What to Expect (With Your Skin) When You’re Expecting

Anita Arora, MD
September 10, 2020
What to Expect (With Your Skin) When You’re Expecting

Whether you consider yourself to be a low or high maintenance type of girl, we all have some type of cosmetic routine that we follow. Pregnancy brings its own set of beauty challenges, so maintaining that routine can become quite a task. Along with an influx of pregnancy hormones, your body is changing rapidly and everything seems to affect your appearance. It’s important to maintain a beauty routine as much as possible and confront pregnancy-specific challenges with helpful solutions. As an OB/GYN, I am routinely asked about what cosmetic procedures and options are considered safe in pregnancy. Here is what I tell my patients…

That pregnancy Glow!

What exactly causes it? During pregnancy, increased blood volume and increased production of the hormone human chorionic gonadotropin (HCG) work together to create a pregnancy glow. Greater blood volume brings more blood to vessels, resulting in skin that looks slightly flushed and plump. The hormones HCG and progesterone also cause the glands of the skin to produce more oil and help skin look smoother and slightly shinier.


Up to 90 percent of pregnant women will show signs of hyperpigmentation (darkened spots or discolorations of the skin), and thank goodness, it is typically generalized and mild. However, accentuation of normally hyperpigmented areas such as the genitals, neck, underarms, neck, inner thighs, belly button area and breasts (areola) can occur and worsen as pregnancy progresses. Also, the skin of the abdomen in the midline can become darkly pigmented to form the linea nigra-that line straight down the center of your stomach. These hormonally driven changes are considered to be normal and typically go away postpartum.

Melasma, the “mask of pregnancy”, is a symmetric, blotchy, but sharply demarcated tan to dark brown hyperpigmentation of the face that typically occurs in the second half of pregnancy in about 60% of women. For those of you who have experienced it, I’m sure you know it can be cosmetically distressing. The effects of melasma in pregnancy can be accelerated by sun exposure. To treat melasma, the best offense is a good defense. Since you can’t change the hormonal effects, you should avoid the sun especially during peak sun hours (between 10 am and 3 pm), use hats and sunglasses, and consistently use  sunscreen in order to lessen the chances of developing significant melasma. Unfortunately, there is a genetic predisposition, so if you mother or sister developed it you are more likely to develop it, too.

Even with the best sunscreen, you may still face hyperpigmentation that you want to treat. In a non-pregnant patient, dermatologists typically recommend the use of a sunscreen (as discussed above), lightening agents like azelaic acid, retinoic acid (tretinoin), and combination therapies containing hydroquinone, tretinoin, and corticosteroids. In pregnancy, however, the use of hydroquinone is avoided as the absorption though the skin can be as high as 45%. Topical retinoids should always be avoided in pregnancy due to documented cases of birth defects in women who used them during pregnancy. Azelaic acid, however, is considered a safe lightening agent in pregnancy and does not require a prescription.


Sunburn is caused by UV radiation, either from the sun or artificial sources, such as tanning beds. There are no studies that clearly document that pregnancy will make a women more sensitive to UV radiation. You will, however, have more surface area of skin to protect – especially towards the end of pregnancy. In addition, sun exposure can make hyperpigmentation more pronounced.

Dermatologists recommend the use of barriers (UV protective clothing) and sunscreen when going outdoors during daylight hours to protect your skin against UV damage. I often get asked about mineral versus chemical sunscreens. Probably the most commonly used sunscreens are chemical sunscreens and act as absorbers of UV radiation. They contain carbon compounds made in a laboratory. Some 22 chemicals have become available in the U.S. to shield the skin from the sun’s harmful rays since the first compound PABA was developed in the 1940s.

Mineral sunscreens, however, are physical barriers/blockers that come in two types: zinc oxide and titanium dioxide, which are natural minerals ground down to fine powders. They work by reflecting UV radiation off of the skin. The benefit of physical blockers is that they last a lot longer than chemical sunscreens and stay longer on your skin. No sunscreen, though, is 100% effective and if not applied properly, there is still a chance that you may develop sunburn. ALL sunscreen should be reapplied every 2 hours AND after swimming or excessive sweating. Most of us need about an ounce (a shot glass full) for our entire bodies.


Excessive sun exposure is NEVER a good idea for a zillion different reasons and tanning booths are ALWAYS a bad idea (even though I did not listen to my mother and visited one several times before prom, and vacation, and my wedding… but guess who is paying the price now?).  Tanning beds are considered excessive sun exposure. Period. Ok, so no real tans. What about a faux-glow?

I often get asked if self-tanning products are safe. The chemical used in self-tanning agents is dihydroxyacetone. These products contain concentrations ranging from 1% – 15% and when applied topically, the amounts absorbed through the skin are minimal. As a result, they are considered to be safe in pregnancy. Bronzers (which wash off like makeup) are not absorbed and are considered to be very safe.


Sadly acne is very common during pregnancy and causes significant distress to many pregnant women. In fact, half of all pregnant women can expect to develop acne. In some cases, the acne may be severe. Why does this happen?  The answer is yet again hormones! The higher levels of hormones during pregnancy increases the skin’s production of natural oils. It is hard to predict who will develop pregnancy acne. You have a higher risk, though, if you have a history of acne or have acne flares at the start of your menstrual cycle. If you do not develop acne during the first trimester, it’s unlikely you’ll have breakouts that are out of the ordinary during the second or third trimesters.

If you notice acne developing, a good place to start is with over-the-counter options. The topical agents salicylic acid, glycolic acid, azelic acid and benzoyl peroxide are often recommended in pregnancy as relatively small amounts of these agents are absorbed into the skin. In addition, there are no studies documenting risk to the baby with these topical formulations, but the direct effects of these agents to the fetus are unknown.  These agents work in the treatment of acne through their antimicrobial and anti-inflammatory actions, in particular topically on the skin.

If you think you may require a prescription to treat your acne, your doctor may recommend topical antibiotics such as clindamycin or erythromycin – either alone or in combination with other agents like benzoyl peroxide. These topical antibiotics are considered safe in both the topical and oral forms.

As noted above, the use of topical retinoids should always be avoided in pregnancy. There is no data to prove that the over-the-counter retinol containing products are safe in pregnancy, so I advise my patients to avoid these products while pregnant and breastfeeding.

Chemical Peels

Chemical peels contain much higher doses of salicylic acid, glycolic acid, or trichloroacetic acid than what is available in over-the-counter preparations and are used to strip off the top layer of skin to give it a smoother and more youthful appearance. There are very few studies that document the safety of these procedures in pregnancy, so I advise my patients to wait until after birth and the breast feeding period to resume or consider these treatments.

If there is ever a question about the safety of products you are considering always consult your doctor. In the meantime enjoy your pregnancy glow, but if you notice that pregnancy has brought on a few undesired skin changes, you do have some options!

Anita Arora, MD

Anita Arora, MD

Dr. Anita Arora Gill received her medical degree from Louisiana State University Health Sciences Center in New Orleans, which is linked to the world-famous Charity Hospital. Later she moved to Texas where she obtained her dermatology training at the prestigious Texas Medical Center at University of Texas at Houston and MD Anderson Cancer Center. Her special interests in her field include skin cancer treatment and prevention, acne, psoriasis, and cosmetic dermatology. Dr. Gill is board-certified by the American Board of Dermatology. Professional memberships include the American Academy of Dermatology, Women’s Dermatological Society, and the Texas Dermatological Society. Dr. Anita Arora Gill chose Dermatology, because, as she put it: “I love it! It has never felt like work to me.” Her philosophy of treating her patients is even more so. All she really cares about is you – and your overall health and well-being. In fact, she says, “My practice focuses on the comprehensive, quality care of each and every person who comes to me.” In her free time, Dr. Gill loves spending time with her husband, Dr. Paul Gill, a plastic surgeon in the Woodlands, Texas, and her 2 young daughters. She enjoys traveling, a good book and a great restaurant.

Follow Anita on Facebook @gilldermatology.

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