It was during her third trimester that Reshma first noticed the appearance of rash on her abdomen. The first-time mother-to-be discovered that the rash was along the stretch marks that had developed on her abdomen. "Although the itching was not pronounced, I was concerned and immediately consulted with my doctor," she recalls.
Reshma was relieved when she was told that the rashes would not have any adverse effects on her pregnancy. Her doctor prescribed her some oral antihistamines and a topical application cream. "That truly helped," recalls the now mother of one. "The rash disappeared in a couple of days."
However, Diane was not so lucky. Pregnant with her second child, the Dubai resident who had a history of psoriasis, found her skin condition flaring up during her second trimester. "I was a little surprised because I was told that pregnancy usually does not have a major bearing on psoriasis," she says.
Specialist dermatologist Dr Ikramullah Al Nasir begs to differ, "Certain pre-existing skin conditions including atopic dermatitis, psoriasis, candidal and some fungal infections may change during pregnancy," he says. "While in many cases they improve during pregnancy, in some cases atopic dermatitis and psoriasis may worsen. Sadly, Diane’s case belonged to the latter." She was prescribed a course of medications and monitored regularly but it took a while before the condition could be brought under control.
Dr Ikramullah, who has more than 30 years of experience in treating dermatological conditions, says treating fungal infections in pregnant women generally require a longer course because many oral treatments often cannot be prescribed as they may have some adverse effects on the mother and the foetus. It is for this reason that greater care should be taken when treating pregnant women and lactating mothers in particular.
So, what are some common benign skin conditions seen in pregnancy?
"I’d list four," says the doctor. "Stretch marks, hyperpigmentation, changes in hair and nails, and vascular changes."
Nine out of 10 pregnant women end up with stretch marks – pink-purple, atrophic lines or bands on the abdomen, breasts, thighs and upper thighs, or arms – by the third trimester, says the doctor. While more common in younger women, those carrying larger foetuses, women with higher body mass indices, darker complexioned and mothers-to-be with a history of stretch marks are more likely to end up with striae. Physical factors such as actual stretching of the skin and hormonal factors such as effects of adrenocortical steroids, oestrogen and relaxin on the skin’s elastic fibres are largely the causes of stretch marks.
While numerous creams, emollients and oils including vitamin E cream, cocoa butter, aloe vera lotion, olive oil are commonly used to prevent striae, the doctor says there is no evidence that these treatments are effective cent per cent.
While most striae fade to pale- or flesh-coloured lines and shrink postpartum, they usually do not disappear completely. However, certain laser modalities have been found to have some success, he says.
Nearly all women experience some degree of hyperpigmentation during pregnancy with it being more pronounced in women with a darker complexion. The face, armpits and groin areas are most commonly affected; pre-existing scars and moles also may darken.
According to the doctor, melasma, also known as chloasma or mask of pregnancy – dark, discoloured patches on the skin – may be the most cosmetically troublesome skin condition associated with pregnancy. "At least seven out of 10 pregnant women may experience this condition that may also occur in women taking oral contraceptives," he says. "Facial skin, mainly over the cheek bones, bridge of the nose, temples, forehead, upper lips and chin are commonly affected." In extreme cases, it can affect the neck and even upper chest.
Since exposure to sunlight can worsen melasma, avoiding exposure and using broad-spectrum (ultraviolet A and B) sunscreens may prevent it from developing or becoming exacerbated. While this often resolves postpartum in many women it may reoccur with future pregnancies or with use of oral contraceptive pills.
Hair and nail changes
Changes in growth and production of hair are common during pregnancy, says Dr Ikramullah. Some degree of excessive hair growth on the face, limbs and back caused by endocrine changes during pregnancy is common in many women but this usually resolves postpartum. "In cases where it does not, cosmetic removal like hair waxing may be considered post delivery," he says.
Pregnant women may also notice mild thickening of scalp hair. However, following delivery, many women experience severe hair fall which may last for several months after pregnancy. "A few women may also notice hair loss concentrated above the forehead. Sadly for them, this may not resolve after pregnancy."
Nails usually grow faster during pregnancy but pregnant women often complain of increased brittleness of the nail plate, transverse grooves (deep lines) on nails, cracking/breaking of nail plate, and skin thickening below the nail bed. "Most of these conditions resolve over time," says the Dubai-based specialist. Ensuring a healthy diet and regular care of nails can help, he adds.
Changes in oestrogen production during pregnancy can cause dilatation, proliferation, instability, and congestion of blood vessels but most of these vascular changes regress postpartum. Spider telangiectasias (also called spider nevi or cherry angiomas) occur in some pregnant women, often on the face, neck, and arms, but can be seen on any other parts of the body as well, he says. "The condition most commonly appears during the second trimesters. Mild redness of palms is also commonly seen in pregnant women."
Other common conditions include edema of the face, eyelids, and extremities in a large number of pregnant women. Facial flushing, hives, hot and cold sensations; and marble skin (patchy complexion), a condition characterized by bluish skin discoloration from an exaggerated response to cold is also found in some pregnant women, says Dr Ikramullah. A pregnant woman who notices such symptoms should immediately bring them to the notice of her doctor, he adds.
Skin challenges during menopause
Hormonal changes caused by menopause can lead to several skin and hair issues. As hormone levels plummet, facial hair can increase while scalp hair loss becomes noticeable. The skin can become dry, slack, and thin. While hormones or rather the lack of them, are a reason, environmental and emotional stresses not to mention poor dietary habits and lifestyle of the past years can also be responsible, says the doctor.
But why do skin changes occur during menopause?
Put simply, lower levels of oestrogen on the component parts of skin, and collagen have a huge role to play. Reduced collagen content causes skin to become less elastic and weaker, while low levels of glycosaminoglycans affects the water content of skin. Together these changes cause wrinkles. However, the good news is that with the right skin care regimen, you can lessen these effects, says Dr Ikramullah. A dermatologist will be able to prescribe individual specific guidelines and medications, if required, after a detailed consultation.
Age spots and signs of sun-damaged skin can appear on your face, hands, neck, arms, or chest during menopause. Skin cancer and pre-cancerous skin growths also become more common, mainly in Caucasian women, says Dr Ikramullah.
What you can do: Apply a broad-spectrum sunscreen with SPF 30 or higher to all exposed parts every time you step outdoors. This can help fade age spots, prevent new spots from forming, and reduce your risk of getting skin cancer.
• Since the risk of getting skin cancer increases with age, schedule an appointment with a dermatologist for a screening. Women with moles also need to get them checked and mole-mapped on regular intervals. The earlier you find skin cancer and pre-cancerous growths, the more treatable they are.
• Start skin self-exams. Ask your dermatologist how often you should examine your own skin.
• Before you treat age spots, see your dermatologist for a skin examination. "Importantly, skin cancer sometimes looks like an age spot or a dark spot on your skin. If you use an age-spot treatment on a skin cancer, you may fade the spot and delay treatment giving the cancer time to possibly grow and spread. This can make the cancer more difficult to treat," he says.
As estrogen levels fall, the skin becomes thinner; the result: it bruises more easily.
What you can do: Apply a broad-spectrum sunscreen with SPF 30 or higher on all exposed areas every day even during winter. While this cannot thicken your skin, it can prevent further thinning. A dermatologist about treatment options.
Menopause can lead to dry skin. This can get worse when the air is dry in winter.
What you can do: Wash with a mild cleanser instead of soap. Skip deodorant bars. Follow a healthy diet that includes plenty of vegetables.
Apply moisturiser after bath and throughout the day whenever your skin feels dry.
As levels of female hormones fall, unwanted hair sprouts under your chin and along your jaw line or on the upper lip.
What you can do: Waxing may be an option, but if your skin is too thin, it can tear and bleed. Visit a specialised dermatology centre for laser hair removal.
Hair loss on scalp
The first sign may be a widening part.
What you can do: When it comes to hair loss, the earlier you start treating it the better your results.
Jowls, slack skin, and wrinkles
Studies show that women’s skin loses about 30 per cent of its collagen during the first five years of menopause. Women lose about 2 per cent of their collagen every year for the next 20 years.
As collagen diminishes, our skin loses it firmness and begins to sag. Jowls appear. Permanent lines run from the tip of the nose to the corners of the mouth. Wrinkles that used to appear only with a smile or frown become visible all the time. You may see pouches under your eyes. Large pores also are due to lack of skin firmness.
What you can do: Protect your skin from the sun. This can reduce visible wrinkles and prevent new wrinkles.
As levels of female hormones drop before and during menopause, some women develop teenage-like acne.
What you can do: Because a woman’s skin is thinner and drier, treatments for teenage acne are often too harsh. Wash acne-prone skin with a gentle cleanser. Avoid acne products that dry your skin.
Rashes and easily irritated skin
At around age 50, the pH level of our skin changes making it more sensitive and prone to develop rashes. If you have an existing skin condition, such as eczema or rosacea, this could worsen.
What you can do: Use a fragrance-free moisturizer. This can reduce irritation.
Wounds heal more slowly
Hormones play an important role in healing our skin. When hormones levels fall, skin takes longer to heal.
What you can do: Realise that your skin will heal. Only that it may take longer now.
One in two perimenopausal women and almost all postmenopausal women complain of night sweats, hyperhydrosis (abnormally excessive sweating that’s not necessarily related to heat or exercise), and hot flashes (flushing).
What changes to make
Lifestyle measures: Apart from using a broad-spectrum sunscreen, avoiding skin-care products that may exacerbate dryness (such as harsh soaps) is important for women with dry and/or flaking skin. Such women should also use occlusive skin creams (which prevent water loss from the skin) to promote adequate hydration. Menopausal women should also avoid smoking as it enhances the dermal ageing process. Proper hygiene, vigilant care, and balanced nutrition are important to protect skin from premature ageing.
Caring for skin in your 30s and 40s
Pampering and caring for your skin is as crucial during your thirties and forties as it is during any time of your life. It may be particular more so during this period as most women get busy with their career/family and may end up neglecting caring for their skin at this time, says the doctor.
Follow these tips to look like the super mom you are:
• Cleanse, moisturise and protect your skin from sun. Exfoliate weekly, use antioxidants and apply anti-wrinkle and skin firming preparations on regular basis to delay early signs of skin ageing.
• Make hair care a regular routine.
• Never ever go to bed with make-up.
• Take extra care to remove eye make-up as skin around your eyes is the thinnest and most delicate compared to your entire body.
• Hydrate throughout the day.
• Use peptide-containing moisturisers/serums to further boost collagen production.
• Use a face cream and sunscreen combo every day.
• Always use a clean pillowcase. Not many know that a soiled pillow and pillowcase can lead to many dermatological issues
• Avoid using a tanning bed.
• Don’t pick at your skin, it will leave you with "ugly" blemishes.
• Workout regularly.
• Don’t binge on junk food.
• Avoid aggressive exfoliation, both on face and body.
• Wear sunglasses year-round.
• Clean your cell phone daily. The screen is very often in close contact with your facial skin and a dirty screen can cause skin issues.
• Get ample sleep every day.
• Stay cheerful and positive. It will reflect on your skin.