Hair grows well during Only to fall out afterwards….

• Estrogens thought to change normal hair growth cycle, retaining more hairs in active growth (anagen) phase • Ratio reverses postpartum, causing shedding 2-3+ mos after delivery • Telogen effluvium

• Shedding usually lasts 1-5 mos, but can be >1 year

• May unmask genetic pattern alopecia http //www.belgraviacentre.com

http //toppik.com.au/female-hair-loss

Telogen effluvium Pigmented lesions and pregnancy

• No treatment needed (or particularly helpful) • Nevi (moles) may darken slightly during • Some try topical minoxidil and/or biotin supplements pregnancy, but should not otherwise substantially change • Usually resolves over matter of months

• Any mole that looks funny (“ugly • If shedding persists, check for thyroid disease and/or iron duckling”) or changes during pregnancy deficiency should be evaluated and managed appropriately

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Indoor tanning and melanoma Itching during pregnancy

• Indoor tanning considered major contributing cause of high • Many pregnant women melanoma rates in young women

• Most important thing to determine: rash or no rash? • Legislative efforts in past few years have successfully resulted in banning or limiting tanning among minors now in 39 states

www.huffingtonpost.com

Itch without a rash Itch with a rash

• A history of allergies, asthma, hay fever or eczema suggests • Pts with atopic diathesis may have flare of any of the pruritic atopic diathesis disorders known as “atopic eruption of pregnancy” • May respond to moisturizers, antihistamines, topical steroids • Diagnosis is usually clinical • No history of atopy: look for underlying causes • Responds to gentle skin care, emollients (Vaseline always good) and regular • Meds use of topical steroids • Iron deficiency • We like triamcinolone 0.1% cream or ointment (comes in a 1lb jar) • Thyroid disease • Kidney disease • Liver disease • Intrahepatic cholestasis of pregnancy

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Itch with a rash and : gestational (pemphigoid gestationis)

• Rare autoimmune blistering disease with autoantibodies to adhesion molecule antigen 2 (BPAg 2) in skin

• Onset anytime during pregnancy, but usually 2nd or 3rd trimester

Gestational pemphigoid

• Disease often flares at delivery

• Can recur during successive , during menses or with use of OCPs

• Association with prematurity, low birth weight

• Baby can be transiently affected with blisters

8 Gestational pemphigoid Common skin conditions during pregnancy

• Diagnosis via skin (including one for • Pregnancy has varied and unpredictable effects on preexisting immunofluorescence studies) +/- bloodwork skin disorders

• Treatment: oral • Some improve, others worsen • Alternatives: cyclosporine, IVIg • Acne may improve or worsen • postpartum options: mycophenolate mofetil, azathioprine, dapsone, • Connective tissue diseases often improve; however SLE may first methotrexate, rituximab present or worsen dramatically • Psoriasis may flare or improve; rare cases of “” or • Although disease usually remits postpartum, may need treatment pustular psoriasis of pregnancy for months • Consider the drugs dermatologists use to treat some of these conditions

Acne Even our topical drugs can be bad….

• Some of our most teratogenic or toxic drugs used to treat acne • Safety of topical retinoids (adapalene, tretinoin) not entirely clear • Pregnancy category C • Isotretinoin (Accutane®) Category X • Oral tetracyclines Category D • Tazarotene (Tazorac®) is Category X • Oral contraceptives Category X • Pregnancy testing within two weeks of initial prescription required • Spironolactone Category C • (inhibits 5-α reductase, antagonizes androgen receptors: risk of hypospadias and feminization in males)

9 What can we use safely to treat acne? And just because a woman is pregnant….

• Topical antibiotics • Not all skin problems during pregnancy are related to the • Clindamycin, erythromycin pregnancy!

• Benzoyl peroxide • Pregnancy category C • Metabolized to benzoic acid (dietary thought to be higher than that from skin)

• Azelaic acid • Pregnancy category B • Natural occurring product of Pityrosporum ovale yeast • Treats mild-moderate acne

Contact info

• [email protected]

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