Pregnancy Skin Changes
May 2009
Q: What type of skin changes should I expect during pregnancy?
A: Pregnancy is an exciting time that is filled with new experiences as well as changes in the body. When you think of the impact of pregnancy on skin, stretch marks probably come to mind first. But there are several benign rashes that expectant mothers may also experience.
One type of rash, PUPPP—short for pruritic urticarial papules and plaques of pregnancy (try saying that three times fast!)—is the most common type of rash to develop during pregnancy. This condition is harmless to the mother and baby but can be very itchy and annoying. PUPPP typically develops in the third trimester with the average onset at 35 weeks. It usually lasts about six weeks and resolves spontaneously within two weeks of delivery. The itching is most bothersome during the first week.
“PUPPP typically develops in the third trimester with the average onset at 35 weeks.”
PUPPP is diagnosed by its unique appearance—small red bumps (often resembling hives or blisters) within stretch marks on the abdomen. However, it does not develop on the belly button. Over the course of the first few days the rash may extend to the buttocks, chest, thighs and arms. The exact cause of PUPPP is unknown; however, topical steroid creams and antihistamine lotions can help alleviate itching. If a woman has had PUPPP during one pregnancy, it will not necessarily return in subsequent pregnancies.
Pemphigus gestationis, or herpes gestationis, is a rare autoimmune disease that can appear as a rash in the second and third trimesters that begins near the belly button and spreads to the trunk, arms, palms and soles of the feet. This rash is not a result of infection with the herpes virus, and the scalp, face and mouth are not usually affected. Two to four weeks after the condition’s onset, large blisters develop on the affected areas as well as normal-appearing skin. The blisters typically heal without scarring.
Your doctor can diagnose pemphigus gestationis by sampling both the blistered and normal-appearing skin. Topical steroids and antihistamines may be helpful, but oral steroids are often needed to control this outbreak. About five percent of babies born to mothers with this condition have a noticeable rash at birth that resolves on its own. Studies have shown an increased risk of premature delivery among expectant mothers with pemphigus gestationis but no increased risk of miscarriage.
Stretch marks (striae) are probably the most common cosmetic skin concern among mothers-to-be. Stretch marks occur most frequently on the abdomen, thighs and breasts and initially appear pink in color and fade to a flesh tone. Several factors affect their development, including genetics, hormones and the distance the skin must stretch. Up to 90 percent of pregnant women develop striae, and a surplus of over-the-counter products promise to “prevent” or “treat” these feared marks. Unfortunately, the majority of these products show little, if any, actual improvement in the skin’s appearance. Laser treatments can lighten any lingering color, but the marks themselves will remain.
With all the changes that occur during pregnancy, it is no surprise that your skin during this period may also exhibit surprises of its own. Most pregnancy-associated rashes are benign, but you should still relay any concerns you may have about your skin to your obstetrician and dermatologist.