The skin, hair, nails, and mucous membranes during pregnancy
- Miriam Keltz Pomeranz, MD
Miriam Keltz Pomeranz, MD
- Associate Professor of Dermatology
- New York University School of Medicine
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology and Public Health
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
The maternal skin and related structures, including hair, nails, and mucosa, undergo numerous changes during pregnancy and the puerperium. The normal physiological alterations in skin during pregnancy are reviewed here (table 1). Pathologic cutaneous changes and their management are discussed elsewhere. (See "Dermatoses of pregnancy".)
The overall clinical appearance of skin is related to pigmentation, glands, vasculature, and connective tissue. Cutaneous changes during pregnancy can be best understood by examining each of these different aspects of skin structure.
Pigmentation — Almost all pregnant women develop some degree of increased skin pigmentation. This usually occurs in discrete, localized areas and may be due to regional differences in melanocyte density within the epidermis . Occasionally, generalized hyperpigmentation occurs [2-4]. However, pregnancy is a rare cause of generalized hyperpigmentation, so other causes, such as Addison's disease, should be considered when it occurs.
The pathogenesis of the increased pigmentation is not completely understood. One possibility is that estrogens and progesterone cause melanocytic stimulation [5-7]. However, it has been shown that the pigmentary changes occur early in pregnancy and before the elevation in alpha-melanocyte stimulating hormone (MSH) plasma levels, which occur in late gestation .
The most frequent cutaneous pigmentary change is a darkening of the linea alba, which becomes the linea nigra . The increased pigmentation may span from the pubic symphysis to the xiphoid process, but usually reverts to its normal hypopigmented state postpartum.
- Elling SV, Powell FC. Physiological changes in the skin during pregnancy. Clin Dermatol 1997; 15:35.
- Martin AG, Leal-Khouri S. Physiologic skin changes associated with pregnancy. Int J Dermatol 1992; 31:375.
- Murray JC. Pregnancy and the skin. Dermatol Clin 1990; 8:327.
- Kumari R, Jaisankar TJ, Thappa DM. A clinical study of skin changes in pregnancy. Indian J Dermatol Venereol Leprol 2007; 73:141.
- Winton GB, Lewis CW. Dermatoses of pregnancy. J Am Acad Dermatol 1982; 6:977.
- Sanchez NP, Pathak MA, Sato S, et al. Melasma: a clinical, light microscopic, ultrastructural, and immunofluorescence study. J Am Acad Dermatol 1981; 4:698.
- Geraghty LN, Pomeranz MK. Physiologic changes and dermatoses of pregnancy. Int J Dermatol 2011; 50:771.
- Clark D, Thody AJ, Shuster S, Bowers H. Immunoreactive alpha-MSH in human plasma in pregnancy. Nature 1978; 273:163.
- Estève E, Saudeau L, Pierre F, et al. [Physiological cutaneous signs in normal pregnancy: a study of 60 pregnant women]. Ann Dermatol Venereol 1994; 121:227.
- Muzaffar F, Hussain I, Haroon TS. Physiologic skin changes during pregnancy: a study of 140 cases. Int J Dermatol 1998; 37:429.
- Nakama T, Hashikawa K, Higuchi M, et al. Pigmentary demarcation lines associated with pregnancy. Clin Exp Dermatol 2009; 34:e573.
- Driscoll MS, Grant-Kels JM. Hormones, nevi, and melanoma: an approach to the patient. J Am Acad Dermatol 2007; 57:919.
- Foucar E, Bentley TJ, Laube DW, Rosai J. A histopathologic evaluation of nevocellular nevi in pregnancy. Arch Dermatol 1985; 121:350.
- Pennoyer JW, Grin CM, Driscoll MS, et al. Changes in size of melanocytic nevi during pregnancy. J Am Acad Dermatol 1997; 36:378.
- Grin CM, Rojas AI, Grant-Kels JM. Does pregnancy alter melanocytic nevi? J Cutan Pathol 2001; 28:389.
- Moin A, Jabery Z, Fallah N. Prevalence and awareness of melasma during pregnancy. Int J Dermatol 2006; 45:285.
- Shankar K, Godse K, Aurangabadkar S, et al. Evidence-based treatment for melasma: expert opinion and a review. Dermatol Ther (Heidelb) 2014; 4:165.
- Victor FC, Gelber J, Rao B. Melasma: a review. J Cutan Med Surg 2004; 8:97.
- Wilkin JK, Smith JG Jr, Cullison DA, et al. Unilateral dermatomal superficial telangiectasia. Nine new cases and a review of unilateral dermatomal superficial telangiectasia. J Am Acad Dermatol 1983; 8:468.
- Kern P. Sclerotherapy of varicose leg veins. Technique, indications and complications. Int Angiol 2002; 21:40.
- Ross V, Domankevitz Y. Laser leg vein treatment: a brief overview. J Cosmet Laser Ther 2003; 5:192.
- Leung SW, Leung PL, Yuen PM, Rogers MS. Isolated vulval varicosity in the non-pregnant state: a case report with review of the treatment options. Aust N Z J Obstet Gynaecol 2005; 45:254.
- Ninia JG, Goldberg TL. Treatment of vulvar varicosities by injection-compression sclerotherapy and a pelvic supporter. Obstet Gynecol 1996; 87:786.
- Cordts PR, Eclavea A, Buckley PJ, et al. Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization. J Vasc Surg 1998; 28:862.
- Scultetus AH, Villavicencio JL, Gillespie DL, et al. The pelvic venous syndromes: analysis of our experience with 57 patients. J Vasc Surg 2002; 36:881.
- Bell D, Kane PB, Liang S, et al. Vulvar varices: an uncommon entity in surgical pathology. Int J Gynecol Pathol 2007; 26:99.
- Løes S, Tornes K. Misinterpretation of histopathological results as an important risk factor for unneeded surgery - case report of a "near miss" event in a pregnant woman. Patient Saf Surg 2008; 2:14.
- Sills ES, Zegarelli DJ, Hoschander MM, Strider WE. Clinical diagnosis and management of hormonally responsive oral pregnancy tumor (pyogenic granuloma). J Reprod Med 1996; 41:467.
- Cummings, K, Derbes, VJ. Dermatoses associated with pregnancy. Cutis 1967; 3:120.
- Laymon CW, Peterson WC Jr. Glomangioma (glomus tumor). A clinicopathologic study with special reference to multiple lesions appearing during pregnancy. Arch Dermatol 1965; 92:509.
- Parmley T, O'Brien TJ. Skin changes during pregnancy. Clin Obstet Gynecol 1990; 33:713.
- Kang S, Kim KJ, Griffiths CE, et al. Topical tretinoin (retinoic acid) improves early stretch marks. Arch Dermatol 1996; 132:519.
- Wong RC, Ellis CN. Physiologic skin changes in pregnancy. J Am Acad Dermatol 1984; 10:929.
- Watson RE, Parry EJ, Humphries JD, et al. Fibrillin microfibrils are reduced in skin exhibiting striae distensae. Br J Dermatol 1998; 138:931.
- Chang AL, Agredano YZ, Kimball AB. Risk factors associated with striae gravidarum. J Am Acad Dermatol 2004; 51:881.
- Osman H, Rubeiz N, Tamim H, Nassar AH. Risk factors for the development of striae gravidarum. Am J Obstet Gynecol 2007; 196:62.e1.
- Brennan M, Young G, Devane D. Topical preparations for preventing stretch marks in pregnancy. Cochrane Database Syst Rev 2012; 11:CD000066.
- Elsaie ML, Baumann LS, Elsaaiee LT. Striae distensae (stretch marks) and different modalities of therapy: an update. Dermatol Surg 2009; 35:563.
- Goldberg DJ, Sarradet D, Hussain M. 308-nm Excimer laser treatment of mature hypopigmented striae. Dermatol Surg 2003; 29:596.
- Rangel O, Arias I, García E, Lopez-Padilla S. Topical tretinoin 0.1% for pregnancy-related abdominal striae: an open-label, multicenter, prospective study. Adv Ther 2001; 18:181.
- Ash K, Lord J, Zukowski M, McDaniel DH. Comparison of topical therapy for striae alba (20% glycolic acid/0.05% tretinoin versus 20% glycolic acid/10% L-ascorbic acid). Dermatol Surg 1998; 24:849.
- Pribanich S, Simpson FG, Held B, et al. Low-dose tretinoin does not improve striae distensae: a double-blind, placebo-controlled study. Cutis 1994; 54:121.
- Osman H, Usta IM, Rubeiz N, et al. Cocoa butter lotion for prevention of striae gravidarum: a double-blind, randomised and placebo-controlled trial. BJOG 2008; 115:1138.
- Soltanipoor F, Delaram M, Taavoni S, Haghani H. The effect of olive oil on prevention of striae gravidarum: a randomized controlled clinical trial. Complement Ther Med 2012; 20:263.
- Taavoni S, Soltanipour F, Haghani H, et al. Effects of olive oil on striae gravidarum in the second trimester of pregnancy. Complement Ther Clin Pract 2011; 17:167.
- Schatz M, Petitti D. Antihistamines and pregnancy. Ann Allergy Asthma Immunol 1997; 78:157.
- Kluger N. Can a mother get a tattoo during pregnancy or while breastfeeding? Eur J Obstet Gynecol Reprod Biol 2012; 161:234.
- Kluger N. Body art and pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 153:3.
- Douglas MJ, Swenerton JE. Epidural anesthesia in three parturients with lumbar tattoos: a review of possible implications. Can J Anaesth 2002; 49:1057.
- Jacobs VR, Morrison JE Jr, Paepke S, Kiechle M. Body piercing affecting laparoscopy: perioperative precautions. J Am Assoc Gynecol Laparosc 2004; 11:537.
- - Nevi
- - Melasma
- Vascular changes
- - Spider angiomas
- - Palmar erythema
- - Varicosities
- - Vascular tumors
- - Other vascular changes
- Striae gravidarum
- Tattoos and piercing
- ECCRINE, APOCRINE, AND SEBACEOUS GLANDS
- Anagen and telogen hair
- Androgenic alopecia
- MUCOUS MEMBRANES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS