Your mind might naturally think of the womb or placenta as the important organs, but did you know the biggest organ in your body is the skin? Around 2 square meters in surface area (21.5 square feet), your skin performs essential functions such as acting as a barrier to the outside world and regulating temperature control.

Skin is subject to the surge in hormones during pregnancy. It’s very common to experience skin changes at this time, both good and not so welcome. Having acne, oily skin, skin pigment changes, dry skin, and hair changes in pregnancy are all part of the ups and downs.

Is the “pregnancy glow” a myth? The flush of pregnancy is a real phenomenon caused by increased blood flow to the skin and increased sebum production (basically oil), giving your skin a soft shine. But it isn’t a given that this will be the case.

From the pale, tired look brought about by nausea to acne and skin pigmentation changes, the skin also goes on its own journey so it’s worth knowing what to look out for. Read on as we answer your skin-related questions in pregnancy.

Pigmentation changes during pregnancy

Hormonal changes lead to a surge in melanin—a substance responsible for pigment changes in the skin. Pregnancy skin is associated with patterns that can seem somewhat random and mysterious.

• Skin darkening. Why does your neck get dark during pregnancy? Your nipples, neck, underams, and the area around your inner thighs can appear darker when pregnant, possibly due to hormonal changes.
• Linea nigra. You may develop a dark vertical line down the center of your abdomen known as linea nigra. It’s the reason your belly button might turn brown or black if you’re of darker skin.
• Melasma. It affects the face especially in light brown skin types, when combined with exposure to the sun. Often referred to as “the mask of pregnancy,” these patches of brown pigment can spread across your face. Their appearance can vary from mimicking a gentle spattering of large freckles to an uneven effect that is cosmetically unacceptable to the affected individual. Avoid direct sunlight, wear a broad-spectrum sunscreen with an SPF (sun protection factor) of 50, and a wide brim hat to help reduce melasma progression. The discoloration should fade after pregnancy once your hormone levels go back to normal. If they persist, various treatments are available. Consult with your healthcare provider, but most are not suitable for use during pregnancy.

Stretchmarks

Everyone asks about them. Are stretchmarks inevitable? Will they go away? Do stretchmarks get worse with each pregnancy? What can I do to avoid them? Most people have their go-to person when it comes to treatment. Trust your friends to recommend various oils that guarantee your return to the taut skin and smooth look (if that’s where you started from).

I once read a woman describing her old stretchmarks with pleasure, seeing them as the markers of her body’s journey and triumphs throughout her life. Since then, I see them as normal and attractive in their silvery streaky lines spreading across the abdomen. A reminder of the work done by your body and a life well-lived. That’s just me, and we know that opinions and feelings about skin appearance differ from one individual (and culture) to another.

Stretchmarks are due to physical stretching and hormonal changes in the skin’s elasticity that happen during pregnancy. Their appearance depends on the amount of collagen present in the skin. They begin as dark pink, red, or brown marks and can itch before appearing. Stretch marks will fade after delivery. You may want to keep your skin supple and well moisturized, but no cream or oil is particularly proven to fade them. If you really dislike them, a dermatologist or plastic surgeon may offer cosmetic treatment options.

PUPPP rash

Occasionally an intensely itchy rash may appear in stretch marks of the abdomen during the last trimester. This rash is known as PUPPP, which is short for pruritic urticarial papules plaques of pregnancy. PUPPP clears with delivery and it’s not harmful to the baby hence your newborn will not be affected.

You can treat the itchiness with antihistamines. Check with your physician but many can be used safely in pregnancy.

Oily skin in pregnancy

Everyone associates acne with the teenage years, but an increase in sebum can clog pores and cause acne breakouts in pregnancy. The basics of acne care apply; use a light facial wash that’s not too harsh. It’s tempting to strip away the oil with a powerful cleanser, but this tricks your body into thinking it must make more oil, leading to even more grease than before. Use a light moisturizer that doesn’t clog pores.

Most of the usual acne treatments aren’t recommended in pregnancy, particularly the often effective retinoids. You can use antibiotic creams or gels. Have a chat with your dermatologist about this.

Is dry skin a symptom of pregnancy?

You may have dry skin as well as oily skin while pregnant—nothing is predictable, right? Dry skin requires you to moisturize frequently and stay well hydrated. It’s often itchy, so wear loose cotton clothes and have cool baths if this is the case. If you’re itching without an apparent reason or underlying rash, check with your doctor about testing for an uncommon condition called obstetric cholestasis. This condition is related to the liver and it usually presents as itching in its early stages.

Does your hair change when you’re pregnant?

Hair is broadly categorized as an accessory structure of the skin so yes, your hair changes in pregnancy. It has a standard 3 phase growth cycle: growth, rest, and shedding. Surges of the estrogen hormone promote less hair shedding from the 2nd trimester onwards. Your hair may therefore appear thicker. Hair may also appear in less welcome places like around the abdomen.

This all changes after delivery. From around 2-4 months, the shedding accelerates. Don’t be alarmed to see more hair than usual on your pillow or your hairbrush. Eventually the hair cycle settles back to normal (this can take up to 1 year).

If you’re worried that the hair loss seems excessive, it’s worth asking for a blood test to check your iron levels and thyroid function.

How to have great skin in pregnancy

With a bit of luck on your side, you might experience the pregnancy glow. Acne sufferers may even find that pregnancy reduces acne. Eating a healthy diet, staying well hydrated, and following a regular skin care regimen will help you have good skin during pregnancy and beyond.

Don’t hesitate to ask for help if your skin is making you feel down. And if your skin is (literally) giving you a bumpy ride, remember that things often fluctuate during pregnancy and will settle down after delivery.