Understanding and treating common skin changes during pregnancy

From pregnancy mask to hormonal acne, carrying a child can mean big changes to your skin. We asked Diana Westgate, MD, PPG – Premier Dermatology & Skincare, to walk us through some of the most common issues and what can be done to resolve them safely.
Pregnancy mask

This change in the skin’s color, commonly referred to as “pregnancy mask” is actually a condition called melasma. While it’s most commonly associated with pregnancy, melasma can be triggered by any hormonal change, so men or women experiencing a change in estrogen levels due to a condition or medication can see this increase in pigmentation.

Those experiencing melasma during pregnancy will often see an activation of pigment-producing cells on multiple areas of the skin, including the stomach (linea nigra), nipples, cheeks, upper lip, mid forehead, under arm or genitalia.

Melasma typically regresses after pregnancy, but can be tough because some women begin hormonal therapy, such as birth control, which can exacerbate the problem.

During pregnancy, the only safe, FDA-approved thing you can do to combat melasma is to use sunscreen. Sun is the enemy of melasma. The more sun you get, the darker the discoloration will get, which is a challenge for women pregnant in the summer. Use a sunscreen with at least SPF 50, and one that contains a physical blocker, such as zinc oxide or titanium, rather than a chemical blocker. A physical blocker offers immediate, safe protection from the sun’s rays. I can’t emphasize it enough; If you don’t use sunscreen, nothing else is going to work.

There are a few over-the-counter treatments that offer a modest effect at best for lightening melasma, including topical coffeeberry and kojic acid. Post pregnancy, there are several stronger treatments a woman can try, including a hydroquinone-based agent, often paired with chemical peels.

Linea nigra

The linea nigra – that dark line that runs from the belly button down the front of the stomach – is a separate entity from melisma, though both are an activation of pigmentation. Pregnancy is a heightened pigment state, so the occurrence of this change is fairly common but not guaranteed. This is a very natural pigmentation change and should naturally fade after delivery.


Not everyone will experience acne during pregnancy, though it is fairly common. This type of acne is typically hormonal in nature, so the pattern is different from standard acne. Hormonal acne is most often seen on the lower face, upper chest and upper back, whereas teens often see acne more in their forehead, temple, nose and mid face.

During pregnancy, acne can be treated safely using a benzoyl peroxide wash, Clindamycin topical acid or Azelaic acid gel, all of which help control oil and inflammation. Certain antibiotics can be used safely as well, if the acne is more aggressive, but a lot of the traditional treatments, including retinoids, and strong antibiotics are not safe during pregnancy.

Another option that is safe, though not FDA approved and therefore not covered by insurance, is blue light therapy. For the treatment, skin is placed close to an intense visible light source on the blue light spectrum, which decreases inflammation in skin. While patients do have to wear eye protection, this treatment does not have any dangerous side effects such as cancer risk or skin damage.

For a natural, more holistic approach to treatment, there are some dietary changes you can make to address hormonal acne. Avoid whey protein, which can increase acne breakouts, as well as dairy. You should also avoid simple sugars and foods that have a high glycemic index. It’s worse to eat a bowl of white pasta than it is whole wheat, due to the burst of simple sugar.

Stretch marks

The cause of stretch marks is a rapid stretching of the skin, which puts stress on underlying fibers of the skin that give tone and structure. The quicker the skin stretches, the more likely you are to have stretch marks.

I tell patients to …
1) Be sure you’re applying a good, thick moisturizer (from a pot, not a pump) and massaging to prepare the skin. A topical vitamin C serum can also help reduce redness and stretch marks. This will help but won’t eliminate possibility of stretch marks.
2) There is a genetic component to stretch marks, so if your mom was covered in them after having children, so, likely will you. This is also true with spider veins.
3) It’s important to try to control your weight gain. The thought is that, a slow steady gain can reduce that rapid stretching and therefore potentially lessen the effects.
4) Stay well-hydrated. Edema is more common in pregnancy if you’re dehydrated, so if you’re not drinking enough water, you’re more likely to notice swelling which can be linked to stretch marks.  

After delivery, there are laser treatments that can be used to modestly reduce redness, tone and texture, and make the stretch marks less noticeable.

It’s important to always talk to your dermatologist about your family planning, including whether you are pregnant, breast feeding or trying to become pregnant, so they can develop a safe, effective treatment plan for you. 

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