Whose Skin Is This?

Your skin will change during pregnancy. Full stop. Some of these changes are specific to pregnancy, others are the result of pre-existing conditions that exacerbate or are altered by pregnancy. These changes are normal, usually temporary, and not likely dangerous. We spoke to Los Angeles based dermatologist Karyn Grossman about the most common skin concerns women experience during pregnancy and after giving birth, and the most effective treatments.


DRY SKIN

While staying hydrated during and after pregnancy is important for many reasons (from amniotic fluid to breast milk production), it is also important for your skin. “Dry skin can be a sign of severe dehydration,” says Grossman. “But environment, your age, and how you care for your skin tends to play a much larger role in skin dryness than how much water you drink.”


What causes it? 

“Dry skin is typically caused by either over cleansing, a dry environment, or a genetic tendency toward a loss of water in your skin’s epidermal barrier,” says Grossman. 


Where on the body does it usually show up?

Dry flaky skin can occur anywhere on the face and body.  Most postpartum women complain of dryness in their lower extremities, usually on their legs and feet.


How do I treat it?

Grossman suggests starting with lifestyle changes. When you shower, use lukewarm water (hot and cold water tend to be more drying). And use body wash sparingly. A tip for helping your skin absorb moisturizer: Pat the skin dry, and while the skin is still damp, apply moisturizer to the entire body. [sidebar link to Anya body butter] (Avoid lotions with any exfoliating acid.) Put a humidifier in your bedroom (and any room where you spend a lot of time), wash your clothes with fragrance-free and dye-free detergents. And, especially if breastfeeding, experts suggest drinking twice the amount of water daily as you normally would.


ECZEMA

Over 31 million Americans have some form of eczema, the skin condition that makes skin itchy and inflamed. There are actually seven types of eczema, and though treatment is often the same, if you think you suffer from eczema, see a dermatologist to diagnose which kind you have. Women with a history of eczema often experience flares during pregnancy.


What causes it?

Eczema is a genetic condition caused by an over-reactive immune system, which may flare up at any time. Research by the National Eczema Association (NEA) has found that some people with eczema have a mutation of the gene responsible for creating filaggrin, a protein that helps our bodies maintain a healthy protective barrier on the very top layer of the skin. “One traditionally thinks of eczema as something that starts in childhood, improves, then may flare again as an adult depending upon circumstances,” says Grossman. One of these circumstances is pregnancy.  


During pregnancy, the mother’s immune system shifts from Th1-dominant immunity toTh-2 dominant immunity in order to protect the growing fetus. A side effect of this shift is that the mother may become more sensitive to outside allergens, resulting in an eczema flare up.




Where on the body does it usually show up?

“Eczema flare ups are commonly seen on the hands in new moms due to increased hand washing from handling the baby and changing diapers,” says Grossman. “It is even worse now during COVID times.”


How do I treat it?

The first step to managing itchy skin is to reduce the risk of it happening in the first place. Wash your hands less frequently and use a soap made for sensitive skin, says Grossman. The NEA created a list of harsh cleansers and ingredients that can be especially irritating to the skin. Then look for a moisturizer with richer emollients, like urea and glycerol, and keep it near your sink so you can apply it to the skin immediately after hand washing. In severe cases, your dermatologist may suggest prescription steroids or coal tar bath soaks but if you are pregnant or breastfeeding, it is important that you discuss any treatments with your obstetrician as well.


Additionally, “an anti-inflammatory diet may help,” says Grossman. Foods rich in omega-3 fats—chia seeds, walnuts, flaxseed oil, green leafy vegetables—have been shown to curb inflammation. Ginger also has anti-inflammatory properties and is a key ingredient used in several Anya products. 

 


MOLES

Moles are a proliferation of melanocytes, the cells that give skin its pigment. There are elevated moles (dermal nevi) and flat dark moles (melanocytic nevinevi), and both can change in appearance during pregnancy.


What causes them?

Elevated moles tend to be genetic and may occur anywhere on the body. They are usually benign, but if they grow or change you should have them checked by your dermatologist. “Often these are the moles that people come in complaining about because they are elevated,” says Grossman. “Fortunately, they are typically annoying but unlikely dangerous.”


Flat dark moles, on the other hand, are the types of moles that are more likely turn into skin cancer. “These are the moles that need to be watched,” says Grossman. Melanocytic nevi can be genetic or caused by excessive sun exposure, and the hormones from pregnancy can worsen them. “Irregular or abnormal melanocytic nevi can be precursors to malignant melanoma,” says Grossman.  


Where on the body does it usually show up?

Melanocytic nevi may occur anywhere on the body, “and it is not uncommon for these types of moles to grow and change during pregnancy,” says Grossman. “Sometimes it is a true change, other times it may just be the belly stretching.”


How do I treat it?

Everyone should have their skin checked by a dermatologist every 6 to 12 months. It is especially important to see your dermatologist before, during, and after pregnancy so they can map any changes in the skin.  



LOOSE SKIN

Loose skin is normal after you give birth. The skin has been slowly stretched out over many months. It will tighten up over time but may never return completely to its former elasticity.


What causes it?

“There is a significant genetic tendency toward what I affectionately term ‘postpartum jelly belly’—that kind of jiggly, not taut look of the skin after birth,” says Grossman. “If you have multiples or gain over 30 lbs during pregnancy it may be a bit worse.” Those without a genetic predisposition are still likely to experience loose skin, but it is more likely to return to its pre-pregnancy weight in the postpartum months. 


Can you prevent it?   

“Try not to gain over 30 lbs during pregnancy, unless otherwise instructed by your doctor,” says Grossman. And keep your belly out of the sun. “UV exposure decreases collagen and elastin in the skin, which is what is needed for the skin to snap back to pre-baby shape,” she says. Applying lotion or oil to the skin every day and making sure the abdomen is thoroughly moisturized will also help. 


How do I treat it?

“When you think about helping your belly skin go back to normal, remember that this is a new normal,” says Grossman. Your body just built a baby and changes to your skin after you give birth are totally normal. 


There are different types of treatments to quicken the results. If you are pregnant or breastfeeding, it is important that you discuss any treatments with your obstetrician.


Topical vitamin A derivative. 

Prescription retinoids are proven to stimulate collagen and elastin production in the skin, which will give it a firmer appearance over time. A nonprescription retinol is less powerful (it will take about 6 months to see results) but also effective. Neither are safe to use if you are pregnant or breastfeeding.


Radio Frequency Skin Tightening 

“An RF treatment is an application of heat to the skin that has been shown to stimulate collagen and elastin fibers in the dermis and in the fibroseptal network, the strands of collagen that connect the bottom of the skin to the structures below,” explains Grossman. There are different types of RF treatment (examples include Thermage, Ulthera, TruSculpt) and depending on the type it can require a single treatment and be somewhat painful or a series of 3 to 5 treatments that typically do not hurt at all. 


Hyperdilute Sculptra

Hyperdilute Sculptra is the process of injecting a dilute solution of sculptra [plla] under the skin to help build collagen. It can be done in the abdomen, buttocks, and legs. Grossman recommends a series of injections spaced 6 to 8 weeks apart for the best results. “I often combine this with other treatments, like RF tightening to maximize results.”



ACNE

Pregnancy acne—rashy red bumps, blackheads, whiteheads—is no different from regular acne.  But safe treatment options during pregnancy are very different.


What causes it?

Hormone fluxes during pregnancy, after pregnancy, and during breastfeeding and weaning can cause breakouts even if you’ve never had breakouts before. The increase in androgen production causes the glands in your skin to produce more sebum.


Where on the body does it usually show up?

“During pregnancy, acne flare-ups may show up on the face or body,” says Grossman. The chest, back, and butt are the most breakout-prone areas on the body. 


Can you prevent it?

Shower immediately after exercise and wash the face and body to get rid of surface bacteria that could be causing the acne. Some people also get hot flashes and sweating postpartum, so try to shower then as well.  “The key is to get sweat off your face and body using a gentle cleanser that won’t strip any oils from the skin and over dry it.” Washing too aggressively can also exacerbate acne so a mild cleanser is important. And avoid makeup whenever you can—it may cover the acne, but it’s not making it any better. 


How do I treat it?

Prescription acne medications are not safe to take during pregnancy because they can cause serious birth defects. If you want to treat acne during your pregnancy or while breastfeeding, consult your obstetrician or dermatologist. “Natural anti-inflammatory ingredients such as licorice, and chamomile can reduce inflammation in the skin,” says Grossman. “And at night you can consider the topical retinoid Differin—if it’s okay’d by your obstetrician and pediatrician—and a gentle cleanser and moisturizer. If that doesn’t do it, see your dermatologist for topical antibiotics.” 


Diet modifications may also help. Experts point to anecdotal evidence that suggests a causality between inflammatory food and acne breakouts. Grossman suggests avoiding triggers, like caffeine, highly processed or spicy food, and alcohol. “I also have some patients who find that reducing dairy in particular can be helpful,” she says. 


MELASMA

This is a form of hyperpigmentation in which the skin becomes discolored or darkened and usually appears as a patch of darkness on the face. Up to fifty percent of people with melasma have reported that someone else in the family also has it.


What causes it?

“Melasma is commonly triggered by increased estrogen, progesterone, and melanocyte-stimulating hormones during pregnancy, and it usually increases as the pregnancy progresses,” says Grossman. Other causes of melasma include radiation (from ultraviolet, visible light, or infrared light) and genetics.  


Where on the body does it usually show up?

Also known as “the pregnancy mask,” melasma is typically seen on the face, either a central or peripheral pattern. It’s usually a large block of pigment (as opposed to small round freckles). It may also show up on the chest and forearms.


Can you prevent it? 

Yes. “The mainstay of preventing and treating melasma is complete sun avoidance and lots of sun protection” says Grossman. “An SPF minimum of 50, with physical blocks such and zinc and titanium and blue light blocks, such as Ferrous oxide, should be used daily and reapplied every hour on all exposed skin when you’re outside. Wearing long sleeves, long pants, a wide brimmed hat also important.” The same goes for cloudy and rainy days. 


How do I treat it?

“For some it goes away on its own a few months postpartum, but it usually requires treatment,” says Grossman, noting that any sun exposure on your face or body will certainly exacerbate it.

Other recommended treatments will depend on the severity of the melasma. If you are pregnant or breastfeeding, it is important to discuss any treatments with your obstetrician and pediatrician. 


Topical Antioxidants. 

Skin-brightening serums with a combination of vitamin C with either phloretin or ferulic acid can have strong anti-pigment properties, says Grossman.


Oral Tranexamic Acid (TXA). 

“This is the newest addition to melasma Rx,” says Grossman. “It is an oral medication available by prescription which can be used for severe cases.” Tranexamic acid is a synthetic derivative of the amino acid lysine and works by inhibiting the synthesis of melanin.  


Combination therapy. 

Dermatologists often prefer a combination of treatments to get rid of melasma. A study published in the Journal of Clinical and Aethetic Dermatology found that combining tazarotene (a retinoid), azelaic acid (a skin lightening agent), tacrolimus (an anti-inflammatory) , and micronized zinc oxide (sunscreen) significantly decreased melasma.



SPIDER VEINS

These small superficial veins that appear close to the surface of the skin are typically squiggly red or purple. They are often temporary and totally harmless.


What causes them?

A woman doubles the amount of blood in her body during pregnancy and hormonal changes relax vein walls—the combination often results in spider veins. 


Where on the body does it usually show up?

Often on the back of legs and thighs, occasionally on the face. 


Can you prevent them?

By improving circulation—moving around and changing your sitting or standing position regularly—you can minimize the spread of spider veins. A high-fiber, low-salt diet will also help prevent them. But generally, if your body is predisposed to spider veins, it is hard to prevent them entirely from forming.


How do I treat it?

In most cases, spider veins will shrink and eventually disappear after birth once your blood volume returns to normal. 


In more severe cases, a dermatologist or vascular radiologist may suggest schlerotherapy, in which the veins are injected and ultimately collapse. You may need up to 6 treatments and can expect a 50 to 75 percent reduction in the appearance of the veins.