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INTRODUCTION

Pregnancy is an exciting and intense stage in a woman’s life, filled with physical and emotional changes. As the fetus develops in-utero, the mother’s body will also experience immunological, endocrinological, vascular, and metabolic changes. Skin manifestations in pregnancy can be divided broadly into the following categories:

  1. Physiological skin changes

  2. Exacerbation of pre-existing dermatoses

  3. Specific dermatoses of pregnancy

PHYSIOLOGICAL SKIN CHANGES

Pigmentary changes affect up to 90% of pregnant women and are due to raised levels of melanocyte-stimulating hormone, estrogen, and progesterone (Figures 16–1, 16–2, 16–3, 16–4). The pigmentary changes seen include melasma, linea nigra, and areolar hyperpigmentation. Connective tissue and vascular changes are a result of distention, instability, and proliferation of vessels and manifest as striae gravidarum, spider angiomas, skin tags, hypertrophic scarring or keloids, edema, varicosities, hemorrhoids, palmar erythema, pyogenic granuloma, and gingivitis. Montgomery’s tubercles on the areolae are an early sign of pregnancy. Increased sebaceous gland activity account for shinier hair and a pregnancy glow, as well as acne. Hair changes encompass hirsutism and telogen effluvium, which may unmask underlying androgenetic alopecia.

Figure 16-1

Linea nigra

This 30-week pregnant Chinese female has a hyperpigmented linear streak over her lower abdomen along the midline. Linear nigra is commonly seen in pregnancy, and is due to hypermelanosis of the linea alba. It may be more prominent in darker-skinned patients. This hyperpigmentation often fades after delivery.

Figure 16-2

Striae gravidarum

Striae gravidarum is a common cosmetic concern to many patients. In this photo, we see erythematous linear bands over the abdomen. These will gradually fade to become skin-colored or hypopigmented atrophic lines that may be thin or wide. Striae usually occur in the third trimester. Mechanical stretching of the skin in association with hormonal factors has been implicated in the pathogenesis.

Figure 16-3

Striae gravidarum

A side view of the same patient, showing similar erythematous linear bands over the abdomen. Risk factors include higher maternal weight gain and genetic factors such as the presence of previous stretch marks in the thighs or breasts. The popular use of topical vitamin E preparations and hyaluronic acid does not appear to reduce the risk of developing striae.

Figure 16-4

Pyogenic granuloma

Pyogenic granuloma is a friable red growth with surface erosion or ulceration, bleeding easily upon contact. There is an increased incidence and proliferation of pyogenic granulomas in pregnancy. Common sites of occurrence include the scalp, face, lips, and fingers (pictured). Treatment involves shaving the lesion and cauterizing the base for hemostatic control. Recurrences are common.

PRE-EXISTING DERMATOSES EXACERBATED BY PREGNANCY

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