Everything you need to know about pregnancy skincare according to Dr Ginny Mansberg

By Dr Ginny Mansberg

Congratulations! Being pregnant is such an exciting time of your life, waiting to meet your new family member! But apart from the exhaustion, sore boobs and nausea, you might also get some unwelcome skin problems.

So here are some of the more common skin conditions that you may experience during pregnancy and the ingredients that you can actually use; but more importantly – those to steer clear of.

Pregnancy Pigmentation

Dark spots, the line that runs from belly button to the bikini line and pigment patches are caused by an increase in the skin’s natural pigment, melanin, that happens during pregnancy. All of this will generally fade naturally after you give birth.

How to combat it

You can wait it out or:

• Be scrupulous with wearing a broad spectrum sunscreen from sun up to sun down 365 days a year. A hat will help too!
• Depigmentation is complex but there is evidence for using Vitamin B3, AHAs and vitamin C to combat this

What not to use

Vitamin A: While there is good evidence for Vitamin A in skincare for Acne and Pigmentation, in the case of oral Vitamin A, there is a known risk of birth defects. While there is some academic controversy about whether Vitamin A in skincare carries the same risk, for so long as the risk remains, the advice is don’t use it when pregnant or breastfeeding.

Hydroquinone: It is still considered the gold standard ingredient for depigmentation. In the case of pregnancy and risk of using it, there isn’t a lot of specific data to work with. But because 35 percent to 45 percent of it is absorbed through the skin, into our systems (that’s high) and because we don’t know for sure that it is OK for bub, the recommendation is to not use it. Add to that the safety clouds around it more generally, which has resulted in its use around the world being restricted – that makes for a strong recommendation not to use it while pregnant or breastfeeding.

Pregnancy acne

Up to 42 percent of pregnant women suffer from acne and 90 percent of these women had acne before they got pregnant, often after a reasonable period of decent skin. Believe it or not we still don’t know exactly why it happens. There are theories about hormone levels, changing bacterial microbiome on the face and altered immune system. But they remain theories at this point.

How to combat it

• Cleanse your skin with a gentle cleanser. Avoid facial scrubs, astringents or toners and masks that can tend to irritate your skin, and make your acne worse. Pat your skin dry gently, don’t rub your face too hard with a towel.
• Avoid high pH cleansers (eg. Soap) and skincare products. We recommend below a pH of 5.5 where possible. Acne bacteria love a pH of around 6.5 and thrive there.
• Don’t pick or squeeze pimples. That’s just a recipe for infection and possibly scarring.
• Avoid greasy moisturisers, sunscreens, and foundation that block pores and create a paradise for bacteria and zits. Use oil free products, sometimes labeled ‘noncomedogenic’, which means they are less likely to cause acne.

Treating acne in pregnancy is often fraught because so many of the products we usually recommend for acne can’t be used in pregnancy (see below). Here are ingredients you can use:

• Antibiotics applied directly to the skin
• Azelaic acid
• Niacinamide
• Alpha Hydroxy Acids and Salicylic acid
• Benzoyl peroxide (liked by some but it can dry out the skin and get all over your pillowcase and sheets, so I am NOT a fan!)
• Blue-violet or red light phototherapy might be useful additions

Acne treatments to avoid while pregnant

There are lots of acne treatments that must be avoided. Spironalactone (a type of diuretic), hormonal treatments, oral antibiotics (specifically tetracyclines, co-trimoxazole and fluoroquinolones,) and both oral Vitamin A (retinoids) and vitamin A skincare products should be avoided.

While there is no specific reason why it should be a problem for acne and it is fine to use when pregnant, anecdotally we have found that Vitamin C (Ascorbic Acid) may aggravate acne. If you have acne and you want to use Vitamin C, we suggest treading with caution. But if you have checked it out and it doesn’t make your acne worse – go for it.

The pregnancy itch

Lots of people feel itchy when pregnant. There are a few causes. But one we doctors worry about is intrahepatic cholestasis of pregnancy which happens in 1 in 1000 pregnancies. This is a liver disorder where bile builds up in the liver, damaging the liver. It tends to happen in the third trimester of pregnancy and often leads to severe itching. It can also be very harmful for your baby.

For this reason I think all women with a new itch in pregnancy must see a doctor.

Most skincare is fine to use when pregnant and breastfeeding. There are really only two exceptions: Vitamin A and Hydroquinone.

If you are looking for a skincare regime to take you through pregnancy, ESK’s Pregnancy kit is formulated specifically for those special months!