Your skin will change during pregnancy. Full stop. Some of these changes are specific to pregnancy; others are the result of preexisting conditions that are exacerbated or altered by pregnancy. These changes are normal, usually temporary, and not likely dangerous. We spoke to Santa Monica–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 (think amniotic fluid, breast milk production), it is also important for your skin. Dry skin can be a sign of dehydration, says Grossman. But environment, your age, and how you care for your skin tend to play a much larger role in skin dryness than how much water you drink.
What causes it?
“Dry skin is typically caused by overcleansing, a dry environment, or a genetic tendency toward a loss of [water in your skin’s] epidermal barrier,” says Grossman. In the case of postpartum women, dry skin is due to a combination of imbalanced hydration (from breastfeeding) as well as hormonal changes. As estrogen levels drop, so does moisture in the skin.
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), and wash your clothes with fragrance-free and dye-free detergents. And, especially if you’re 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 flare-ups during pregnancy and into the postpartum period.
What causes it?
The exact cause is unknown, but it is likely a combination of genetics and environmental triggers. People who have eczema tend to have over-reactive immune systems, and the condition may flare up at any time in the presence of certain triggers, whether it’s smoke or stress. (Studies show that some people with eczema have mutations in the gene responsible for a healthy epidermal barrier, the outer layer of the skin that protects us from losing too much water. However, not all people with the mutation have eczema, and more research needs to be done.) One traditionally thinks of eczema as something that starts in childhood, improves, then may appear again as an adult depending upon circumstances, says Grossman. One of these circumstances is pregnancy.
During pregnancy, the mother’s immune system shifts. 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.” Another unique area where eczema can occur postpartum is the nipples—the skin will be dry or cracked and itchy. If you’re not sure if it’s eczema or a condition caused by breastfeeding, talk to your doctor.
How do I treat it?
The first step to managing itchy skin is to reduce the risk of it happening in the first place. Decrease handwashing as much as possible, and use a soap made for sensitive skin, says Grossman. The National Eczema Association created a list of ingredients that can be especially irritating to the skin. Then look for a moisturizer with richer emollients, like urea and glycerin, and keep it near your sink so you can apply it to the skin immediately after handwashing. 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. Foods rich in omega-3 fats—chia seeds, walnuts, flaxseed oil, green leafy vegetables—may help reduce symptoms (some research suggests omega-3 fatty acids may calm 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 nevi), and both can change in appearance during pregnancy and may stay that way into the postpartum period and beyond.
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 change 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 12 months (or more frequently if you’re at higher risk for skin cancer). 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 completely return to its former elasticity.
What causes it?
“There is a significant genetic tendency toward that jiggly, not-taut look [of the skin after birth],” says Grossman. “If you have multiples or gain over 30 pounds 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 prepregnancy appearance (or close to it) in the postpartum months.
Can you prevent it?
Grossman advises keeping weight gain under 35 pounds during pregnancy, unless otherwise instructed by your doctor. 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 prebaby shape,” she says. Applying lotion or oil to the skin every day and making sure the abdomen is thoroughly moisturized may 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 myriad ways to improve the appearance of loose skin over time, including massage (to promote blood flow), exfoliation (to encourage collagen production), a healthy diet (rich in vitamin C, zinc, and copper), and of course regular exercise. You won’t see results overnight, and you have to stay committed to doing all of the above, but over time, skin will appear less slack.
There are also more aggressive treatments that can quicken the results, but discuss any treatments or procedures you are considering with your obstetrician, especially if you are breastfeeding or planning to have more children.
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.
Radiofrequency 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.
Hyperdilute Sculptra
This is the process of injecting a dilute solution of Sculptra (a dermal filler) under the skin to help build collagen.
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, for example.
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. “Always use a gentle cleanser that won’t strip any oils from the skin and overdry 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 recommended during pregnancy because some can cause serious birth defects, and for others the safety data is lacking. 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 use [the topical retinoid] Differin—if it’s OK’d by your obstetrician and pediatrician—and a gentle cleanser and moisturizer. If that doesn’t do it, see your dermatologist for topical antibiotics.”
Postnatal Multivitamin + Omega-3
Diet modifications may also help. Experts point to anecdotal evidence that suggests a correlation between inflammatory foods 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 50 percent of people with melasma have reported that another family member also has it.
What causes it?
“Melasma is commonly triggered by elevated hormones during pregnancy, and it usually increases as the pregnancy progresses,” says Grossman. Other potential 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 “pregnancy mask,” melasma is typically seen on the face, either in 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?
Potentially, yes. “The mainstay treatment for melasma is complete sun avoidance and lots of SPF,” says Grossman. “An SPF minimum of 50 with physical blocks, such as 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, and a wide-brimmed hat are also important.” The same goes for cloudy and rainy days.
How do I treat it?
Melasma may go away during the postpartum period, but more likely than not, it won’t. It also tends to get worse in the summer and fade a bit in the winter, and once you have melasma, it’s possible it may return even after treatment.
If you’re still breastfeeding, the most important thing you can do is stay out of the sun—the sworn enemy of melasma—and wear a physical (not chemical) sunscreen. Look for anything with zinc that has an SPF of at least 50. Topical antioxidants, like vitamin C, will also help even the skin tone and mitigate dark spots.
“For some, it goes away on its own [postpartum], but most [cases] require treatment,” says Grossman, who points to several more aggressive treatments that can be successful in treating melasma. As always, discuss them with your doctor first to determine what is safe to do while pregnant or breastfeeding.
Topical Antioxidants
Skin-brightening serums with a combination of vitamin C and either phloretin or ferulic acid (which are not safe while breastfeeding) can have strong anti-pigment properties, says Grossman.
Hydroquinone
This medication is a common treatment for melasma that works by evening out your skin tone. It’s available by prescription.
Tranexamic Acid (TXA)
“This is the newest addition to melasma Rx,” says Grossman. “It is an oral medication available by prescription that can be used for severe cases.”
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 usually harmless.
What causes them?
A woman increases the amount of blood in her body by as much as 50 percent during pregnancy, and hormonal changes relax vein walls. The combination often results in spider veins.
Where on the body do they usually show up?
Often on the backs of legs and thighs and occasionally on the face.
Can you prevent them?
By improving circulation—moving around and changing your sitting or standing position regularly—you may minimize the spread of spider veins. A high-fiber, low-salt diet will also help. But generally, if you’re genetically predisposed to spider veins, it is hard to prevent them entirely from forming.
How do I treat them?
In some cases, spider veins will shrink and eventually disappear after birth once your body returns to normal.
In some cases, a dermatologist may suggest sclerotherapy, in which the veins are injected with a solution and ultimately collapse. You may need multiple treatments and can expect a potential 50 to 80 percent reduction in the appearance of the veins. However, the procedure cannot be done while pregnant.
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.
Dr. Karyn Grossman is an adviser to Anya.
