Cutaneous Changes Commonly Associated with Pregnancy at a Glance
- 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. A comprehensive list of physiologic alterations within the skin and appendages is provided in Table 108-1.1–3
Table 108-1 Physiologic Skin Changes during Pregnancy |Favorite Table|Download (.pdf)
Table 108-1 Physiologic Skin Changes during Pregnancy
- Diffuse hyperpigmentation
- Selective hyperpigmentation (genitalia, axillae, recent scars)
- Secondary areolae
- Linea nigra
- Melasma (chloasma, mask of pregnancy)
- Darkening of ephelides and melanocytic nevia
- Thickening of scalp hair
- Postpartum telogen effluvium
- Postpartum androgenetic alopecia
- Subungual hyperkeratosis
- Distal onycholysis
- Transverse grooving
- Accelerated growth
- Increased eccrine function (except palms) (miliaria, dyshidrotic eczema, hyperhidrosis)
- Elevated thyroid activity with resultant relative iodine deficiency
- Increased sebaceous function (growth in Montgomery's tubercles) (see eFig. 108-0.1)
- Decreased apocrine function
- Striae distensae (striae gravidarum)
- Molluscum fibrosum gravidarum (acrochordons)
- Spider angiomas (spider nevi, nevi aranei) (Fig. 108-1)
- Palmar erythema (see eFig. 108-0.2)
- Nonpitting edema (hands, ankles, feet, face)
- Cutis marmorata
- Vasomotor instability
- Gingival hyperemia or hyperplasia
- Pyogenic granuloma (granuloma gravidarum, pregnancy epulis)
- Hemangiomas, hemangioendotheliomas, glomangiomas
- Unilateral nevoid telangiectasia (unilateral dermatomal superficial telangiectasia)
- Gingivitis (marginal gingivitis, papillomatous hypertrophy of the gums)
- Jacquemier–Chadwick sign (bluish discoloration of vagina and cervix)
- Goodell's sign (cervical softening)
Pigmentary disturbances are the most common of these physiologic changes (see Table 108-1). Hyperpigmentation of the areola, axillae, and genitalia is 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 xiphoid process of the sternum (Fig. 108-2). Melasma or chloasma is a related finding comprising irregular, blotchy, facial hyperpigmentation that occurs in up to 70% of pregnant women (see ...