What you didn’t expect when you’re expecting

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!

photo credit: skincare-service.com

photo credit: skincare-service.com


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:

photo credit: finantempleton.com

photo credit: finantempleton.com


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:

photo credit: procedureclinic.com

photo credit: procedureclinic.com


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:

photo credit: byebyedoctor.com

photo credit: byebyedoctor.com


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.

e.Nevi/moles:

photo credit: hawaiidermatology.com

photo credit: hawaiidermatology.com

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!

By the hair of my chinny chin chin….

My dog Beaudi. He graciously agreed to be the model.

My dog Beaudi. He graciously agreed to be the model.

As a kid, hearing about  hair on your chinny chin chin was an amusing part of a fairy tale. As an adult female, having hair on your chinny chin chin is no laughing matter, right ladies? And not to leave the guys out …..having rogue earlobe hairs and feeling like a sasquatch may not be your thing, so the good news is that over the last few decades the options for hair removal have expanded and improved.

There are numerous methods available for hair removal, some of which are very temporary and some of which have the potential to permanently reduce hair growth. Notice I didn’t say permanently remove hair. I am a New Yorker to my core, despite living on the West Coast for many years,  I’m gonna tell it like it is…if it sounds too good to be true, it most likely is…so I’m not going to try to convince you otherwise.  As a dermatologist it is my job to provide facts, details and opinions so that my patients can make informed decisions. So even though this site is not intended to treat, diagnose or cure any disease or ailment, and as readers you are not patients, I am committed to providing clear, concise (well maybe not that concise, I am known to ramble a bit) explanations of issues in hopes of being helpful.

So let’s start with the basics of hair. I am sure many of you have tweezed, shaved, waxed, threaded,  sugared or “been lasered” only to be befuddled by the fact that some hairs stay gone and others rear their wiry heads way too soon. This is due to the fact that hair grows in three phases: the actively growing phase (anagen), which comprises about 80-90% of hairs. On the scalp this phase lasts about 2-6 years, whereas on the arms, legs, eyelashes, and eyebrows the phase is only about 30-45 days which helps explain why hair in these areas is much shorter than the scalp. The next phase or  transitional phase known as catagen comprises 3% of all hairs at any time. This phase lasts for about 2-3 weeks. The last phase is the resting  phase (telogen) which comprises 10-15% of hairs and last approximately 100 days. It is during the telogen phase when “shedding” occurs and about 25-100 telogen hairs are shed each day. The kicker is that hairs are not in sync with each other and while some hairs are growing, others are transitioning or falling out.  Moreover, it’s only when hairs are in anagen (growing hairs) that they are responsive to removal modalities (i.e. electrolysis, laser).

Now that we have the basics down, how do you choose the best hair removal method? There are several factors to consider: convenience, pain threshold (a very subjective factor), cost, goal for temporary vs. more long-lasting results and anatomic location. Most of these factors are intimately intertwined.

For instance, shaving is very convenient as you can do it yourself, in your home, cost is lower (although the cost of razor blades these days is nutty), pain is minimal but the results are very temporary as you have to shave every few days because you are only trimming the hair not removing it.

Waxing/threading/sugaring: convenient as the service is readily available and it’s quick, cost is relatively low, can be done on most if not all external anatomic locations. The downside is that it can be painful and the results usually only last about 3-6 weeks. With repeated treatments the hair follicles may be disrupted/ damaged  which may lead to permanent hair loss (but most likely patchy at best).

Electrolysis: So how does it work? An electric current is applied with a very fine needle-shaped electrode, or metal probe into each hair follicle to destroy the root. The pros are that this method has a good track record for permanent hair reduction and in some cases permanent removal. Since it targets the follicle itself, this method can be used on most skin types. The cons are that it can be painful, requires many treatments (can be upwards of 15-30)  and can be expensive. Also operator dependent so results can vary.

Laser: Laser hair removal is one of the most commonly performed cosmetic procedures in the U.S. A beam of  highly concentrated light penetrates into hair follicles. It is the pigment in the follicles that absorbs the light and this destroys the hair.  The technology of lasers has advanced so that patients of color can safely have laser performed without damaging skin tone. As with other methods, only the anagen follicles are targeted so treatments need to be repeated every 6-8 weeks to capture more and more of the anagen follicles until the desired level of hair reduction is achieved.

The pros are that laser can be done relatively quickly depending on the site treated and the results are long-lasting. Treatments literally can take as little as 5 minutes! The cons are cost, number of treatments required (usually 6-12) depending on body part treated and pain. I can attest to the fact that current lasers are way less painful than lasers used in 2008 even, and that is saying a lot because I am a big wimp. Risks of treatment other than pain , include swelling at treatment site, burns (go to someone with expertise and experience, and have a test spot done first: settings can be adjusted to avoid this). Although with the advances in technology this does not happen as often, but lightening or darkening of the skin in the treated area can occur.  The other issue with lasers are that they are best used on course hair: legs, back, bikini, underarm, men’s beards. Although they are used for women’s facial hair, the light colored, peach fuzz found on women’s cheeks, chins and lips is unlikely to respond as well. Lasers target a color and the lighter the hair the less there is to target.

Topical therapy: A serendipitous discovery of hair loss was noted when using an anti-malarial drug (eflornithine). The medicine is formulated under the trade name Vaniqua which is a prescription cream used to reduce facial hair growth in women. The mode of action is to block the enzyme that leads to hair growth. This ” blockage” is gradual and can take up to six months to take effect, during which time other hair removal methods would need to be continued. It’s a twice daily application and the downside is that once you stop using it…the hair growth is no longer blocked and hair will eventually return.

So as you can see there are many options…this is a good thing. The best expected outcome is permanent hair reduction and in some cases permanent hair removal may occur. Now don’t get me wrong, I’m a glass half full kind of a girl (and if the wine is really good, fill her up’) but when it comes to issues in medicine I am a realist, and I hope armed with this information you will be too so that you can decide which if any of these modalities might work for you and you will not be disappointed with the result. If none of these float your boat, au natural is beautiful too!