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  • Cutaneous changes result from the altered endocrine, metabolic, and immunologic milieus that characterize pregnancy.

  • Pigmentary disturbances, including hyperpigmentation, darkening of the linea alba, and melasma are the changes most commonly observed.

  • Significant change in nevi size is not a feature of most pregnancies.

  • Structural changes known to occur during pregnancy include, most commonly, striae distensae.

  • Pruritus is a common complaint during pregnancy and may be related to flare of a preexisting dermatosis or onset of a specific dermatosis of pregnancy.

Pregnancy is characterized by altered endocrine, metabolic, and immunologic milieus. These dramatic alterations result in multiple cutaneous changes, both physiologic and pathologic. Table 105-1 provides a comprehensive list of physiologic alterations within the skin and appendages.1-4

Table 105-1Physiologic Skin Changes During Pregnancy

Pigmentary disturbances are the most common of these physiologic changes. Hyperpigmentation of the areola, axillae, and genitalia are well documented in pregnancy. Linea nigra refers to the typically reversible darkening of the linea alba, a hypopigmented linear patch extending from the pubis symphysis to the sternal xiphoid process (Fig. 105-1). Melasma or chloasma comprises irregular, blotchy, facial hyperpigmentation that occurs in up to 70% of pregnant women (Fig. 105-2). It is aggravated by sun exposure and by oral contraceptive intake in nonpregnant women. Melasma may regress postpartum, but oftentimes persists, posing a therapeutic challenge.1

Figure 105-1

Linea nigra. A hyperpigmented line extends from the pubis symphysis to the xiphoid process of the sternum. Hyperpigmentation is often more pronounced inferior to the umbilicus.

Figure 105-2

Melasma. Blotchy, ...

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