Clive Anderson
THE BODY goes through significant hormonal and physiological changes during pregnancy. These changes are meant to ensure the successful tenancy of the foetus.
The main hormones are oestrogen, progesterone and a melanocyte-producing hormone. This trio of chemical conductors along with others, like relaxin, prepare the uterus to house the developing embryo. They allow the uterine tissue to stretch to accommodate the expanding guest, notch up the blood supply to feed the guest, and temporarily disable parts of our immune system so that our body does not reject the boarder. This cascade of hormones, while doing a wonderful job at maintaining the pregnancy, may also affect our skin in some unwelcome ways.
The hormones stimulate the production of melanin, the pigment in our skin causing a mild generalised darkening. Areas of skin that are usually darker in colour may become even more so. This includes the area around the nipples, the underarm, and groin. The linea nigra develops as a dark line stretching over the pregnant abdomen from navel to groin. These areas of hyperpigmentation usually recede after delivery.
A significant patchy increase in pigment may occur on the face. This is the mask of pregnancy, or melasma. It occurs frequently in pregnant females and may be worsened by visible and ultraviolet light. Melasma may recur with subsequent pregnancies or with the use of oral contraceptives.
Often, there are changes in hair growth. During pregnancy there may be excessive growth, with extra hairs appearing on the face, and the scalp hairs become thicker. After pregnancy these hairs are lost and, conversely, the new mother may experience significant hair loss. This occurs because the prolonged growth phase of the hairs that give rise to the lustrous hair growth during pregnancy is replaced by a prolonged resting phase during which the hair follicles temporarily shut down. This hair loss, called telogen effluvium, may last up to 15 months.
THE CONNECTIVE TISSUES
Significant changes also take place in the connective tissues - the skin's building blocks. The changes that take place in the mother's weight and the stretching of the skin over the expanding uterus results in the development of stretch marks. These stretch marks occur commonly over the abdomen as red or purple marks that gradually become paler. Unfortunately, the stretch marks of pregnancy do not go away after delivery. The various creams that are marketed to reduce the incidence of stretch marks, or to cause them to go away, are unable to fulfil their marketing claims. These dermal scars may be made less visible by peels, dermabrasion or chemical surgery but are rarely completely cleared.
The skin's glands also undergo changes. Sweat gland function increases with more sweating and the appearance of heat rash.
INCREASED BLOOD FLOW
The blood volume and flow are increased in the body. Increased blood flow in the tiny vessels of the face results in the 'healthy glow' of pregnancy. During the third trimester, however, this increased blood flow may result in the eyelids and face becoming puffy, usually in the morning. The increased blood volume and increasing pressure in the abdomen are some of the factors that lead to the development of spider veins and varicosities in the legs. Other important factors are rapid maternal weight gain and large foetal size.
Hormonal changes may result in the nails growing faster than usual, while other nail changes, like brittleness and the appearance of a central grove in the nails, are not as welcome.
A few women will develop a particular set of skin diseases during pregnancy that appear as itchy, red lesions over the abdomen, thighs and buttocks. The itching may be quite severe, generally beginning in the third trimester with spontaneous resolution after delivery. Treatment with potent topical or oral steroids is sometimes necessary.
Most existing skin conditions will have a variable course during pregnancy. Eczemas generally improve during the pregnancy, but after childbirth, hand and nipple eczemas are common. Acne improves initially only to worsen during late pregnancy.
Often, gentle skin care with pH neutral cleansing bars and frequent application of a good moisturiser is all that is needed to maintain good skin health during this miraculous period.
Dr. Clive Anderson is a dermatologist and venereologist; email: yourhealth@gleanerjm.com.
