There are lots of skin changes that might happen during pregnancy; some are due to physiologic and hormonal changes and some are more serious. Let’s talk about some of the more common ones.

Spider angiomas. These are little vascular spots that can show up on your skin during pregnancy. They are typically not concerning and will go away when you are no longer pregnant. The only time we would be concerned by them is if you have a history of liver problems or if you began having symptoms that would be concerning for a liver problem (which is rare). 

Linea nigra. This is a normal dark vertical line that can arise from your belly button down towards your pubic bone. It develops because of certain hormonal changes but it will fade away partially once the baby is born. During pregnancy, the placenta develops a hormone called melanocyte-stimulating hormone (MSH). This extra MSH stimulates some cells to make extra melanin which causes these cells to get darker.

Darkened areolae and darkened armpits. There are a lot of changes that may occur with the breasts during pregnancy. The nipples and areolae may become a darker shade due again to extra MSH. Similarly, the color should fade back to near its usual color after the baby is born. While this is completely normal, any redness of the breast should be investigated further by your doctor. The same thing goes for the arm pits. You may notice that they are darker, and may even look a gray or brown color. This is normal and will fade mostly back to normal as well once the baby is born. 

Melasma. Another case of hyperpigmentation in pregnancy! Are you kidding me?! Are you noticing a theme yet? Unfortunately, this one occurs on the face and women typically do not like it. It will appear as a gray or brown patchy/spotty or general change in the coloration of the face. What may be more upsetting to hear is that we don’t have a good treatment for it. If it’s still present a few months after you’ve delivered, talk to your doctor about possible treatments. You can prevent it from getting worse by using sun protection like sunscreens, hats, etc. Any sun exposure can make it worse. 

Polymorphic eruption of pregnancy (PEP). PEP is a rash of pregnancy that can occur during the third trimester on the abdomen and sometimes upper thighs. This previously was called pruritic urticarial papules and plaques of pregnancy (PUPPP). It will be very itchy and look like plaques, red bumps, or even hive-like. It can start out in the stretch marks and is not harmful to you or baby, but can be very annoying for you because of the itch. Treatment is a topical steroid cream that your doctor will prescribe for you, and possibly an oral antihistamine (e.g., Benadryl) to control the itch. Cool wet compresses and oatmeal baths may help with the itching.Pemphigoid gestationis. This rash can occur during the second or third trimester or sometimes right after delivery. This can have similar features to PEP but can extend further on your body beyond legs and thighs. It may develop blisters as well. The treatment is the same as it is for PEP. There are some other causes of rash and itching as well, including atopic eruption of pregnancy and pustular psoriasis of pregnancy. Remember, if your main symptom is intense itching without a rash, be sure to discuss intrahepatic cholestasis of pregnancy with your doctor as this requires medical treatment and earlier delivery.