How to Treat Common Pregnancy and Postpartum Skincare Woes
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Dr. Jennifer Sawaya is board-certified dermatologist with a focus on cosmetic dermatology, and a mama-to-be currently in her second trimester (expecting her first child in August 2020). She also happens to be our co-founder Julie’s sister! Today, Dr. Jen shares her top tips for addressing the most common pregnancy skincare woes--from hormonal acne, to stretch marks, and more.
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Breaking down the top pregnancy and postpartum skincare challenges.
My patient base includes many women who are in the life stage of before, during, and after pregnancy. I am in my early thirties, and so many of my friends, fellow doctors, and extended family are trying to conceive, currently expecting, or newly postpartum. This is a topic near and dear to my heart.
While pregnancy is a magical time, the rapid hormonal changes can lead to several less than desirable changes to the skin. Your skin is your body’s largest organ, and so it’s common to see any imbalances or fluctuations manifested in the skin’s appearance.
The most common worries that I see in my patients are: i) hormonal acne (on the face or body), ii) stretch marks (prevention and treatment), and iii) hyperpigmentation of the skin. I’ll break down the cause of each of these below, and share my tips on how to address them.
What it is: Hormonal acne is a subtype of acne that is closely related to hormonal changes. Normally, acne may be due to a variety of different factors including inflammation, bacteria, clogged pores, and hormonal factors. Many women notice a change in their skin as they progress through their menstrual cycle, and this is largely due to fluctuating levels of estrogen and progesterone. In pregnancy these hormones are continuously elevated above baseline and stimulate the sebaceous glands in the skin to produce more oil. For some women, this may result in a more-beautiful-than-ever “pregnancy glow”, whereas for others this may lead to a flare or new onset of acne.
When it most commonly appears: Hormonal acne is typically most pronounced in the first trimester of pregnancy. In the first trimester, the change in hormone levels is due to an abrupt increase in the production of estrogen and progesterone by a mama’s ovaries. As the pregnancy progresses into the second trimester, the placenta starts to take over some of this hormonal burden and women may see an improvement in many of their symptoms, including acne. Although this is the most common scenario, some women may see their acne continue or even worsen into later trimesters.
Acne on the body: Pregnant women may also notice acne on their bodies, usually on the chest and back. While this is also hormonally influenced, I find that with body acne it is usually worsened by external factors. This typically includes wearing tight clothing when exercising and/or sweating, which causes clogging of the sweat ducts and pores. I recommend wearing loose-fitting clothing while exercising and showering immediately after sweating. I also recommend using the same acne treatments as for the face (see below).
How to treat it: Unfortunately many of the usual acne treatments are not safe for use in pregnancy, especially many of the oral medications that dermatologists prescribe to treat acne. These include isotretinoin, commonly referred to as accutane, oral antibiotics such as doxycycline, and hormonal treatments such as birth control pills or spironolactone. In addition, it is not safe to use topical prescription retinoids or over the counter retinols in pregnancy.
There are, however, a variety of topical medications that are safe for use in pregnancy. Chief among these are topical antibiotics including clindamycin and azelaic acid. I also love glycolic acid, an alpha hydroxy acid that acts as a chemical exfoliant, for acne and general skin care. Finally, it has recently been shown that low concentrations (i.e. <2%) of the over the counter ingredients salicylic acid and benzoyl peroxide are safe for topical use in pregnancy.
How nutrition and lifestyle may influence it (treating from within): We know that acne is an inflammatory disorder of the skin, and I do believe that there is a role for a non-inflammatory diet in the treatment of acne (including boosting your Omega-3 levels). I counsel my patients that they may want to try reducing or eliminating their intake of dairy, refined sugar and/or gluten for a period of time to see if they see an improvement in their acne.
What they are: Striae distensae, commonly known as stretch marks, are visible linear scars that are due to the abrupt and/or repeated stretching of skin. Striae typically occur during periods of rapid skin expansion such as in puberty, pregnancy, obesity, and certain other health conditions. In pregnancy, stretch marks are commonly located on the abdomen, breasts, hips, and buttocks. They typically start as red linear marks and over time can develop into skin-colored or slightly lighter depressed scars.
When they most commonly appear: Stretch marks typically appear in the late second and third trimesters.
What causes them: Stretch marks are caused by the rapid expansion of skin resulting in defects in the connective tissue. There is likely a genetic component to stretch marks. Other factors that influence the development of stretch marks are the quantity and distribution of weight gain and hormonal factors.
How to treat them topically: The best treatment is prevention. This can be done by maintaining a healthy lifestyle and regular daily use of a moisturizer or belly oil to keep the skin soft and pliable during periods of expansion.
Once they have developed, the appearance of stretch marks may be improved with laser treatment. It is easier to treat stretch marks when they are in the early red phase, with a vascular laser. Once stretch marks become skin-colored, depressed, or more scar-like the best treatment is with a resurfacing laser. These procedures are generally done once the patient has finished breastfeeding.
How nutrition and lifestyle may influence them (treating from within): although they are largely driven by genetics, maintaining a healthy weight and staying active may help to reduce the likelihood of their appearance. There is also anecdotal evidence that consuming collagen peptides may improve the appearance of stretch marks for some mamas. I also recommend daily application of a moisturizer or oil with gentle massage.
What it is: Hyperpigmentation is a broad term used to describe increased pigment in the skin. In pregnancy, there is a greater production of the natural skin pigment melanin. Clinically, this shows up as new or darker moles, darkening of nipples and the anogenital area, melasma (facial hyperpigmentation), and the appearance of a linea nigra (a vertical line down the abdomen).
When it most commonly appears: any point in pregnancy, usually more pronounced as pregnancy progresses.
What causes it: Elevated levels of estrogen and progesterone influence the production of melanin.
How to treat it topically: I do not recommend skin lightening treatments in pregnancy. The best way to minimize hyperpigmentation is by wearing a good sunscreen (SPF 30 or greater, a physical blocker with zinc oxide or titanium dioxide) daily and to reapply every 2 hours when outside. These changes are generally temporary and will subside after pregnancy, but please consult a dermatologist for any questionable new lesions.
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