Skin Changes During Pregnancy
Acne In Pregnancy
Skin changes are common characteristics of pregnancy; and oily skin and acne are often a source of discomfort, embarrassment, low self-esteem and depression. These symptoms are a result of hormonal changes associated with pregnancy, which cause an increase in sebaceous glands secretion. This, in turn, creates fertile ground for the proliferation of acne-causing bacteria (propionbacterium acnes).
The developing fetus must be a primary consideration when medical treatments for acne are recommended for pregnant women. Many available drugs are not recommended by the manufacturer, because they have not been properly tested or have been found to induce fetal abnormalities. For example, erythromycin estolate is associated with hepatitis. Tetracycline can cause fatty liver atrophy in the mother, as well as dental staining in the offspring. Acutane or isotretinoin can cause a multitude of skeletal, cardiovascular and craniofacial abnormalities. Even Retin-A, which works on skin cell DNA has a theoretical risk to the developing embryo and should be avoided, if possible.
Acne in pregnancy is different from teen acne and requires a different type of treatment. It often presents with comedones and papular lesions on the lower face, chin and jaw. Many times these lesions are superficial. On the other hand, acne in teenagers consists of deep, cystic lesions on the upper face and forehead which often contains pus. Topical therapy is the preferred method of treatment for skin conditions related to pregnancy, where the absorption of drugs through the skin is minimal. Also, effective drug combinations can be better tailored to this type of acne. If most of the lesions are comedones and superficial inflammatory papules, topical benzoyl peroxide or topical antibiotics can be used. For deeper lesions and cysts, it may be necessary to add an oral antibiotic. There is a hesitation on the part of pregnant women and their obstetricians to recommend treatment, because of a concern for the safety of current products on the market and the feeling that pregnancy is a temporary state not requiring immediate attention.
Stretch Marks
Also known as striae gravidarium, stretch marks affect 50 - 90 percent of all pregnant women. Although common, their unsightly physical appearance and the fact that they tend to persist after delivery can cause anxiety.
Symptoms: In most cases stretch marks do not present any symptoms. However, on occasion they can be associated with intense itching and burning.
Location: Stretch marks can appear on various parts of the body. The most likely areas are those that undergo rapid expansion such as the abdomen, hips, thighs, breasts, and underarms.
Appearance: Stretch marks first appear as pinkish, purple lesions that are slightly elevated, called striae rubra. In time, these lesions become blanched, linear streaks with surface depressions and fine wrinkling called linea alba. On microscopic study, striae show a thinning of the dermis, which is a layer of connective tissue beneath the skin's surface. These areas are remarkable for atrophy and a decrease in elastic fibers and collagen in the areas of skin where striae occur.
Cause: It is not completely known what causes stretch marks. Available data is somewhat confusing, since you can develop them in one pregnancy but not in another. Genetics, age and race all play a role, but rapid stretching of the skin and the rise in hormone levels (estrogen and cortisol) are key factors in their development.
Prevention and Treatment: Once stretch marks are formed, they are permanent. Various remedies have been developed to reduce their unsightly appearance, but they can only be used after delivery, since their safety for the developing fetus is not yet been established. Used topically, but not approved for use during pregnancy, tretinoin in conjunction with pulsed laser therapy has shown some success in reducing the appearance of stretch marks postpartum; but it does not eliminate them.
