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Helping Patients Manage Common Pregnancy-Related Skin Conditions

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Helping Patients Manage Common Pregnancy-Related Skin Conditions Retail Clinician CE Lesson This lesson is supported by an educational grant from Union Swiss. helping patients manage common pregnancy-related skin conditions IntroductIon with normal hormonal changes during tial benefits, safety and proper use of While pregnancy usually is character- pregnancy. Women with such pre-exist- nonprescription and prescription skin ized by symptoms of morning sickness, ing skin diseases as eczema, psoriasis or creams and lotions. Understanding the constipation and backaches, a woman’s acne may see a worsening of symptoms different types of skin conditions, mech- skin also goes through many noticeable throughout pregnancy. anism for development and potential changes during her pregnancy. Stretch Pregnancy dermatoses are defined risk factors is the first step in being able marks probably are the most common as a rare group of inflammatory and to communicate with both the pregnant skin change that pregnant women expe- pruritic skin diseases specifically re- and postpartum patient. rience. However, a variety of other skin lated to pregnancy or immediately fol- conditions can occur not only through- lowing delivery.1 Many of these skin Pregnancy and the skIn out pregnancy but postpartum as well. diseases that require healthcare pro- Hormones play a significant role It is estimated that stretch marks vider referral develop in the last few in causing the various dermatological typically occur in up to 90% of pregnant weeks of pregnancy and can range changes observed during pregnancy or women by the third trimester or after from mild to severe. Although an excit- postpartum. Progesterone and estrogen the 24th week of gestation.1-3 There are ing time in a woman’s life, the physi- are the primary hormones for maintain- three categories of pregnancy-associated cal changes that accompany pregnancy ing pregnancy and development of the skin conditions that have been identi- and the postpartum period come with fetus. Both hormones continue to rise fied, including benign skin changes re- many concerns and questions. throughout pregnancy and appear to be sulting from normal hormonal changes, Accessibility of skin care products re- the primary risk factor for many of the exacerbation or changes in pre-existing quires the clinician to be knowledgeable pregnancy-related skin abnormalities. skin diseases and pregnancy-specific on managing common pregnancy-relat- Skin changes, especially those that are dermatoses.1 Stretch marks, hyperpig- ed skin conditions. Clinicians should be visible, can cause additional emotional mentation and vascular changes are able to effectively counsel the pregnant stress to the patient. It is necessary to classified as skin conditions associated and postpartum patient on the poten- identify the different skin conditions so By: Brooke D. Fidler, PharmD, assistant professor 1. Describe the most common types of skin condi- tion, of which 1.00 (one) hour is accredited for phar- of pharmacy practice, Arnold & Marie Schwartz tions — including etiology and signs and symp- macology, by Partners in Healthcare Education, College of Pharmacy and Health Sciences, Long toms — that are associated with pregnancy. LLC, an approved provider of nurse practitioner Island University 2. Identify those patients during pregnancy continuing education by the American Academy of and postpartum who are eligible for self- Nurse Practitioners, provider No. 031206. Initial release date: Aug. 2, 2010 management versus those who may require Planned expiration date: Aug. 2, 2011 prescription treatment or referral. To obtain credit: Answer the test questions at the 3. Compare and contrast the different nonpre- end of this lesson, and complete the evaluation This program is accredited for 1.50 (one and scription products used in the treatment and online at RetailClinician.com. After completion of one-half) hours of continuing education credit, prevention of skin conditions during and after the post-test with a score of 70% or above, and of which 1.00 (one) hour is considered pharma- pregnancy. completion of the program evaluation, a printable cology credit. 4. Discuss the safety of topical and oral prod- certificate will be available. ucts used in this patient population. Program Goal: To improve the clinician’s ability to 5. Provide patient consultation on appropriate Questions regarding statements of credit provide consultation on management and preven- skin care techniques and other nonpharma- should be directed to W. Lane Edwards Jr. at tion of pregnancy-associated skin conditions. cological methods to care for skin during and [email protected]. This lesson is avail- after pregnancy. able free of charge to retail clinicians. Learning Objectives: Upon completion of this program, the clinician This independent learning activity is accredited for Copyright ©2010 by Lebhar-Friedman Inc. should be able to: 1.50 (one and one-half) hours of continuing educa- All rights reserved. Retail Clinician RetailClinician.com Fall 2010 • 1 Retail Clinician CE Lesson that appropriate and safe treatment can skin, leading to stretch marks. of estrogen and progesterone, which be initiated along with the necessary A recent study by Osman et al. con- stimulate melanocytes to increase pro- nonpharmacological measures. cluded that risk factors for the devel- duction of melanin, the substance that opment of striae include younger ma- provides color to the skin and hair.6 normal skin changes ternal age during pregnancy, family Hyperpigmentation of the face also is Stretch marks, hyperpigmentation history of developing striae, nonwhite referred to as melasma gravidarum, and hair, nail and vascular changes all race, excess weight gain during preg- chloasma or the “mask of pregnancy.” It occur during pregnancy as a result of nancy, higher maternal body weight is characterized by brown, flat, blotchy normal hormonal changes. Some wom- and carrying a larger baby.3 The study patches that may appear on the fore- en may experience an increase in hair also concluded that the most common head, cheeks, nose, upper lip and chin, growth and thickness due to an altera- sites of striae are the abdomen and the or around the eyes. tion in the hair cycle. This excess in hair thighs and/or breasts, in 47% and 24% Melasma is more common and evi- typically is noticeable on the scalp but of women, respectively.3 dent in women with darker skin com- also may be present on the face, chest Since weight gain during pregnancy plexions.5 It is estimated that up to 70% and arms. This temporary state of hirsut- has been shown to correlate to the devel- of women will experience melasma ism may be bothersome to some women, opment of stretch marks, it is important during pregnancy, with higher rates ob- but they should be reassured that several for women to maintain a healthy diet served in Hispanic, Indian, Asian and months following delivery, hair cycles and manage their weight gain appropri- African-American populations.1,5,6 The should return to normal with normalized ately throughout pregnancy. The Ameri- condition can be worsened by excessive hormone levels. Similar to hair, nails also can College of Obstetricians and Gyne- sun exposure, resulting in an even dark- may undergo changes during pregnancy, cologists recommended a weight gain of er appearance to the skin. such as increased growth, brittleness and 25 lbs. to 37 lbs. for women of normal Pregnant women also may notice a indentations. These nail changes typi- weight before pregnancy.4 Underweight dark line that runs from the belly button cally resolve postpartum, but promot- women should gain between 28 lbs. and to the pubic region, which is referred to ing good nail hygiene is essential during 40 lbs., and overweight women should as linea nigra. This line is always there, pregnancy. Healthcare provider referral gain between 15 lbs. and 25 lbs. A wom- but prior to pregnancy, it is flesh colored should take place if hair and nail changes an who is concerned about her diet or and cannot be seen. In some cases of me- continue to occur or improvement is not excess weight gain should seek referral lasma, symptoms may persist for months seen months after delivery. to a nutritionist for appropriate counsel- or years following a pregnancy. Howev- ing and healthy meal-planning. er, hyperpigmentation generally is a self- Stretch mark scarring While not related to hormonal chang- limiting condition; areas of darker skin Stretch marks, also known as striae es during pregnancy, another type of gradually lighten after delivery when gravidarum, are characterized by thick scar that is part of a surgical delivery is hormone levels return to normal. or thin linear bands or streaks that may a Cesarean section scar. Nonprescrip- be present on the abdomen, buttocks, tion products used in the management Vascular changes breasts, thighs or arms. When they first of all types of scars, including stretch During pregnancy, the volume of develop they may appear pink, red or marks, contain ingredients that can help blood increases by 50%, which results purple in color. Stretch marks will nev- to promote scar fading, softening and in more blood circulation within the er completely go away, but they will smoothing. Even with no treatment, any body and changes to blood vessels.5,7,8 gradually fade over time. The streaks type of scar tissue will become softer Normal vascular changes that may oc- eventually will become silver, skin- and less red on its own. cur during pregnancy include spider toned or hypopigmented. veins, varicose veins and facial erythe- Stretch marks, also classified as atro- Hyperpigmentation ma. Increased blood circulation to the phic scars, result from thinning, dimin- Approximately 90% of pregnant face may cause a brightening to the face ished or reorganized skin elasticity and women will experience hyperpigmen- or the “pregnancy glow.” This, coupled strength.2,3 Although there is some con- tation of the skin.5 Common areas for with increased secretions of facial oil flicting evidence on the relationship, these darker spots include the breasts glands, also provides a shiny glow to stretch marks are thought to be caused and inner thighs.
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