A guide to common skin disorders while pregnant.
Description. Atopic dermatitis is the most common type of eczema, which usually affects people who have asthma and/or hay fever or who have relatives who suffer from these conditions (National Eczema Association [NEA], n.d.). This type of eczema appears as a red, itchy rash usually found on the arms, cheeks, and legs. Other types of eczema cause itching and redness, but can also cause blisters (NEA, n.d.).
Symptoms related to pregnancy. The most common rash during pregnancy is atopic dermatitis as described above (AAD, 2016). Pregnancy brings on an immune system shift that could trigger atopic dermatitis or eczema in women who have already experienced eczema (AAD, 2016).
Medications. Mild or moderate topical corticosteroids are safe during pregnancy (AAD, 2016). They can also be diluted with a moisturizer to reduce the amount of medication used while still promoting healing. If topical corticosteroids are not effective, then a short-term treatment of more potent formulations can be used (AAD, 2016). Immunosuppressants may be used before pregnancy but will only be prescribed if a severe outbreak occurs. A healthcare provider will manage these types of drugs.
Self-care measures. Bathing and showering at least once a day is recommended, followed by the application of moisturizers (NEA, n.d.). Safety is a concern while bathing, as the extra weight during pregnancy can cause balance problems. Women should be aware for body changes and be sure to stabilize themselves when entering or exiting a bath or shower. Mothers should avoid substances that irritate their skin. Clothes should be soft and made of breathable material (e.g. cotton), avoiding fabrics like wool that can be irritating (NEA, n.d.). Following are some natural topical treatments, but it is recommended that the mother's healthcare provider be consulted before trying any of these remedies.
Coconut oil. Virgin or cold pressed oil should be applied once or twice daily to damp skin. It has been reported that coconut oil both moisturizes and reduces staph bacteria on the skin (NEA, n.d.).
Sunflower oil. Apply to skin once or twice daily shortly after a bath. It is a skin moisturizer and barrier that has anti-inflammatory properties (NEA, n.d.).
Cardiospermum. This flowering tropical vine is extracted and infused into oil that can be applied as a topical ointment. It can help reduce itch, inflammation, and bacteria on the skin (NEA, n.d.)
Mind-Body. Stress beyond being pregnant can trigger eczema. Some techniques used to lower stress include meditation and massage. Find ways to set aside time to relax.
When to seek help. Consultation with a healthcare provider should be sought early in pregnancy if eczema is already being treated or if it is a new condition. A major complication of eczema can be bacterial, fungal, and/or viral infections of the skin, because skin with eczema lacks infection-fighting proteins (National Institute of Allergy and Infectious Diseases, 2015.). If an infection occurs, it is important to seek medical treatment as soon as possible.
Description. Psoriasis can occur anywhere on the body. Plaque psoriasis is the most common type and can appear most often on the elbows, knees, and scalp with well-demarcated red plaques with a silver scale. It can be diagnosed by history and physical examinations, but a skin biopsy can be done to rule out other conditions. It is a life-long autoimmune disease with a genetic component making it common in families. It is usually triggered by environmental events, such as stress, a viral infection, or hormonal responses (Sullivan, Weatherspoon, & Weatherspoon, 2016). Parents may worry that their child may inherit psoriasis if it is present in the family. If one parent has psoriasis the offspring has about a 15% chance of developing the disease; if both parents have the condition then the chances go up to about 75% (Psoriasis and Psoriatic Arthritis Alliance [PAPAA], n.d.). About a third of those who have psoriasis have a relative who also has or had psoriasis.
Symptoms related to pregnancy. Each year psoriasis affects 65,000-107,000 women during pregnancy and childbirth (Horn, Chambers, Menter, Kimball, & Council, 2009). Immune system shifts while pregnant can sometimes cause psoriasis to improve (AAD, 20160). "About half of pregnant women experience a dramatic improvement that may allow them to temporarily discontinue treatment" (AAD, 2016, para. 4).
Medications and Treatments. Systemic medications, such as biologics, should be avoided. Mild or moderate topical corticosteroids are safe during pregnancy. They can also be diluted with a moisturizer to reduce the amount of medication used while still promoting healing. High-potency topical corticosteroids should not be applied to the nipple if breastfeeding to avoid passing medication to the baby. If topical corticosteroids are not effective or if additional treatment is necessary, then phototherapy may be recommended (AAD, 2016). Narrowband ultraviolet B is recommended for pregnant and breastfeeding mothers. However, psoralen with ultraviolet A (PUVA) treatment is not recommended because the psoralen can enter breastmilk and lead to light sensitivity (AAD, 2016). After pregnancy, if any psoriasis treatment was changed, resume the pre-pregnancy regimen. If breastfeeding, consult your doctor.
Self-care measures. Much of the evidence for alternative therapies is anecdotal, but many therapies for psoriasis are the same as listed for eczema earlier in this article. Again, always recommend that the parents talk with a healthcare provider before adding any complementary and alternative therapies.
When to seek help. A healthcare provider should be consulted early in pregnancy if psoriasis is being treated or if it is a new condition. Any treatment, even if topical, needs to be evaluated as it can affect the unborn fetus.
Description. Acne is a disorder of the skin's oil glands and hair follicles caused by hormonal actions and other substances (National Institute of Health: National Institute of Arthritis and Musculoskeletal and Skin Disease, 2015). The red pustule lesions usually occur on the face, neck, back, chest, and shoulders.
Symptoms related to pregnancy. Due to an increase in androgen hormones, many women will experience acne flares. This may seem trivial, but it can make a pregnant mom more self-conscious about her ever-changing body (AAD, n.d.).
Medications. A healthcare provider should monitor the treatment plan. Treatments that might be recommended include over-the counter acne medications (Glycolic acid and benzoyl peroxide) and prescription antibiotics. Pregnant women should avoid tetracycline antibiotics (AAD, n.d.). If the mother breastfeeds, she should follow the same precautions as during pregnancy.
Self-care measures. Wash skin with lukewarm water and mild cleansers. Use sunscreen with an SPF of 30 or higher every day to protect against pigment changes in the skin.
When to seek help. If acne becomes irritated or infected, seek treatment from a healthcare provider.
Description. A melanoma is a dangerous form of skin cancer that develops from damaged skin cells (Skin Cancer Foundation, n.d.). Most melanomas are black or brown and resemble moles, but they can also be pink, red, purple, blue, white, or even skin colored (Skin Cancer Foundation, n.d.).
Symptoms related to pregnancy. Pregnancy does not increase the risk for melanoma, but this cancer often develops during childbearing years, between 20-40 years of age (AAD, n.d). It is safe to have a skin biopsy during pregnancy.
Medications. There are safe treatments during pregnancy, especially if caught early. Basically, the treatment for a pregnant woman would be the same treatment used in a non-pregnant patient. In the early stages, the melanoma would be removed along with a section of normal skin. If it has grown deep, then the cancer may have spread and treatment options may be limited. Interferon appears to be safe. Radiation of the head and neck is an option, but not the pelvic area because it can cause birth defects (AAD, n.d.). Breastfeeding is usually fine if you had a melanoma while pregnant.
Self-care measures. Early detection is the best self-care; the pregnant mother should be familiar with her skin and be able to recognize any changes in moles.
When to seek help. If you see a change in a mole, or if it is growing or bleeding, you should ask your doctor to look at it as soon as possible. The ABCDE signs of a melanoma are a good way for the pregnant mother to evaluate changes in her skin. If any one of the signs is present, medical treatment should be sought. Following are the ABCDE signs of melanoma from Skin Cancer Foundation (n.d.):
* A - Asymmetry. The benign mole is symmetrical and a malignant mole can be asymmetrical
* B - Border. The melanoma will have an uneven border
* C - Color. The melanoma will most commonly have different shades of the primary color such as brown, black, or tan.
* D - Diameter. Melanomas are usually larger in diameter but could be smaller.
* E - Evolving. Any change in size, shape, color, elevation, or another trait, or a new symptom like bleeding, itching, or crusting, can point to danger.
Skin conditions can be exacerbated by pregnancy and lactation due to changes in hormone levels and stress. It is always a good idea to seek medical advice when skin changes occur, as the need for treatment may be warranted. The childbirth educator will benefit by being aware of skin disorders during pregnancy in order to advise the parents of treatment options.
American Academy of Dermatology. (2016). Medication for mons-to-be: Managing skin condition in pregnancy. Retrieved November 10, 2016, from https://www.aad.org/media/news-releases/medication-for-moms-to-be
American Academy of Dermatology. (2014). Acne can put a damper on hopes of glowing skin during pregnancy. Retrieved November 10, 2016, from https://www.aad.org/media/news-releases/acne-can-put-a-damper-on -hopes-of-glowing-skin-during-pregnancy
American Academy of Dermatology. (n.d.). Melanoma during pregnancy: What it means for you and your baby. Retrieved November 15, 2016, from https://www.aad.org/public/diseases/skin-cancer/melanoma/melanoma-during-pregnancy
Horn, E. J., Chambers, C. D., Menter, A., Kimball, A. B. & Council, I. P. (2009). Pregnancy outcomes in psoriasis: why do we know so little? Journal of American Academy of Dermatology, 6/(2), 5-8. doi:10.1016/j. jaad.2009.05.004
National Eczema Association. (n.d.). Itching for relief? Retrieved November 30, 2016, from https://nationaleczema.org/eczema/types-of-eczema/atopicdermatitis/
National Institute of Health: National Institute of Allergy and Infectious Diseases. (2015). Eczema (atopic dermatitis) complications. Retrieved November 30, 2016, from https://www.niaid.nih.gov/diseases-conditions/ eczema-complications
National Institute of Health: National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2015). Questions and answers about acne. Retrieved November 30, 2016, from https://www.niams.nih.gov/health_info/acne/
Psoriasis and Psoriatic Arthritis Alliance. (n.d.). Psoriasis fertility, conception, and pregnancy. Retrieved November 10, 2016, from http://www.papaa.org/ children/psoriasis-fertility-conception-and-pregnancy
Skin Cancer Foundation. (n.d.). Melanoma. Retrieved November 10, 2016, from http://www.skincancer.org/skin-cancer-information/melanoma
Sullivan, D., Weatherspoon, D., & Weatherspoon, C. (2016). Pregnancy with psoriasis: What new parents need to know. Journal of Childbirth Education, 3/(3).
Dr. Debra Sullivan is full time faculty for Walden University where she teaches graduate level nurses. As a certified nurse educator (CNE) and certified online instructor (COI), she enjoys research and writing in the area of education. She has published internationally and nationally in nursing journals and presented at many local, state, national, and international conferences.
Virginia Sullivan is a microbiology major at the University of Tennessee, Knoxville, TN. She has a special interest in immunology and plans to specialize in Women's Health in Medical School.
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|Author:||Sullivan, Debra; Sullivan, Virginia|
|Publication:||International Journal of Childbirth Education|
|Date:||Jan 1, 2017|
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