Aah, the joys of pregnancy. You are basking in the glory of carrying your bundle of love. Your hair is more lush and plentiful, you have that “glow”, you can indulge your every craving guilt free, and you can finally fill out that low-cut top you’ve coveted without any er, um…supplemental padding. But alas, you discover that the “Girlfriend’s guide to pregnancy” left out a few significant details about what could happen to your skin over the course of those nine months. Well, girlfriend, I’m here to tell you ugly truth. Your skin is your window to what’s happening on the inside. With a baby growing inside of you, your body is functioning in overdrive and all that growth and change happening for the baby translates into a lot of growths and changes with your skin, hair and nails. Having gone through this process a few times myself, I have had the unfortunate pleasure of experiencing a few of these lovelies and the good news is that most of the changes I’ll detail below do go away after pregnancy, and those that linger can be “taken care of” shall we say, by your local dermatologist. So even though you didn’t expect these things when you found out you were expecting, don’t worry, I’m here to guide you through it.
Lumps, bumps and tags oh my!
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a.Common benign growths during pregnancy include skin tags also known as acrochordons or fibroepithelial polyps which love to occur in all the inconvenient places like crevices and skin folds for example around your neck, in your armpits, along your bra line and groin. They also like the face, especially around the eyes. Skin tags are typically skin colored or hyperpigmented(darker)lesions 2-5mm in size that may be smooth or irregular in appearance and are often raised from the surface of the skin on a fleshy stalk. They are usually asymptomatic unless they get irritated or itchy from being rubbed by clothing or jewelry. Other than being seen during pregnancy, skin tags may have a causal genetic link as well as a link to metabolic syndromes such as diabetes. These lesions can easily be removed if desired or warranted via cauterization, cryosurgery, excision or surgical ligation.
b. Seborrheic keratoses:
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These benign lesions are raised thickenings of the skin that typically appear as variable shades of brown and can appear black at times raising concern for a differential diagnosis of melanoma and therefore are likely to be biopsied for confirmation. Some refer to seborrheic keratosis as “barnacles on the ship of life” as they typically appear later in adult life. I personally refer to them as “gifts of maturity”. Now granted, it’s like the gift from your Aunt Minny, you really don’t want the gift, you have no need for it and it’s downright ugly, but you can’t give it back and you can’t exchange it, so you might as well make the most of it and give it a nice name right? Just like tags, they don’t need to be removed, but if they become irritated or bothersome the same methods of removal for tags can be used for seborrheic keratoses.
c. Pyogenic granuloma:
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These lesions are also referred to as granuloma gravidarum, eruptive hemangioma, granulation tissue-type hemangioma, lobular capillary hemangioma, and tumor of pregnancy. I had the distinct displeasure of having one of these in my mouth during pregnancy, a common location, and in this location it is coined an “epulis of pregnancy”. A pyogenic granuloma or epulis is essentially granulation tissue which appears as an overgrowth of tissue due to irritation, physical trauma or hormonal factors. Because they are composed of groups of blood vessels they are extremely friable and can bleed significantly with minor trauma. The good news is that they often resolve spontaneously. The caveat is that if a lesion doesn’t resolve on it’s own and removal is performed but incompletely so, the lesion can recur with “friends” i.e. multiple lesions can occur. Again, being a benign lesion this is not a long term concern, but acutely it can raise false alarm for more concerning skin conditions including malignancy if you don’t inform your doctor of your prior procedure.
d. Cherry angiomas:
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Who doesn’t like a cherry on top? Well, when it comes to having them all over your body you may not. Cherry angiomas are another vascular benign neoplasm that can occur at all stages of life from childhood to adulthood, but it seems that during pregnancy they like show up even more. These lesions range from 2-5mm and may be flat or raised. The larger the lesion, the more likely that it may bleed with minor trauma. An important thing to know about these lesions that if they do become traumatized they take on a blue/black appearance which similar to seborrheic keratoses, can mimic melanoma and prompt a biopsy to rule out this possibility. Unlike pyogenic granulomas and skin tags, cherry angiomas linger long after pregnancy and in most cases become a permanent fixture on your body. Like most other lesions though they can be removed via excision, cauterization or laser therapy.
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These are benign lesions comprised of melanocytes which are your pigment producing cells. They range in color from flesh-colored to shades of brown. Melanocytes are also the cells which give rise to melanoma, the deadliest form of skin cancer. Melanoma can arise de novo, meaning the lesion originates as a cancer, or it can evolve from a pre-existing nevus/mole that undergoes changes in terms of its size, shape and color. During pregnancy it is not uncommon that pre-existing nevi/moles become darker than they were at their onset due to an increase in a hormone called melanocyte stimulating hormone. This darkening effect can be seen in other areas where melanocytes are found including genital skin, breast areolar tissue and that line from your belly button to your pubic area which is referred to as the linea nigra. Following pregnancy, the affected lesions and skin may return to their previous state, though more commonly they remain slightly darker than they were originally. The concern for melanoma is low in these situations unless it is noted that a pre-existing lesion has significantly changed in size, shape as well as color or a new lesion has appeared during pregnancy that stands out from all the other lesions a patient has, both of these scenarios may prompt a biopsy for further evaluation.
There are a host of other issues that may arise during pregnancy including: soft, brittle nails that grow at warp speed; outbreaks of acne; spider veins; stretch marks; melasma (patchy darkening of facial skin: the key is sun protection); new rashes that itch as well as exacerbation and new manifestations of underlying skin conditions like psoriasis and immuno-bullous disease. And if that weren’t enough, that luscious head of hair you acquired during pregnancy is going to start to shed starting around 3 months postpartum and last for about 3 months known as telogen effluvium. Sounds awful doesn’t it? Don’t worry, most women experience a few of these things but not all of them, and most of these issues resolve spontaneously. For all other issues and any lesions that concern you, consult your local dermatologist.
Pregnancy may not be all rainbows and butterflies, but at least now you know what to expect right? Good luck and enjoy the journey!