SKIN TO SKIN

Preg­nancy skin so­lu­tions

Little Treasures - - CONTENTS -

Preg­nancy is a jour­ney of sur­prises – with a lifechang­ing one at the end. Along the way, skin can be­come un­set­tled and un­dergo changes, some of them dra­matic. We en­listed the help of der­ma­tol­o­gist Dr. Vic­to­ria Scott-lang – new mum for the sec­ond time – to ad­dress our read­ers’ skin is­sues. 1 “With my third and fourth preg­nancy, I suf­fered from loads of skin tags from my neck to my ch­est” – An­drea Dr Scott-lang: Th­ese are harm­less fleshly lit­tle growths which ap­pear as we get older and also dur­ing preg­nancy, typ­i­cally in ar­eas of fric­tion (un­der the arms, un­der the breasts, around the neck and groin). They may shrink and dis­ap­pear af­ter you de­liver your baby. If you no­tice that they are still present, they can eas­ily be snipped off by a doc­tor un­der lo­cal anaes­thetic. 2 “I have spi­der naevi all over my hands!” – Char­lotte Dr Scott-lang: Spi­der naevi are di­lated blood ves­sels which of­ten ap­pear on the ch­est, neck, face and arms but can also ap­pear any­where on the body. They are present when there is more oe­stro­gen in the body, hence their de­vel­op­ment in preg­nancy. Spi­der naevi are quite red and prom­i­nent in ap­pear­ance, but this may im­prove af­ter de­liv­ery. If they don’t re­solve they can be treated with In­tense Pulsed Light (IPL) or laser. They’re harm­less but many women will seek treat­ment for cos­metic rea­sons, par­tic­u­larly if they af­fect the face or dé­col­letage. 3 “I got bad eczema around my hair­line and I’m still suf­fer­ing from it now that baby is two months old” – Kelly Dr Scott-lang: Women who have a pre­vi­ous his­tory

of atopic eczema (der­mati­tis) of­ten find that it re­turns or flares up dur­ing preg­nancy. It can also ap­pear for the first time dur­ing preg­nancy. In­ter­est­ingly, some women find that their eczema im­proves when they are preg­nant – it varies from per­son to per­son and can be un­pre­dictable due to al­ter­ation of the im­mune sys­tem. De­pend­ing on sever­ity, eczema can be man­aged in dif­fer­ent ways. Mois­tur­is­ing reg­u­larly is an im­por­tant part of treat­ment. Stud­ies have shown no ad­verse as­so­ci­a­tion with ma­ter­nal use of top­i­cal steroids and preg­nancy out­comes, but de­spite this many women will pre­fer to avoid them. For oth­ers, they’re an im­por­tant part of treat­ment. In se­vere cases, UVB pho­tother­apy can be safely used to treat eczema. In gen­eral, oral drug treat­ments need to be avoided dur­ing preg­nancy. Avoid­ance of ir­ri­tants e.g. fra­grance, bub­ble baths, cer­tain preser­va­tives in cos­met­ics, wool and nickel can be an im­por­tant part of keep­ing your skin as healthy as pos­si­ble if you are prone to eczema.

4 “A heavy dose ofme­lasma re­sulted in a panda ef­fect around my eyes and around the top of my fore­head” – Sarah

Dr Scott-lang says: Me­lasma is rel­a­tively com­mon dur­ing preg­nancy, and is prob­a­bly one of the hard­est skin con­di­tions to treat. I treat a lot of women look­ing for help with me­lasma fol­low­ing a preg­nancy as it has not re­solved. Me­lasma is es­sen­tially brown or grey­ish pig­men­ta­tion which af­fects the fore­head, cheeks and above the lip, more of­ten seen in peo­ple with darker skin. It is thought to be re­lated to high oesto­gen lev­els (also seen in women who take hor­monal con­tra­cep­tives). We know that me­lasma is ex­ac­er­bated by ul­tra­vi­o­let light, so New Zeal­en­ders need to be strict with ap­ply­ing a good-qual­ity sun­screen (with UVA and UVB pro­tec­tion) ev­ery day, along with wear­ing a hat when out­doors. Us­ing make-up with good cov­er­age can be help­ful for cam­ou­flag­ing it, and will also of­fer some UV pro­tec­tion (my per­sonal favourite is Es­tee Lauder Dou­ble Wear which con­fers SPF 10 or SPF 25, de­pend­ing on the prod­uct). For women whose me­lasma does not fade post de­liv­ery, it can be treated with dif­fer­ent ap­proaches. My pref­er­ence is to start with a light­en­ing cream, usu­ally four per cent hy­dro­quinone. Fol­low­ing a month of hy­dro­quinone, a spe­cific laser (called Q-switched ND:YAG) can be tried for pa­tients with fairer skin types (not suit­able for in­di­vid­u­als with darker skin types). Laser should be per­formed by a nurse or doc­tor who has trained and is skilled in this field, ideally un­der the su­per­vi­sion of a der­ma­tol­o­gist.

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