Pregnancy – skin changes

You may experience some of the following skin changes when you are pregnant. 

Marks and growths:

• stretch marks – indented streaks that often appear on your abdomen (tummy), breasts, hips, buttocks and thighs
• benign (non-cancerous) skin growths including skin tags and pyogenic granulomas.

Skin pigmentation (colour) changes:

• linea nigra – a dark line down the centre of your belly
• darkening of your areola, nipples, armpits and the skin around your genitals
• possible darkening of your moles and scars
• melasma – a blotchy, brownish area on your face often called the mask of pregnancy.

Blood vessel or vein changes:

• spider veins – tiny, thin veins just under the surface of your skin, often on your face
• varicose veins – enlarged veins in your legs or vulva
• palmar erythema – increased redness of your palms.

Rash and itch:

• dermatitis and psoriasis – dry, itchy skin
• prurigo of pregnancy
• pruritic urticarial papules and plaques of pregnancy (PUPPP) – small, itchy, red bumps that usually start near the stretch marks around your belly button.

Uncommon itchy skin conditions that are of particular concern:

• cholestasis of pregnancy – a rare, intense itch without a rash
• pemphigoid gestationis ­– also rare, this usually begins in the second or third trimester with itchy, red bumps, a bit like hives, around your belly button.

Stretch marks

Stretch marks happen when the middle layer of your skin (the dermis) is stretched a long way, quickly or over a long period of time. 

Developing stretch marks may be hereditary (passed down in your family) so it can be helpful to know if your mother or grandmother had them. 

• Stretch marks will fade over time.
• Many creams, ointments and other products claim to prevent or treat stretch marks. There is no evidence that these treatments are effective. At best they may help a bit, but won't remove or prevent stretch marks completely.
• If you decide you want to use a stretch mark product, start using it before the stretch marks appear and check it is safe to use in pregnancy.
• Areas to focus on are your abdomen (tummy), breasts, legs and arms.

Pyogenic granuloma 

During pregnancy, 1 in 20 people develop a benign (non-cancerous) skin growth called pyogenic granuloma.

• The most common place is in your mouth, although one may also appear on your head, neck, upper torso, hands or feet.
• They start as small, red, brown or blue-black spots the size of a pinhead, and grow quickly over a few days or weeks.
• They can grow to 2cm in diameter or, less commonly, as big as 5cm.
• A pyogenic granuloma can be unsightly and uncomfortable, and can bleed a lot if knocked.
• This type of skin growth generally disappears after your baby is born. If not, it can be removed. This is also an option while you are pregnant if it is causing you problems. 

During pregnancy, the area around your nipples and the skin on your inner thighs, genitals and neck might darken, possibly due to hormonal changes.

Linea nigra

Linea nigra (simply meaning ‘dark line’) is a harmless line that may appear om your belly from your navel to your pubic bone. It is more likely to show if you have darker skin. 

• Linea nigra usually occurs around the second trimester of pregnancy, when the muscles in your abdomen (tummy) stretch and separate slightly to accommodate your growing bump.
• The line is caused by a pigment called melanin which marks where the muscles have separated.
• It generally disappears within a few months of giving birth.

Mask of pregnancy (melasma)

Mask of pregnancy, or melasma, is a blotchy, brownish area that appears on your face. Melasma can have a number of causes and pregnancy is just one of them. 

Melasma comes on slowly and after childbirth skin usually returns to its normal colour over several months. However, some dark patches might never go away. 

If you develop skin pigment changes on your face:

• try to stay out of the sun as much as possible
• use a high sun protection factor (SPF) sunscreen all year
• use mild cleansers to reduce any drying or irritation. 

Spider veins or angiomas 

When pregnant, your body pumps more blood around your body to meet the needs of you and your baby. That can put your blood vessels under some strain and cause some of the smallest vessels – the capillaries – to leak or burst. This leads to a small area of fine red or purple lines.

• Your face is the most common place for spider veins, as it is more likely to be exposed to extremes of temperature.
• Spider veins fade with time but you can minimise them by protecting bare skin from very hot or very cold conditions.

Varicose veins 

You might develop enlarged veins in your legs or vulva (varicose veins) due to your uterus (womb) putting greater pressure on these veins. Hormonal changes during pregnancy also might play a role. 

Varicose veins that develop during pregnancy generally improve without medical treatment 3–12 months after delivery. If they are painful or causing distress your lead maternity carer (LMC) or GP can suggest ways to manage them. 

Eczema 

Eczema is a common cause of itchy, dry skin in pregnancy. Hormonal changes during pregnancy affect the way your immune system works and can make your skin drier and more sensitive. 

If you had acne, eczema or psoriasis before you were pregnant, it is a good idea to see your GP or dermatologist when you discover you are pregnant, to review your treatment. 

If you have eczema:

• try having a shower instead of a bath and reduce the number of times you bathe
• keep cool as much as possible, as overheating can make the itching worse
• swap your soap or shower gel for a soap-free cleanser
• wear soft, smooth clothes and avoid wool, which can make the itch worse
• use a moisturising lotion, cream or ointment to protect your skin. 

Pruritic urticarial papules and plaques of pregnancy (PUPPP) 

This condition is thought to result from rapid stretching of your skin. Another name for it is polymorphic eruption of pregnancy.

• It is more common if you are a first-time mother or are carrying more than one baby.
• It usually develops in the third trimester.
• Symptoms include small, itchy, red bumps that usually start near the stretch marks around your belly button. They may have a white halo around them.
• Gradually, the bumps join up to form raised patches and may spread to your thighs, buttocks, arms and legs.

Your LMC or GP will be able to advise you on treatment, which may include a cream or ointment to protect your skin, a steroid cream or an antihistamine. PUPPP usually disappears once your baby is born. 

Prurigo of pregnancy 

This is a condition that causes itchy red bumps usually on the outer surface of your arms and legs. It can occur in any part of pregnancy and the cause is unknown. It may persist for months after your baby has been born but has no serious effects for you or your baby.

Your LMC or GP may prescribe steroid creams or antihistamines for relief. 

Obstetric cholestasis 

A rare liver condition in pregnancy, known as obstetric cholestasis, is identified by intensely itchy skin. The itchiness is most common on the palms of your hands and soles of your feet but can spread to the rest of your body.

There is no rash but other symptoms can include:

• dark-coloured urine (pee) and pale stools (poo)
• jaundice or yellowing of your skin
• feeling generally unwell or losing your appetite.

If you experience these symptoms, it's important to talk to your LMC or GP. 

Pemphigoid gestationis 

Pemphigoid gestationis is a rare skin condition associated with pregnancy. It has also been called herpes gestationis, although it has nothing to do with the herpes virus. It is caused when your immune system begins to react against your own body tissue.

• The condition usually begins in the second or third trimester with itchy, red bumps – a bit like hives – around your belly button.
• The rash spreads to other parts of your body, including your trunk, legs and arms.
• Fluid-filled blisters or raised red patches form after 2–4 weeks.
• Usually the rash disappears once your baby is born. In a few cases, it flares up with future pregnancies, menstrual periods or when you use oral contraceptives (the pill).

If you have these symptoms, talk to your LMC or GP, who may refer you to a dermatologist.