Pregnancy is a privileged state - but what do you do when the hormones make your skin go haywire? It can be really unsettling not knowing what you can and can’t use safely when so much change is happening to your body. So let me share with you my straightforward approach to tackling the big issues you’ll face when it comes to your skin. 


Step 1 - Do No Harm

The important skincare ingredients I advise my patients to stop include retinoids, hydroquinone and salicylic acid. The key thing is to plan this and wean skin onto a safe alternative to avoid anxiety around conception - I suggest doing this as soon as you start trying to get pregnant. I also recommend skipping soy in skincare as this might theoretically increase the risk of melasma. Finally I recommend skipping cosmetic treatments, like Botox and fillers, in pregnant women. 

In terms of skin issues during pregnancy there are 3 main concerns. 

Step 2 - Manage hyperpigmentation

Pregnancy hormones can trigger changes in pigmentation – as many as 50% of women experience the ‘mask of pregnancy’ or melasma. Freckles and moles may also become more prominent. 

Treating melasma and preventing it from resurfacing require both lifestyle changes and a proper skincare regimen. Clearly, it's important to stay out of the sun. Even when triggered by pregnancy hormones, melasma gets worse when the skin is exposed to UV rays. Wear sunscreen on a daily basis, wear a sun hat and sunglasses, and avoid tanning beds and deliberate outdoor tanning. I like hats from Eric Javitts, Scala and Helen Kaminski as they offer proper UV protection. 

When it comes to safe treatment products we still have options - Key ingredients including vitamin C, niacinamide and azelaic acid. All three can be used together and they work synergistically  to temper over-enthusiastic melanocytes. 


Step 3 - Troubleshoot breakouts

Stopping your regular acne medications can be daunting - but I do find that provided acne is well-controlled before starting to try for a baby, switching to a pregnancy-safe regime is usually a smoother process than expected. Be sure to plan this well ahead with your dermatologist, especially if you’re taking oral medications like spironolactone, isotretinoin or tetracyclines, which are all contra-indicated in pregnancy. The good news is you do still have safe and effective options. I find the combination of benzoyl peroxide and azelaic acid to be very effective at both treating and preventing acne in pregnancy; and the addition of niacinamide is also calming and helpful in tackling post-blemish marks. 

Step 4 - Stretch Marks - can anything be done?

Stretch marks are difficult. They basically represent torn elastin fibres in the dermis - the classic scenario is the continuous and progressive stretching of the skin over the abdomen during pregnancy ( as many as 90% of pregnant women get them), but they also commonly develop during the growth spurt in puberty, on the shoulders of body builders and in those who are overweight.  Ultimately it’s the complex biochemistry of a woman’s body during pregnancy that is largely responsible for stretch marks.

Total resolution is not a realistic goal at this time, unfortunately. 

Common home remedies that were not found to be helpful include cocoa butter, olive oil and vitamin E. 

The only topical agent that there is any convincing evidence for is a topical retinoid - but this needs to be used for 3-6 months to make any impact. And of course, retinoids should not be used by pregnant women. Lasers can be helpful in improving the red phase of stretch marks when they first appear (striae rubra); but its difficult to improve the appearance of the more advanced white silvery stretch marks. Collagen-stimulating treatments like medical needling and non-ablative fractional lasers may help but we need more research in this area. My advice – moisturise skin well, make sure you’re getting plenty of vitamin C in your diet and leave it at that.


Final considerations - how do you cope with skin itchiness?

Again, taking a proactive approach is the smart move. Switch to a shower wash like Cetaphil Restoraderm or Bioderma Atoderm Shower Oil, which  helps prevent the drying effects of bathing and showering. And keep water warm, not hot and avoid overly long baths. I also like bland, soothing moisturisers like Cetaphil Restoraderm Body Moisturiser, Avene Xeracalm and La Roche Posay Lipikar Baume – apply when skin is damp and be generous. 

Certain rashes can also be associated with pregnancy (and it can trigger a flare-up of common inflammatory conditions like eczema and psoriasis) – so if your skin starts behaving oddly, have a low threshold for seeing your doctor to discuss safe treatment options. Similarly, if you’re concerned about changes in your moles, seek advice.