By Dr. Kaycee Reyes
Pregnancy is undoubtedly one of the key milestones a woman will undergo in her lifetime. This is the time of sudden and dramatic changes in hormones (especially in estrogen and progesterone) that cause a number of noticeable changes in the woman’s moods and physiology.
With these hormonal changes, we can also witness common skin changes in a woman’s skin, such as stretch marks, hyperpigmentation (melasma, linea nigra, underarm pigmentation), and acne.
Stretch marks are fine lines of scar caused by tearing of the tissue under the skin caused by over-stretching, combined with genetic predisposition and hormones. This is commonly seen in the abdomen, breast, and upper thighs of pregnant women. According to studies, the safest way to prevent the formation of stretch marks during pregnancy is to apply topical vitamin C serum, alpha hydroxy acids (such as glycolic acid and lactic acid), and emollients (shea or cocoa butter). This should be done regularly at least twice or thrice a day to the affected area, but it does not necessarily remove existing stretch marks. For actual removal of stretch marks, we might need topical and laser treatments that are not advisable to be used during pregnancy.
Hyperpigmentation is a common condition during pregnancy since hormones play a big role in the development of darker skin splotches. Pregnant women are more prone to have an increased melanin in the skin, especially the axilla, areola, and a vertical line down the center of stomach called linea nigra and even melasma (symmetrical brownish facial pigmentation). To be able to prevent this, pregnant women should avoid too much sun exposure without sun protection. It is advised to wear sunscreen containing physical sun block ingredients such as zinc oxide or titanium dioxide. Alpha hydroxy acids and azelaic acid can also be used to lessen melasma and hyperpigmentation. Pregnant women may also apply vitamin C serum to areas prone to hyperpigmentation. It has natural brightening and anti-aging effect, thus improving discoloration and skin texture of the affected area. Hydroquinone and retinoids, on the other hand, are definitive topical treatments for pigmentation but are avoided in pregnancy due to possible risk of fetal defects.
Acne breakout may be experienced in pregnancy due to abrupt increase in hormones, which promote more oil production in sebaceous glands that can clog the pores and lead to bacterial infection and inflammation. Since safety data are lacking that support topical treatment for pregnancy acne, it is difficult to advise on treatment when patients are complaining of terrible acne breakout. The treatment that is considered safe are alpha hydroxy acids, which peel off the top layer of skin, removing the dead skin cells that contribute to clogging of the pores. Other topical medications such as clindamycin, erythromycin, and azelaic acid are in Class B category of FDA for pregnancy, which indicate “No Evidence of Risk in Humans.” Some doctors recommend these to patients who are experiencing full blown acne breakout during pregnancy. Benzoyl peroxide and salicylic acid, on the other hand, are in Class C Category of FDA, and a bit controversial if given during pregnancy. No studies have shown that they are harmful for pregnant women but animal studies show that they can cause birth defects if taken in large doses. These are given depending on the patient’s skin condition and stage of pregnancy. Topical retinoids such as adapalene, tretinoin, and isotretinoin should be avoided due to their teratogenic side effects.
In summary, pregnant women should make their skin care routine simple. Although it can be a struggle, especially if one experiences the issues discussed earlier, we should never forget that this is temporary and there are safe choices available. If you are not quite sure about the safety of the ingredients, please consult with your physician or dermatologist regarding the best practice for skincare during pregnancy. Wishing you all the best in this exciting stage of your lives with your baby!