Pregnancy Skincare Primer

PREGNANCY SKINCARE PRIMER
SKINCARE EXPERT DR. JEANNETTE GRAF TELLS YOU HOW TO LOOK GOOD IN THE FACE OF
SOME OF THE CHANGES YOU'LL UNDERGO DURING YOUR PREGNANCY

During this time of growth, your skin undergoes many changes. These changes are mostly due to
fluctuating hormonal levels, which are essential for a healthy pregnancy—though not so fun to endure.
Here are my top five skin conditions to look out for during your 40 weeks on bump watch, along with
some helpful tips on how to combat the changes and look—and feel—your best.

Acne
During pregnancy, there are changes in hormonal levels, particularly estrogen and progesterone, which can
result in changes of sebaceous glands, oiliness and acne cysts. These changes are especially common during the first four months. In addition, rosacea flare-ups may occur as blood flow increases and new blood vessels are formed. Note that if a cyst is painful, a small injection given by your dermatologist can provide quick relief and is quite safe. There are only a few acne medications considered safe for use during pregnancy, including topical Erythromycin and sulfur (not the oral antibiotic sulfa). It is best to avoid salicylic acid and benzoyl peroxide as well.

The Mask of Pregnancy
Melasma or chloasma refers to a hormonally mediated skin discoloration that can occur during pregnancy. These patches of darker skin, which occur most commonly on the forehead, cheeks and around the mouth, are due to increasing estrogen levels. There is no way to predict who will get the mask of pregnancy; however, it is more likely to occur in women with darker skin tones. Treating the melasma during pregnancy with bleaching agents, such as hydroquinone, is not recommended. On the contrary, it’s recommended that you wait until after you are finished nursing before using a hydroquinone. Also, some of the darkening may fade as your hormone levels diminish. It is, however, absolutely essential to wear a broad-spectrum sunblock with UVA and UVB protection and practice sun avoidance as much as possible. In addition, lighteners such as topical vitamin C, paper mulberry and licorice extract are fine to use during pregnancy. Using an AHA (alpha hydroxy acid) like lactic acid and glycolic acid can also be helpful in minimizing the darkening.

Skin Darkening and Linea Nigra
It is absolutely normal to have darkening of certain areas of the body during pregnancy. In fact, darkening of the skin on or around the nipples is to be expected during pregnancy. Another place that can get dark is the line that runs down the mid-abdomen from the belly button to the pubic area. This line is called the linea alba and its darkening, known as linea nigra, is caused by an increase in estrogen and is absolutely normal during pregnancy. These changes reverse over a few months following delivery, returning the skin to its normal color.

In addition to estrogen, growth factors needed for the baby to grow result in annoying skin tags, which are little flaps of skin that grow on the neck, underarms and under the bra area and seborrheic keratoses. It’s also quite common for existing moles to get larger and darker. It is a good idea for your moles to be checked by your dermatologist, especially if you notice them beginning to change. These growths can be removed after delivery unless irritation and discomfort are associated with them.

Stretch Marks
Stretch marks, also known as striae distensae, occur in more than 90 percent of women during the sixth and seventh months of pregnancy. They first appear as pink or purple streaks on the lower abdomen and, in a few cases, can also appear on the breasts and thighs. Although stretch marks appear where there is the most rapid stretching of skin, their cause is actually hormonal. During pregnancy, the adrenal gland, which sits on top of the kidney, secretes hormones called glucocorticoids. These elevated levels of glucocorticoids are responsible for the formation of stretch marks, as are genetics, which always play a role in how your body reacts to pregnancy. Although they may look scary and unsightly at first, with time they fade into a silvery color, becoming much less visible.

Stretch marks are best dealt with when they are fresh (usually red in color), as that is when there may be some response in trying to lay down new collagen in the dermis, which has been stretched apart. At this early stage, using treatments containing topical vitamin C can be helpful in laying down new collagen. Also, using Mederma, a scar gel derived from onion extract, can be helpful. Topically applied vitamin A creams, such as those containing retinol, can be used after delivery, since all vitamin A derivatives are to be avoided during pregnancy. Skin creams containing peptides like Matrixyl can also be helpful in laying down new collagen in the stretch mark after delivery. Matrixyl is a small peptide that mimics the precursor of collagen; in essence, it fools the skin into making new collagen.

Spider Veins and Varicosities
Extremely common during pregnancy is the new road map of veins, either superficial or deep, that occurs as your bump grows. As such, it is important to stay active during your pregnancy and walk to improve circulation. Sitting or standing for long periods of time should be avoided, as should tight knee-high stockings, which can cause bulging and swelling.

Stockings, such as ones made by Jobst or Sigvaris brands, are quite helpful and should be worn over the knee and mid-thigh. After you deliver, if your varicosities are unsightly, I can’t say enough about the great results you can get with sclerotherapy. Having had it myself, I can vouch that it is painless and effective.

And remember, all of these changes are absolutely normal and occur as a result of very important physiologic changes needed to ensure a healthy and beautiful baby. So enjoy these nine-plus months and have a great delivery!

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Dr. Jeannette Graf, MD, FAAD, is a leading skin science expert, board-certified, clinical and research dermatologist. A top industry expert, published author and National Institute of Health award winner, Dr. Graf combines minimally invasive office procedures with effective skincare products and nutrition and lifestyle counseling to elicit both an inner and outer beauty from each of her clients. To get your glow, go to www.askdrgraf.com.