Skin changes in pregnancy: dark patches, stretch marks and itching

Pregnancy changes more than your belly; it can change your skin too. Some people glow, others get dark patches, stretch marks or itching. Most of this is harmless and a natural result of hormones or the skin stretching. There is one exception, though, and it helps to know about it from the start.

Darkening and melasma

During pregnancy, the skin's pigment cells respond to hormones. So you might notice:

• A dark line from the navel down to the pubic area (linea nigra)
• Darker nipples and surrounding skin
• Brown patches on the face, especially on the cheeks, forehead and upper lip (melasma, sometimes called the mask of pregnancy)
• Moles and freckles, and colour changes in the armpits and groin

Sunlight makes melasma more visible. Protecting yourself from the sun (a wide-brimmed hat, shade, and a suitable sunscreen after checking with your doctor) is the most effective step. Most patches lighten in the months after birth; some may not disappear completely. If a mole thickens, darkens or bleeds, please have a doctor look at it.

Stretch marks

Fine lines can appear on the belly, hips, breasts and thighs. Fast stretching of the skin, family tendency and hormones all play a part. They often look red or purple at first and gradually become lighter and silvery.

No method is known to prevent stretch marks for sure. Moisturiser and massage can soothe the skin and ease itching, but evidence that they prevent stretch marks is limited. Gaining weight gradually may also help. Stretch marks are not a flaw in you or your skin; they are very common.

Itching

Stretching belly skin can itch. This is usually mild, and these may help:

• A lukewarm (not hot) shower and short baths
• Fragrance-free moisturiser several times a day
• Loose cotton clothing
• Keeping nails short
• A cool room

Some rashes (for example raised, itchy red patches that start on the belly) can also appear in pregnancy. They are mostly harmless but should be assessed by a doctor.

Cholestasis: the important exception to itching

Pregnancy cholestasis, which can occur especially in the last three months, happens when bile flow in the liver is disturbed. It is rare, but taken seriously because it calls for monitoring for the baby's sake. Typical features:

• Intense itching that starts especially on the palms and soles and gets worse at night
• No obvious rash on the skin
• Sometimes dark urine, pale stools or yellowing of the skin
• Itching that does not go away with moisturiser or cooling measures

If this sounds like you, do not wait; a blood test can assess it quickly and easily. When it is noticed early, the needed monitoring and treatment can be planned.

What you can do

• Protect yourself from the sun; this is the most important step for melasma.
• Keep your skin moisturised, and choose simple, fragrance-free products.
• When choosing skin care, ask your doctor or pharmacist about ingredients; some are not suitable in pregnancy.
• Soothe itching with moisturiser or a cool compress rather than scratching.
• Do not let these changes turn into a judgement of yourself; your skin is doing an amazing job.

Skin after birth

As hormones settle, most changes such as darkening, the linea nigra and hair shedding ease within months. Stretch marks fade and look less obvious over time, though a mark may remain. These marks are a record of the work your body has done; they are part of your story. If you are breastfeeding, check skin-care products with your doctor or pharmacist again. If the changes in your skin upset you, talking about it openly is valuable for your mental wellbeing too.

When to contact your doctor

• Intense itching, especially on palms and soles and worse at night: contact your doctor the same day
• Itching together with yellowing of the eyes or skin, dark urine or pale stools
• A rash that spreads quickly, blisters or bothers you a lot
• A mole that grows, changes colour or bleeds
• Itching together with fewer baby movements: get seen right away

This article is for information only; your doctor's or midwife's advice is what counts for your personal situation.