Updated: Nov 29, 2022
By Simran Sethi (Seh-tee), MD, MBA
As a mom of three children, I am familiar with hormonal shifts during pregnancy that can significantly impact our skin, particularly our increase in estrogen and progesterone. A woman produces more estrogen in one pregnancy than she does in a lifetime! The four most common skin changes during pregnancy are hyperpigmentation, acne, stretch marks, and vascular changes, or spider veins.
The first and most common change is hyperpigmentation, or increased pigmentation, which can occur in two ways. The first being in localized areas like the midline of the abdomen. This vertical line of hyperpigmentation, also known as linea nigra, occurs in around 75% of pregnancies. However, the most problematic hyperpigmentation scene in pregnancies is known as melasma, which appears as dark patches on the cheeks, upper lip, and forehead.
Because melasma is most commonly seen in pregnant patients, it’s often called the mask of pregnancy. Even though we know that melasma frequently occurs during the second and third trimesters of pregnancy, we do not know exactly which hormones trigger it. We do know, however, that estrogen levels are at their highest during the first trimester, which may trigger melasma in women who are predisposed to it in the second or third trimester. We know that melasma worsens with exposure to heat and UV light, so diligently wearing sunscreen is the best way to safely reduce pigmentation from melasma during pregnancy. Typically, this hyperpigmentation will not worsen after delivery and can disappear on its own postpartum. However, it may take several months to lessen, so patience is key.
Women experience intense levels of estrogen, which has an impact on their skin. For example, women’s sebaceous glands produce more sebum or oil when estrogen levels are high. This can lead to increased acne lesions, especially in the first and second trimesters, as estrogen levels are highest then. Truncal acne, or acne seen on the back, chest, and shoulders, was seen more in the third trimester than in the first two. While acne is commonly seen in pregnancy, it tends not to be cystic or with very large lesions that cause people to seek medical attention generally. In my practice, I barely see women with hormonal acne from pregnancy because it’s on the milder side, and of course, it does disappear after pregnancy. So if you're experiencing hormonal acne during pregnancy, what can you do?
First, I’d like to say that there are some ingredients that should be avoided in your skincare routine, like retinol and hydroquinone. These are effective pharmaceutical compounds but have not been studied in pregnant women. We do know that taking an oral retinoid called Accutane leads to terrible birth defects, which is why this is only prescribed when women are put on two forms of birth control. Topical retinol, which is commonly used for acne treatments, has not been shown to cause birth defects, but it has also not undergone any large studies in pregnant women. So just to be safe, avoiding any retinoids or hydroquinone in pregnancy is a better approach than seeking more aggressive treatments, especially because this acne is milder and will correct after pregnancy.
Typically, our skin will return to its pre-pregnancy state a few months or even six months postpartum, with many of our pregnancy skin issues also lessening. An exception to this may be a small percentage of those who experienced melasma. But as earlier stated, there are treatments we can do to help with this.
Finally, you should always read the packaging for warnings against use during pregnancy. While everyone’s skin needs different treatments, I would highly recommend consulting with your doctor and or dermatologist to determine which products are safe to use. A routine consisting of a cleanser with salicylic acid, a vitamin C serum, moisturizer, along with sunblock is an effective and safe routine during pregnancy. Using products in my medical grade Signature System actually help create a more even skin tone and smoother texture for that radiant pregnancy glow, and by following a science-based skincare regime, it can truly heal and change your skin during and after pregnancy. On the other hand, facials are safe and a great way to fight your acne. Even facials with microdermabrasion tend to be safe. But again, I would always consult a professional.
ABOUT THE AUTHOR
Simran Sethi (Seh-tee), MD, MBA, has a deep understanding of how melanin works, having conducted skincare research with women of color for 17+ years. Her skincare line, skin by Dr. Simran Sethi, features four targeted skin care systems— all with the intention to safely treat darker skin tones and skin types while keeping melanin in mind. Based on the science of the skin renewal cycle, skin by Dr. Simran Sethi helps women of color who have struggled to find the right skincare products to celebrate and care for their complexion by working with this process rather than against it, supporting healthy skin function by minimizing irritation and inflammation. skin by Dr. Simran Sethi consists of four skin systems: Hydration, Acne, Brightening, and Signature, which were created to target specific skin concerns, and, when used together on a regular basis, deliver consistent, radiant results. skin by Dr. Simran Sethi is a medical-grade skincare line and is free of any synthetic ingredients, dye, fragrances, and other irritants.
Dr. Sethi is also the Founder and Medical Director of RenewMD Beauty & Wellness, a modern medical aesthetics spa with 3 locations across Northern California. Through her 17+ year career as an internist, Dr. Sethi understands how to achieve optimal skin from the inside out and has curated the best non-surgical laser treatments to treat all skin tones and skin types. Inspired by her personal struggle with hyperpigmentation and acne, she set out to curate treatments to safely treat darker skin tones and skin types and “normalize” aesthetic treatments. Dr. Sethi and her team have treated thousands of women of color and have learned what works and what doesn’t. The result - gorgeous, radiant, and “make-up-free” skin.