Pregnancy skin changes O99.7

Group of heterogeneous, physiological and pathological (so-called specific pregnancy dermatoses) skin changes that occur during pregnancy and are largely reversible after pregnancy. Pre-existing skin diseases can also be positively or negatively influenced during pregnancy.

A distinction is made between:

Pregnancy-related skin changes:

• Hyperpigmentation (melanotic dyschromias):
  • Hyperpigmentation (up to 90% of pregnant women) especially of the nipples, genitals, linea fuscea (linea nigra). Less frequent are hyperpigmentation along the front of the upper arm, the back of the thigh, the so-called Voight lines.
  • Melasma gravidarum
  • Hyperpigmentation of melanocytic nevi.
• Changes in connective tissue:
  • Striae cutis distensae (up to 90% of pregnant women).
• Vascular changes:
  • Palmar erythema (erythema palmare et plantare symptomaticum).
  • gingival hyperemia and hyperplasia
  • Pregnancy gingivitis
  • Epulis gravidarum (pregnancy tumor)
  • Nevi aranei and other telangiectasias
  • Granuloma pyogenicum
  • Lymphedema
  • Varices
  • Hemorrhoids
• Changes of hair(Remark! During pregnancy, hair is usually in remarkably good condition. Problems usually appear only after pregnancy)
  • Hypertrichosis
  • Postpartum effluvium
  • Postpartum androgenetic alopecia
• Nail changes: rarely, there is increased brittleness or slight surface cracking; otherwise, the nails are usually unproblematic.
• Changes in glandular functions:
  • Hyperfunction of the eccrine glands is possible (hyperhidrosis).
  • Apocrine glands are dysfunctional

Dermatoses influenced by pregnancy:

• Atopic eczema
• Psoriasis vulgaris
• Impetigo herpetiformis
• Lupus erythematosus
• Pityriasis rosea.

Pregnancy-specific dermatoses:

• pregnancy cholestasis (intrahepatic cholestasis of pregnancy = ICP = pruritus gravidarum)
• Pemphigoid gestationis (herpes gestationis)
• Polymorphous pregnancy dermatosis (PUPP)
• Papular dermatitis in pregnancy (entity disputed)
• Pregnancy dermatosis, atopic
• Autoimmune progesterone dermatitis in pregnancy.
• Folliculitis, pruritic of pregnancy (entity disputed).

See below the respective clinical picture. Basically, in the case of considerable itching:

• Cooling gels, moist compresses, cool douches.
• Tannin 3-5% in lotio alba (apply very thinly)
• Urea (3-5%), menthol (1-2%) or polidocanol (2-5%) in cream or lotion base (e.g. Unguentum emulsificans aquosum or
• "Underdosed" non-halogenated topical glucocorticoids (e.g., 0.5% hydrocortisone acetate).
• Systemic glucocorticoids if significant pruritus. Prednisolone usually short-term therapy only (<4 weeks). In 1st trimester, do not exceed dose of 10-15mg/day for prolonged use.
• Systemic antihistamines(dimetindene, clemastine, loratadine).

1. Ambros-Rudolph CM (2006) Dermatoses of pregnancy. J Dtsch Dermatol Ges 4: 748-759
2. Ambros-Rudolph CM (2010) Specific pregnancy dermatoses. Dermatologist 61: 1014-1020
3. Böer B et al.(2014) Skin diseases and allergies during pregnancy. Act Dermatol 40: 457-467