Pregnant women naturally want to take extra care of their skin during pregnancy. After all, despite the enormous amount of stretching that naturally occurs to abdominal skin and the breasts, everyone would like to get their figure back afterwards, and hope their skin doesn’t betray the stretching that took place with the baby!

What common skin conditions occur in pregnancy? Hormone changes cause some skin changes, including darkening from pigment (melasma), striae gravidarum (stretch marks) and attentive women notice a change in their hair, nails, teeth, and skin.

Unfortunately, pre-existing conditions like atopic eczema, psoriasis, and acne can all get worse, although in some cases, they improve during pregnancy. Late in pregnancy, some women suffer with their skin itching, often due to changes in the way bile flows from the gall bladder through the gut. We call this cholestasis.

So most women take extra care of their skin during pregnancy, seeking out creams that seem to add that extra bit of magic. Names like bio-oil and ceramides, or natural ingredients like shea butter or argan oil sound very attractive, but what works best?

Unfortunately, there is no hard evidence that vitamin E creams, cocoa butter, aloe vera lotion or any of the other natural products, are effective in preventing stretch marks. It seems that the best advice is to try and put the right amount of weight on during pregnancy by eating from a good range of healthy foods. Gaining too much weight, or too quickly, is a sure way of getting stretch marks. There is weak evidence that Bio-oil is effective in improving skin elasticity, and rather weak evidence for some other natural products, but none are proven by double-blind studies.

If you suffer from psoriasis in pregnancy, you will be pleased to know it almost always improves, and you may be able to continue using your usual cream but less often; it is always best to check with your GP or midwife. With eczema, one may need to be a little more careful using steroid creams, as over-use of steroid cream is known to be a risk for stretch marks. However, there are many types of dermatitis related to pregnancy which do improve with steroid creams; pruritic folliculitis, and prurigo for example, as well as atopic eczema.

It is best for your GP to manage things skin-related holistically. Your GP will take account of your stage of pregnancy, any pre-existing skin conditions, and other treatment besides creams that may be required. It is safe to take anti-histamines for itching, or pruritus, and adding a little baby oil to your bath water may help keep the skin supple and hydrated.

You should consider what you eat, any food intolerance or allergies you may have, and your general health. Your skin may require greater sun protection to prevent darkening of the skin of your face – chloasma or melasma on the face can be quite upsetting and takes a long time to resolve after the baby is born. If you and your partner both suffer from atopic eczema or allergies, you may wish to consider taking in extra pro-biotic drinks like live yoghurt, to boost your immune system by ensuring plenty of healthy germs in your gut. Although most women decide to take pre-natal vitamins and folic acid, nothing beats a regular and diverse supply of fresh leafy green vegetables and fruit.

It certainly makes sense to use more diluted steroid creams if you have to use these in pregnancy for eczema, and you can mix your own by diluting one part steroid cream to four or five parts of moisturiser, but always check with your GP that you are not using too much.

Further reading:

https://www.aafp.org/afp/2007/0115/p211.pdf

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jdv.13223