that is an autoimmune response that starts in the placenta causing blistering around the umbilicus, spreading to the trunk and limbs. This appears in the 2nd or 3rd trimester; it is linked to other autoimmune diseases such as thyroid disease. Finally itching is very common in pregnancy, especially in the later stages when the skin on the abdomen is stretched, applying soothing oils and emollients may help here. If the itching is persistent however, typically affecting the hands and feet a less common diagnosis of intrahepatic cholestasis of pregnancy. This can be diagnosed with a blood test and managed carefully.
By the third trimester levels of oestrogen, progesterone and melanocyte stimulating hormone (MSH) are at their highest, this is the most common time to see melasma, the mask of pregnancy. There is usually a symmetrical area of pigmentation seen on the upper forehead, cheeks and sometimes above the lip. Protecting from light with topical vitamin C and a broad-spectrum factor 50 sun cream can help. Some believe that tinted mineral blocks with iron oxide are the best at protecting against melasma.
Is pregnancy acne different to other types of acne? And can it get better if its hormone related?
At first pregnancy related acne is very similar to those experiences outside of pregnancy. It is caused in main by the increased levels of progesterone, this hormone stimulates oil production, a common trigger of acne. Although acne can be a problem throughout the 9 months, many see an improvement as the pregnancy progresses as hormones level out. There are also immune changes in pregnancy that may play a part in inflammatory skin conditions. Benzyl peroxide and Azelaic acid can be used safely in pregnancy as can niacinamide. The benzyl peroxide is anti-microbial and will help to unblock pores. The Azelaic acid will help to unblock pores, reduce inflammation and reduce pigmentation. The niacinamide will protect the skin barrier, reduce inflammation and reduce unwanted post inflammatory hyperpigmentation.
I never got that pregnancy glow people talk about – is it a myth? or why do some people get it and some don’t?
I don’t know why some ‘get the glow’ and others not. If pregnancy triggers acne or disrupts the skin barrier with a mild eczema causing moisture loss, there may be less of a skin glow. Also, I would say Sarah’s skin always looks super healthy and hydrated so hormonal gains may be less visible.
I have had to stop using my tretinoin – advice for how to make your regime work without retinol?
Yes, oral retinoids have been associated with foetal abnormalities. There have been no studies linking topical tretinoin with pregnancy complications, but we do not know how much these topical retinoids are absorbed, so stopping it is the only option as far as I am concerned. Other skin products such as azelaic acid, vitamin C and niacinamide can be used safely, all of which will boost skin glow and most importantly help protect against unwanted pigmentation.
