Skin Changes and Diseases During Pregnancy

Skin Changes and Diseases During Pregnancy! 


(Photo credit:

*By: Dr. Heba Yousef Al-Ojail

The maternal skin and appendages undergo normal physiological changes during pregnancy, as do other organ systems. Cutaneous diseases that are specific to the gravid state may also occur.

Remember that what is common in nonpregnant patients is also common in pregnancy. Always think of common diseases first—atopic dermatitis, acne, and scabies are all commonly misdiagnosed as other, more exotic conditions. 

They can be grouped into :

  1. Dermatoses of Pregnancy; are skin disorders that are limited to pregnant and puerperal women.
  • Pemphigoid gestationis/herpes gestationis “associated with fetal risk”
  • Cholestasis of pregnancy “associated with fetal risk”
  • Pruritic urticarial papules and plaques of pregnancy (PUPPP)/polymorphic eruption of pregnancy (PEP) “no fetal risk”
  • Prurigo of pregnancy—may include pruritic folliculitis “no fetal risk”

2.    Pigmentary Changes of Pregnancy

  • Hyperpigmentation: anogenital region, areola-nipple complex, axillae, inner thighs.
  • Linea nigra on abdomen
  • Melasma
  • Nevi and freckles darkening

3.   Vascular Changes of Pregnancy

  • Gingival hyperemia or hyperplasia
  • Hemorrhoids
  • Nonpitting edema
  • Palmar erythema
  • Pyogenic granulomas
  • Spider angiomas
  • Varicose veins
  • Vasomotor instability

4.    Hair Changes of Pregnancy

  • Hirsutism
  • Postpartum telogen effluvium
  • Postpartum androgenetic alopecia

5.    Nail Changes of Pregnancy (None are Pathognomonic)

  • Subungual hyperkeratosis
  • Onycholysis
  • Transverse grooving
  • Brittleness

6.     Connective Tissue Changes of Pregnancy

  • Striae gravidarum/stretch marks (in up to 90%)

7.     Glandular Changes of Pregnancy

  • Increased eccrine & sebaceous function
  • Decreased apocrine function

8.     Diseases Potentially Improved During Pregnancy

  • Acne
  • Atopic dermatitis
  • Fox-Fordyce disease
  • Hidradenitis suppurativa
  • Psoriasis
  • Rheumatoid arthritis
  • Sarcoidosis

9.     Diseases Potentially Worsened During Pregnancy

  • Infections: Candida vaginitis, condyloma acuminata, herpes simplex, leprosy, pityrosporum folliculitis, trichomoniasis, VZV
  • Immune-mediated diseases: Dermatomyositis/polymyositis,lupus erythematosus, pemphigus vulgaris, systemic sclerosis
  • Metabolic diseases: Acrodermatitis enteropathica, porphyria cutanea tarda
  • Connective tissue disorders: Ehlers-Danlos syndrome, pseudoxanthoma elasticum
  • Miscellaneous: AIDS, cutaneous T-cell lymphoma,erythrokeratoderma variabilis, hereditary hemorrhagic telangiectasia, neurofibromatosis

Heba AlOjail, MBBS
Dammam University
Dammam, Saudi Arabia


Uptodate: Dermatoses of Pregnancy

Uptodate: Skin, Hair, Nail, and Mucous Membrane During Pregnancy

Thieme Clinical Companions Dermatology book

Derm Notes: Dermatology Clinical Pocket Guide