Pregnancy leads to a range of skin changes among women. Some women experience no skin changes while others can experience severe acne, discoloration, or pigmentation.
Most of the changes in the skin during pregnancy can be explained by an increase in the production of androgens in the body.
These changes may not be limited to acne and may also cause increased facial hair growth, skin pigmentation, and discoloration.
Common skincare issues associated with pregnancy
A. Stretch Marks
“Stretch marks (striae gravidarum) are caused by the rupture of collagen and elastin fibers in the dermis occurring mainly in the hips, breasts, buttocks and abdomen regions during pregnancy. They affect approximately 70% of pregnant women between the sixth and seventh month of pregnancy“.
Moisturizers like emollients and humectants are used in order to treat or minimize the injuries caused by tearing of the dermis.
- Alpha-hydroxy acids, ammonium lactate, siliceous organic, lipids, phospholipids, cholesterol, fatty acid, propylene glycol, glycerin and sorbitol can be cited as ingredients for safe use during pregnancy
- Vitamin E it is used in the treatment of rupture of collagen and elastin fibers caused by dehydration or excess of stretching
- Cosmeceutical ingredients may be included in the auxiliary treatment of stretch marks, such as hyaluronic acid, panthenol, allantoin, elastin and collagen. The hyaluronic acid is considered safe for use during pregnancy, due its abundant presence in fetus tissue. Likewise, panthenol (pantothenol) is considered a safe option as constituent of the skin .
“Pigmentary skin disorders are very usual during pregnancy, affecting almost 90% of women in this condition, being even more frequent in those who have darker skin”
The most frequent manifestation is melasma, and can be prevented by using sunscreens and avoiding excess of sun exposure
One of the most suitable sunscreens is the physical filter type, also known as inorganic, because they are not absorbed through the skin and they have low skin-irritation potential.
They have been used in sensitive skin, children and pregnant women. Their mechanism of action occurs through the formation of a layer that reflects and scatters ultraviolet radiation, not allowing it to be absorbed.
The most common molecules account for this blocking action of physical filters are titanium dioxide and zinc oxide.
“The other category of sunscreens that can also be used, but with greater caution because of the risk of dermal absorption, is the organic UV filters. They are made up of ortho/para- substituted aromatic molecules that absorb high energy ultraviolet radiation and turn it into a lower-energy radiation, harmless to human skin, allowing the excess energy be released into the form of heat” .
The minimum sun protection factor (SPF) recommended for pregnant women is 15, values higher than 30 represent unnecessary exposure to increase amounts of organic filters.
The effectiveness of sunscreens is related to the application time before sun exposure. Ideally, it should be used half an hour before sun exposure and reapplied each two hours or whenever necessary .
“When hyperpigmented areas are observed on the skin of pregnant women, even though proper care is taken, it is recommended to wait until childbirth to treat these pigmentary stains. During pregnancy, corrective makeup cosmetics seem to be an appropriate procedure to camouflage stains in order to offer a safe and convenient protocol for the psychological welfare of women in this condition” .
Azelaic acid can also be used to reduce hyperpigmentation spots, and it does not act in regular melanocytes, which prevents the occurrence of leukoderma (white spots) and ochronosis (blue-black hyperpigmentation). According to FDA, azelaic acid belongs to the Group B of risk, and can be used by pregnant women, and also during lactation .
There are also alpha-hydroxy acids (AHA) to improve the treatment of skin pigmentation. At low concentrations they reduce the cohesion of the corneal extract corneocytes, and stimulate the proliferation of cells in the epidermis.
It is safe for use by pregnant women at a concentration of 10%, in the form of lotions, creams, gels, and solutions .
Natural products have been associated with different action mechanisms.
A common association is between chamomile, phytic acid and arbutin. Chamomile acts by inhibiting the endothelins, while phytic acid and arbutin by tyrosinase inhibition.
In addition, the phytic acid also has chelating action of copper, which further increases their whitening efficiency .
These compounds demonstrate better stability when compared to hydroquinone, lower toxicity, have no unpleasant odor and are safe to use during pregnancy .
“Increase in progesterone levels during pregnancy stimulates sebum secretion that, associated to hyperkeratosis and cellular debris accumulation, promotes microbial proliferation and an inflammatory process culminating in the appearance of acne vulgaris lesions” .
Cosmetic formulations based on azelaic acid exhibit activity against Propionibacterium acnes, and they are indicated for the treatment of initial stages of acne
Niacinamide is the active form of nicotinic acid (vitamin B3) and its topical use may be an alternative treatment of mild to moderate acne in pregnant women. It has anti-inflammatory potential and it has comparable efficacy to topical antibiotics
Alpha hydroxy acids (AHA) are suitable for non- inflammatory lesions, acting to reduce follicular plugging. It is recommended applying a thin layer in the affected area, but exacerbation of lesions can occur during the treatment depending on the sensitivity of the skin and frequency of use .
“It is important to note that patients who undergo treatment with AHA may suffer photosensitivity, requiring the application of sunscreens. They also may experience erythema, flaking and sensitivity, which are common adverse reactions of this class of substance”..
D. Anti-Aging Therapy
“Skin aging is associated with the loss of fibrous tissue, decreasing cell renewal and reduction of the vascular and glandular network. These factors are responsible for intrinsic aging, while the extrinsic aging is the result of the photoaging caused by the incidence of UV radiation” .
The most wanted aesthetic facial treatment is the anti-aging treatment. The aging process has genetic causes, hormonal, and environmental factors (UV radiation, smoking habits and alcohol intake).
Many anti-aging cosmetics are produced with antioxidants such as vitamin C, vitamin E, lipoic acid and ubiquinone, in order to reduce the oxidative stress of cells, neutralizing oxygen reactive species, and restoring the balance .
Vitamin C is an antioxidant molecule that promotes collagen synthesis and has a lightening power due to prevention of oxidation during the melanin synthesis process .
Another antioxidant option is vitamin E, also known as tocopherol. An advantage of its use is for the prevention of the appearance of age marks, and is safe for use during the gestational period.
Ubiquinone has an antioxidant action and low molecular weight. When in the presence of free radicals, ubiquinone stops the chain reaction of free radicals. As it has endogenous origin, it does not bring health risks to the fetus and to the pregnant woman if applied in cosmetics.
A third very common anti-aging active is lipoic acid. It is an antioxidant that can be considered a superficial chemical renewal, reducing skin aging and also the damage on skin.
The topical use of lipoic acid is effective when it is at concentrations between 0.5% and 5%. It is safe for pregnant women, since its use has presented no toxic events to the human body .
In addition to the traditional antioxidants, are ferulic acid and resveratrol. Ferulic acid is a derived plant compound found in flaxseed and other sources, such as corn and rice bran. It has high antioxidant effect, working as a cell membrane and hindering the action of free radicals, with the benefit of preventing the formation of erythema caused by UVB radiation.
Resveratrol, as well as ferulic acid, is a phenolic compound found in many plant species including grapes. It has an antioxidant activity related to cytoprotection of plant and animal cells . Resveratrol is considered safe for pregnant women in cosmetic formulations, but its use by oral administration can cause problems for the fetus
E. Vascular Changes
“Edema is the accumulation of fluid in the intercellular spaces that hinders the capillary permeability affecting mainly the lower limbs. Some of the causal factors are hormonal changes, increased capillary permeability, increased capillary pressure, hypoproteinemia, and compression of the venous valves. In this phase, the heavy uterus presses pelvic and abdominal veins, causing a swelling that can be redistributed when the woman is in the reclining position “.
In addition to edema, there are often other problems related to movement accompanying pregnant women, such as the emergence or worsening of preexisting varicose veins.
Cosmetics used for edema relief are relaxing gels and creams that contain arnica, hamamelis and horse chestnut. All these substances have natural origins, but some of them may offer serious risks to pregnant woman.
Oral administration of arnica, for example, may result in abortion due to uterine contraction stimulation.
“When applied in the skin, arnica has anti-inflammatory, healing and analgesic properties, in addition to activating the circulation. Topical formulations offer lower risk compared to the oral route of administration, nevertheless pregnant women may avoid its application”
Witch-hazel is a shrub that blooms in the autumn and has many therapeutic properties. Among them, we can highlight their hemostatic function, anti-inflammatory and vasoconstriction properties .
Another ingredient used in topical preparations for edema is horse chestnut.
It contains aescin, which is a mixture of triterpenoid saponins, responsible for its anti-inflammatory activity in reducing edema.
Its use is quite safe for all population groups, including pregnant women, and the application of horse chestnut for edema is justified
F.Insect Repellents during Gestational Period
“Cosmetic repellents act by slow release outward from the skin of a chemical with repulsive odor to insects . The use of insect repellents by pregnant women has become a public healthcare measure in tropical countries like Brazil, where the incidence of potentially fatal diseases by the Aedes aegypti mosquito (Zika, Dengue and Cikungunya virus) is alarming. The main concern is the Zika virus infection in pregnant women that causes microcephaly in newborns”.
For this reason, the use of repellents in cosmetic products has been strongly recommended by pregnant women in tropical countries, mainly in the second and third trimesters of pregnancy.
The use of repellents containing, n-diethyl-meta- Toluamide (DEET) 10% – 30% for pregnant women is considered safe . However, it is not recommended for use in children under two years of age .
Other chemicals used as repellents include hydroxyethyl isobutyl piperidine carboxylate (Icaridin or Picaridin) 10% – 20% (AII), ethyl butylacetylaminopropionate (EBAAP or IR3535) and essential oils such as citronella, but there is no safety study of its use in pregnant women.