Physiologic Skin Changes of Pregnancy

PHYSIOLOGIC SKIN CHANGES OF PREGNANCY

Barry Ladizinski Dartmouth Medical School

Thursday, October 1, 2009 PHYSIOLOGIC SKIN CHANGES OF PREGNANCY

The normal hormonal adjustments associated with the gravid state result in dermatologic changes that are known as physiologic skin changes or skin changes of endocrine origin. These common and benign manifestations include changes in connective tissue, hair, nails, glandular activity, pigmentation and vasculature. Typically, these cutaneous changes resolve postpartum, although some may persist in a less marked form.

Thursday, October 1, 2009 CONNECTIVE TISSUE CHANGES: STRIAE GRAVIDARUM

• aka striae distensae, ‘stretch marks’

• up to 90% of pregnant women during third trimester

• due to increased estrogen, relaxin, stretching, genetic predisposition

• fade but do not disappear postpartum

www.visualdxhealth.com • treat with tretinoin cream

Thursday, October 1, 2009 Dear Barry, Thank you for your interest in VisualDxHealth and for contacting us in regard to our images. We are pleased to support your educational eforts and are, therefore, granting permission to use the image(s) for the purpose you have described provided you: Leave the copyright watermark intact. - Reference www.visualdxhealth.com in your presentation. Best health,VisualDxHealth CONNECTIVE TISSUE CHANGES: MOLLUSCUM FIBROSUM GRAVIDUARUM

• aka acrochordon, skin tag, soft ﬁbroma, cutaneous papilloma

• occurs in second half of pregnancy

• no malignant potential

• usually regress postpartum but some lesions persist and enlarge with subsequent pregnancies

• treat with cryotherapy, electrocautery or scissor-snip excision

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• pregnancy causes both increase and decrease in hair

• hirsutism on face and extremities [terminal hairs are permanent, lanugo hairs resolve postpartum]

• male pattern androgenetic alopecia [frontoparietal thinning], resolves postpartum

• telogen efﬂuvium occurs 1-5 months postpartum, usually resolves, but hair might not regain thickness www.visualdxhealth.com

• nails grow faster during pregnancy

• nail plate soft and brittle

• dystrophic nails, onycholysis and subungual keratosis

• melanonychia [hyperpigmented streaks in nail bed]

• changes usually resolve postpartum

• transverse grooves [beau’s lines] may www.visualdxhealth.com develop postpartum

• eccrine gland activity progressively increases everywhere except the palms where it decreases

• associated with increased thyroid gland activity and weight gain

• increased dyshidrotic eczema

• increased miliaria [‘prickly heat’]

• hyperhidrosis except in the palms

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• sebaceous gland activity increases in third trimester

• acne course is unpredictable, may improve or worsen during pregnancy

• montgomery glands or tubercles [hypertrophied sebaceous glands on areolae] in up to 50% of pregnant women, usually regress postpartum

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Thursday, October 1, 2009 The faculty has agreed to let you use the images, with the understanding that the content will not be sold or used to generate revenue. Thank you,Valentina UCSF School of Medicine Ofce of Educational Technology Help Desk: 415-502-2800, mailto:[email protected] GLANDULAR CHANGES: DECREASED APOCRINE FUNCTION

• apocrine activity seems to decrease during pregnancy but evidence is conﬂicting

• hidradenitis suppurativa improves

• fox-fordyce disease improves

• decreased apocrine gland activity resolves postpartum and conditions usually rebound

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• up to 90% of pregnant women

• due to increased alpha-MSH, estrogen, progesterone

• accentuation of normally hyperpigmented areas

• ephelides, nevi, scars may darken

• linea alba becomes linea nigra

• pigmentation around areolae produces secondary areolae www.visualdxhealth.com

• aka ‘melasma moustache,’ chloasma, ‘mask of pregnancy’

• up to 75% of pregnant women

• worsens with sun exposure

• treat with tretinoin, hydroquinone, dexamethasone, sun protection

• usually resolves postpartum www.visualdxhealth.com

• aka spider nevi, spider angiomas, nevi aranei, arterial spiders

• up to 67% light-complected women

• up to 11% dark-complected women

• increased estrogen during pregnancy causes proliferation, vasodilation, and congestion of blood vessels

• usually resolves postpartum, 10% persist, treat with electrocautery

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• aka pyogenic granuloma, pregnancy epulis, pregnancy tumor

• 27% of women during second trimester

• due to hormonal changes, trauma and irritation [calculis, caries, crowns]

• usually resolves postpartum

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Elling SV, Powell FC. Physiological changes in the skin during pregnancy. Clin Dermatol. 1997 Jan-Feb;15(1):35-43. Hellreich PD. The skin changes of pregnancy. Cutis 1974;1382-6. Kroumpouzos G, Cohen LM. Dermatoses of pregnancy. J Am Acad Dermatol. 2001 Jul;45(1):1-19. Lynﬁeld YL. Effect of pregnancy on the human hair cycle. J Invest Dermatol. 1960 Dec;35:323-7. Martin AG, Leal-Khouri S. Physiologic skin changes associated with pregnancy. Int J Dermatol. 1992 Jun;31(6):375-8.

McKenzie AW. Skin disorders in pregnancy. Practitioner. 1971 Jun;206(236):773-80. Review Murray JC. Pregnancy and the skin. Dermatol Clin. 1990 Apr;8(2):327-34. Tunzi M, Gray GR. Common skin conditions during pregnancy. Am Fam Physician. 2007 Jan 15;75(2):211-8.

Winton GB, Lewis CW. Dermatoses of pregnancy. J Am Acad Dermatol. 1982 Jun;6(6):977-98. Wong RC, Ellis CN. Physiologic skin changes in pregnancy. J Am Acad Dermatol. 1984 Jun;10(6):929-40.

Thursday, October 1, 2009