Pregnancy Rashes

During pregnancy there are certain changes that the skin can undergo which are regarded as normal. These include stretch marks, brown facial patches, darkened nipples and areola, acne, darkening of moles, skin tags, more visible veins, a blush to the skin and a dark line from the belly button downward (the linea nigra).
Fluctuations in the levels of oestrogen and hormones responsible for skin pigmentation bring about many of these changes, most of which are temporary and will clear up after the birth. Stretch marks (striae gravidarum) do not disappear, but become less noticeable over time.

Rashes Itching & Skin Disorders

Skin conditions that can occur in pregnancy which are not regarded as part of the normal process can be broken down into three basic types:
• Non specific rashes
• Itching without a rash
• Specific dermatoses of pregnancy

Non Specific Rashes

Pregnant women are susceptible to any kind of skin condition that could just as easily arise when they are not pregnant. The causes of such conditions can, however, have potentially damaging consequences in pregnancy. Rashes could be caused by:
• Medicines.
• Tumours.
• Parasites and insect bites.
• Allergies
• Skin infections.
• Viral infections.
Pregnant women who have not had chickenpox should avoid contact with anyone with this condition especially in the later stages of their pregnancy. A vaccine for chickenpox is available for those not immune, but it can only be administered before you become pregnant.
For those planning a pregnancy who have not had measles, mumps or rubella, and therefore have no immunity, it is advised they have the MMR jab. This vaccination cannot be administered while you are pregnant as it can harm the baby. Also it is advised that you do not try to get pregnant till one month after the jab.

Itching without a rash

In the first trimester of pregnancy, some women may experience moderate itching without a rash. If the condition continues for longer or worsens, seek medical advice.
More severe itching in the third trimester, possibly coupled with jaundice, could be a sign of intrahepatic cholestasis of pregnancy or ICP. This condition, also known as Obstetric Cholestasis, occurs when bile secretion becomes impaired in the liver, resulting in a build up of bile acids in the bloodstream. These acids are then deposited in the skin which leads to the itching, and in some cases jaundice. No clear cause has been found for the bile abnormality. Hormones and genes have been suspected to be behind it.
Less than 1% of European women are affected by ICP. Early detection is important as there is a risk of premature labour and still birth. The itching tends to first manifest itself on the palms and soles, then spreads.

Specific dermatose of pregnancy

Certain skin conditions are believed to be a direct result of the gestational process. These are:
• PUPP (pruritic urticarial papules and plaques of pregnancy). This condition, also sometimes known as toxemic rash, is the most common dermatosis of pregnancy, occurring in around 0.5% of pregnancies. It usually occurs during the third trimester and is characterized by strongly itching raised red spots. These spots typically present themselves on the abdomen, spread to the thighs and sometimes the arms and buttocks but not the face. It is harmless to mother and child and can be treated with corticosteroids.

• Prurigo gestationis. This condition occurs in around 1 in 300 pregnancies, and presents itself as a rash of itchy red dots which are bite-like in appearance. It can happen in mid pregnancy where it usually appears on the upper trunk area and upper parts of legs and arms. It can also occur in very late pregnancy where it usually appears on the abdomen especially on stretch marks. The condition will most probably clear up less than a month after giving birth, and is not thought to cause any harm to mother or baby. Diagnosis will most probably be done by the ruling out of other conditions. It is usually treated with antihistamine tablets.

• Impetigo herpetiformis. This rare condition is similar to pustular psoriasis. Pus filled blisters first appear around the groin, in the folds of knees and elbows as well as underarm areas. It can also affect mucus membranes. The disease occurs during the third trimester and is often accompanied by acute illness such as nausea, chills, fever, vomiting, fatigue and diarrhoea. It is quite dangerous to both mother and baby, but can be treated with steroids.

• Pemphigoid gestationis (or herpes gestationis). Another rare condition, completely unrelated to the more common herpes simplex virus. It is characterized by the occurrence of itchy red bumps around the naval area, usually occurring in mid to late pregnancy. These then spread to other parts of the body before turning into fluid filled blisters. Complications for the mother may include scarring from secondary infection and a possibility of kidney damage. For the baby there is a possibility of premature birth, and of being born with the rash, but this usually clears up by itself. The disease is treatable with steroids following identification by skin biopsy.

• Papular dermatitis of pregnancy. This condition is characterized by very itchy raised red spots resembling insect bites, some of which are covered by crusts or scabs. The rash can cover the whole body, and occur during any trimester of pregnancy. It is connected to abnormal levels of blood hormone, and may increase the chances of foetal death. The disease is treated with corticosteroids in high doses.

It is adviseable to seek medical advice from a GP or other health care professional over any rash, itching or other unusual skin changes that occur during pregnancy.