By: Darria Long Gillespie, MD, MBA
Anyone who's been pregnant knows that it's one of the conundrums of pregnancy -- you have sudden changes to your skin (could be multiple, occasional, all at once) AND you're not able to use many of your old faithful skin remedies that have served you so well during your non-pregnant years! Ah, the injustice!
In med school and residency, our education focused on the physiologic changes of pregnancy -- changes to your lungs, weight and even hormones. Got it. But what about the [ahem, equally important!] beauty changes? The spider veins, stretch marks, leg swelling and acne? How did this get left off my medical school curriculum?!
Well, it's time to fill in those gaps in knowledge. I've consulted with top derms and rounded up advice for every skin woe:
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Acne: Unfortunately, most acne medications, such Retin-A or benzoyl peroxide, aren't considered safe during pregnancy; animal studies have shown that there may be risks. That leaves dermatologists to turn to meds that are not first-line in non-pregnant women. "With pregnant women, I start with prescription products first that have been safely used in pregnancy," says Jodi Ganz, MD, of Olansky Dermatology Associates in Atlanta. She might prescribe a topical antibiotic such as erythromycin or clindamycin and pair it with azaleic acid, a topical cream available only by prescription and used to treat moderate acne. Dr. Ganz points out that just because an acne treatment is over-the-counter, you can't assume it's safe to use during pregnancy. "Next I try in-office procedures such as microdermabrasion and blue light therapy," she says. "These can really open up clogged pores and help the inflammation."
It's important to remember that medications for acne should be viewed the same way as any other during pregnancy: "Don't use any of your old prescription acne medications without talking to your doctor first," says Dr. Ganz.
Do no use these medications to treat skin conditions:
Topicals: Retin-A, hydroquine, benzoyl peroxide, many antifungals
Oral: certain antibiotics, such as tetracycline
Dry Skin: "Skin dryness is a big problem during cold weather," says Benjamin Stoff, MD, an Assistant Professor of Dermatology at Emory University. He recommends using lukewarm water, moisturized soap and applying moisturizer to the body immediately after bathing and again twelve hours later to soothe it. Dr. Stoff and Dr. Ganz recommend using CeraVe, Cetaphil, Aveeno and Vanicream. One note of caution: avoid products with paraben during pregnancy, says Joseph Merola, MD, a dermatologist and instructor at Harvard Medical School. When reading labels, look for "paraben-free".
PUPPP: About 1% of pregnant women develop a condition known as PUPPP (pruritic urticarial papules and plagues of pregnancy), in which you get itchy, reddish, raised patches on the skin, says Jamie Weisman, MD, a dermatologist at Medical Dermatology Specialists in Atlanta. Keep your abdomen moisturized, and talk with your doctor about anti-itch creams like calamine lotion or an oatmeal bath. "If PUPPPs isn't better after delivery, it can be treated with UV light therapy," says Dr. Weisman.
Skin Darkening (called melasma if it appears on the face): Due to hormonal changes, your skin is extra-sensitive to the sun during pregnancy. The mainstays here are sun avoidance, using lots of sunscreen and possibly bleaching dark spots after delivery. "Some women's dark spots fade without treatment after delivery," says Dr. Stoff. The dermatologists recommend sticking to sunscreens containing zinc oxide or titanium dioxide. Some good options include: La Roche-Posay Anthelios Mineral SPF 50, Neutrogena Pure and Free Baby Sunscreen, Physicians Formula Super BB Cream SPF 30 and Dermalogica Pure Light SPF 30.
Stretch Marks: Ah, the bane of pregnancy. These can be tough to treat. Some patients may improve with the use of laser treatment after delivery, but that doesn't work for women with textural changes to their skin. Gaining a lot of weight during pregnancy can increase the likelihood of stretch marks. The derms agreed that we shouldn't "believe the hype" about miracle treatments for stretch marks. In addition, "there is no good proof that cocoa butter stops stretch marks," says Dr. Ganz.
Varicose Veins: Unfortunately, the consensus was that the chance of getting varicose veins is largely due to genetics (yeah, another thing to blame on Mom!). But there are some things that you can do to minimize them: keep legs elevated whenever possible, wear compression hose, walk to increase blood flow and -- the same for stretch marks -- avoid excessive weight gain.
Skin tags or little red bumps of tiny blood vessels (called cherry angiomas or telangiectasias): These can grow as a result of the blood flow increases that come with pregnancy. They may go away after pregnancy. If they persist, they can be treated with laser therapy, says Dr. Weisman. You may also see worsening of rosacea or facial flushing as a result of the increased blood flow, which should resolve after delivery.
When should you see your dermatologist? All four derms agreed that there are certain skin changes that should prompt a visit to your doctor. While skin moles may darken during pregnancy, "in general, any change in a mole should be evaluated by a dermatologist", said Dr. Stoff. Dr. Ganz pointed out a scary fact -- melanoma is one of the few cancers that can actually spread to the placenta and affect the baby. That was news to me, and enough to get me an appointment with my own dermatologist to have my skin checked! Other changes include blisters, hives or any worsening of existing skin conditions. "Blisters or strange rashes should always be evaluated since some viral infections can pose a risk to mother and baby [and may present with a rash]," says Dr. Weisman.
The good news? There are some great beauty benefits to pregnancy -- increased blood flow to your skin can give you thicker hair, stronger nails and that special "glow" of pregnancy. So go with the glow - and follow the derms' advice to protect your skin and your baby if skin problems should develop.
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