Skin Changes in Pregnancy

Skin Changes in Pregnancy

Physiological Changes

• Hormonal fluctuations: Increased levels of estrogen and progesterone affect skin, leading to changes in:
  • Pigmentation
  • Vascularization
  • Hydration
  • Elasticity

Common Skin Changes

• Linea nigra: Darkening of the skin from the pubic bone to the navel due to increased melanin production
• Chloasma: Melasma or mask of pregnancy, characterized by patches of hyperpigmentation on the face, especially on the cheeks, nose, and forehead
• Striae gravidarum: Stretch marks on the abdomen, breasts, and thighs due to rapid skin stretching
• Skin darkening: Increased melanin production causes darkening of scars, moles, and areolae
• Vascular spiders: Small, benign blood vessels that appear on the skin, especially on the face, neck, and arms
• Palmar erythema: Redness and inflammation of the palms

Other Skin Changes

• Pruritus: Itching due to hormonal fluctuations and skin stretching
• Skin tags: Small, benign growths that appear in areas where skin folds, such as the neck, groin, and underarms
• Acne: Increased androgen levels can lead to acne breakouts
• Dermatoses: Pregnancy-specific skin conditions, such as:
  • Pemphigoid gestationis
  • Pruritic urticarial papules and plaques of pregnancy (PUPPP)
  • Atopic eruption of pregnancy

Management and Prevention

• Sun protection: Avoid excessive sun exposure to prevent further skin darkening and hyperpigmentation
• Moisturize: Keep skin hydrated to reduce the appearance of stretch marks and improve skin elasticity
• Topical treatments: Use gentle, pregnancy-safe products to manage acne, itching, and other skin concerns
• Avoid irritants: Minimize exposure to irritants, such as harsh chemicals, to reduce skin inflammation and reactions

Skin Changes in Pregnancy

Physiological Changes

• Hormonal fluctuations lead to changes in skin pigmentation, vascularization, hydration, and elasticity due to increased estrogen and progesterone levels.

Common Skin Changes

• Linea nigra is a darkening of the skin from the pubic bone to the navel due to increased melanin production.
• Chloasma is characterized by patches of hyperpigmentation on the face, especially on the cheeks, nose, and forehead.
• Striae gravidarum are stretch marks on the abdomen, breasts, and thighs due to rapid skin stretching.
• Skin darkening occurs due to increased melanin production, causing darkening of scars, moles, and areolae.
• Vascular spiders are small, benign blood vessels that appear on the skin, especially on the face, neck, and arms.
• Palmar erythema is the redness and inflammation of the palms.

Other Skin Changes

• Pruritus is itching due to hormonal fluctuations and skin stretching.
• Skin tags are small, benign growths that appear in areas where skin folds, such as the neck, groin, and underarms.
• Acne can occur due to increased androgen levels.
• Dermatoses are pregnancy-specific skin conditions, including pemphigoid gestationis, pruritic urticarial papules and plaques of pregnancy (PUPPP), and atopic eruption of pregnancy.

Management and Prevention

• Sun protection is crucial to prevent further skin darkening and hyperpigmentation.
• Moisturizing helps keep skin hydrated, reducing the appearance of stretch marks and improving skin elasticity.
• Topical treatments with gentle, pregnancy-safe products can help manage acne, itching, and other skin concerns.
• Avoiding irritants, such as harsh chemicals, reduces skin inflammation and reactions.

Pathophysiology of Intrahepatic Cholestasis of Pregnancy

Etiology

• Genetic mutations affect genes involved in bile acid transport and metabolism
• Increased estrogen levels, particularly estradiol, contribute to hormonal influences
• Selenium deficiency and other nutritional factors may play a role in environmental factors

Physiological Changes

• Increased estrogen levels inhibit bile acid transport and excretion, and enhance bile acid synthesis
• Decreased expression of bile acid transporters, such as BSEP and MRP2, impairs bile acid transport and metabolism
• Increased expression of bile acid synthesizing enzymes, such as CYP7A1, alters bile acid composition
• Altered bile acid composition leads to increased levels of toxic bile acids, such as lithocholic acid

Mechanisms of Cholestasis

• Reduced bile flow and secretion results from decreased bile acid-dependent bile flow and increased bile acid-independent bile flow
• Increased bile acid accumulation in the liver causes toxic effects on hepatocytes and bile ducts
• Activation of inflammatory and immune responses occurs due to bile acid accumulation

Clinical Implications

• Cholestasis and liver dysfunction are characterized by elevated liver enzymes, such as ALT and AST, and increased bilirubin levels
• Fetal risks include increased risk of preterm birth, fetal distress, and stillbirth
• A possible link exists between intrahepatic cholestasis of pregnancy and fetal developmental abnormalities