The Skin and Pregnancy

Pregnancy induces many changes in the skin, some of which are so common as to be considered normal. Hyperpigmentation and vascular changes are common. Striae, hair loss, and melasma are especially troublesome for patients. Preexisting skin diseases can remain stable, worsen during pregnancy, or improve. Various rashes specific to pregnancy may occur, nearly all of which are itchy, but resolve after delivery. The most common rash is pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy (PEP). It most commonly arises in the abdominal striae of primigravidas in the third trimester. It is a harmless rash, but pruritus can be frustrating. Pemphigoid gestationis is a blistering eruption with an increased incidence of prematurity and small-for-gestational-age infants. It mostly occurs in the second or third trimester. Definitive diagnosis is made by immunofluorescence skin biopsy or serologic testing for BP180 (BPAG2) antibodies.