Skin problems and specific skin conditions of pregnancy

Which skin problems are normal during pregnancy?

Pregnancy hormones act directly on the skin, blood vessels and hair. These changes are called physiological: they are not a sign of disease. They are discussed during antenatal care, up to giving birth in Paris.

• Pigmentation: a vertical brown line on the abdomen (linea nigra), darker areolae and genitals, the pregnancy mask (melasma) on the face, made worse by sun exposure.
• Stretch marks: streaks that are first pink or purplish, then whitish, on the abdomen, breasts, hips and thighs.
• Blood vessels: small spider veins, red palms, varicose veins in the legs or vulva, swollen legs at the end of the day.
• Moles: they may darken slightly. A mole that clearly changes shape, size or colour should be shown to a dermatologist, as it would outside pregnancy.
• Skin and hair: acne, oilier or drier skin, thicker hair during pregnancy followed by hair loss after the birth.

To limit the pregnancy mask, high-factor sun protection is advised. No cream has been shown to prevent stretch marks; regular moisturising may however improve comfort.

Can pregnancy affect an existing skin condition?

Yes. Eczema (atopic dermatitis) often gets worse, whereas psoriasis may improve or worsen. Some autoimmune diseases such as lupus need joint care between the obstetrician, dermatologist and internal medicine specialist, ideally planned before pregnancy. Several skin treatments are contraindicated during pregnancy, such as retinoids. Tell your doctor about all your treatments, including creams, and see our article on medicines during pregnancy.

What are the specific skin conditions of pregnancy?

The international classification, proposed by Ambros-Rudolph and colleagues, recognises four conditions specific to pregnancy. All cause itching, but their signs and risks differ.

Obstetric cholestasis: why is it important to test for it?

Intrahepatic cholestasis of pregnancy (obstetric cholestasis) is a liver condition linked to pregnancy: bile acids build up in the blood. It causes intense itching, often at night, on the palms and soles and then all over the body, without a rash.

• Diagnosis: a blood test measuring bile acids and liver function (transaminases). According to the CNGOF (2023), cholestasis is diagnosed when typical itching occurs with total bile acids above 10 µmol/L or a liver enzyme (ALT) level above twice normal, once other causes have been ruled out.
• Risks: premature birth and, more rarely, stillbirth. A meta-analysis published in The Lancet shows that this risk is linked to the bile acid level: it remains close to that of the general population below 100 µmol/L and rises clearly above it (about 3.4% stillbirth in singleton pregnancies).
• Treatment: ursodeoxycholic acid is the first-line treatment (CNGOF 2023, strong recommendation); it reduces itching as well as bile acid and liver enzyme levels.
• Monitoring: regular checks of bile acids. According to the CNGOF (2023), if bile acids reach 100 µmol/L or more, birth is recommended from 36 weeks; below 100 µmol/L, induction may be considered between 37 and 39 weeks.

The itching disappears within a few days to a few weeks after the birth. Cholestasis often recurs in later pregnancies, and a pill containing oestrogen can sometimes trigger it again. After the birth, bile acids and liver enzymes are checked: they should be back to normal before a combined (oestrogen-progestogen) pill is prescribed.

How are the other skin conditions of pregnancy treated?

Polymorphic eruption and atopic eruption

They are uncomfortable but not dangerous for the baby. Steroid creams and emollients usually bring relief; an antihistamine compatible with pregnancy may be prescribed. Polymorphic eruption clears within a few weeks after the birth and rarely recurs.

Pemphigoid gestationis

This is a rare autoimmune disease: antibodies attack the junction between the layers of the skin and form blisters. Diagnosis relies on a skin biopsy with immunofluorescence. Treatment combines steroid creams and, when widespread, oral steroids. A flare at the time of birth is common. The condition often recurs, earlier and more severely, in later pregnancies; the combined pill can also trigger it again. Whether breastfeeding is compatible with the treatment is discussed case by case. Monitoring of the baby's growth is stepped up.

Where necessary, the practice refers you to a dermatologist.

How can I relieve itching in pregnancy day to day?

While waiting for your appointment, and alongside any prescribed treatment, a few simple measures soothe the skin:

• take short, lukewarm showers with a soap-free cleansing bar or oil;
• apply an emollient (plain moisturising cream) once or twice a day, on slightly damp skin;
• wear loose cotton clothes and avoid wool or synthetic fabrics against the skin;
• keep nails short and pat rather than scratch;
• keep the bedroom cool at night, as heat makes itching worse;
• avoid perfumed products, essential oils or creams that have not been prescribed.

These tips do not replace testing: itching that persists despite these measures must be reported, even without a visible rash.

When should I go to the maternity unit urgently?

See your doctor or midwife promptly if you have severe, persistent itching, especially on the palms and soles, or if blisters appear. Go to the maternity emergency department or, if you feel unwell, in France call 15 (SAMU) or 112, or your local emergency number, if:

• you have known cholestasis and your baby's movements decrease or stop;
• itching comes with jaundice (yellow eyes or skin), dark urine or pale stools;
• a rash comes with fever or extreme fatigue, or spreads quickly with blisters or areas of peeling skin;
• you have itching with headache, visual disturbance or pain under the ribs, which may point to liver involvement linked to pre-eclampsia;
• you have contractions, bleeding or leaking fluid.

Other causes of itching are covered in our article itching during pregnancy: when to worry.

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.