Dry, Itchy Skin During Pregnancy

Dry, Itchy Skin During Pregnancy – Prevention and Treatment

1)Use lukewarm or cool water for showering, avoid chlorinated water.

2)Use “mild”, “non-irritating” soaps.

3)After showering, towel yourself and apply a moisturizing cream while your skin is still moist.

4)Drink enough water to keep yourself well hydrated.

5)Avoid sweat-causing activities and wear cotton clothes and underwear.

6)Avoid scented, alcohol-based lotions.

Anti-Itch Creams, Home Remedies and Medications Safe in Pregnancy

PROBABLY SAFE REMEDIES and MEDICATIONS, but speak with your doctor before use:

• Baking soda (sodium bicarbonate) paste, or bath for 15-20 minutes (for non-oozing itchy rash) ⁽⁴⁸⁾
  
• Oatmeal or cornstarch bath (natural moisturizers) home-made, for 15-20 minutes (for non-oozing itchy rash)
• Calamine lotion (zinc oxide plus ferrous oxide; cools the skin, for non-oozing itchy rash) ⁽³⁶⁾
• Colloidal oatmeal bath, commercial (for non-oozing itchy rash) ^(45,46)
• Diphenhydramine cream (antihistamine) ⁽²⁸⁾
• Diphenhydramine pills (antihistamine) ^(11,26)
• Epsom salt bath (magnesium sulfate; for non-oozing itchy rash) ⁽¹⁶⁾
• Lactic Acid/Salicylic acid/Urea cream mixture (for scaly skin) ⁽³⁹⁾
• Lidocaine cream (local anesthetic) ⁽³⁰⁾
• Loratadine pills (antihistamine) ⁽⁶⁰⁾
• Menthol cream (to reduce itch in allergies) ⁽³¹⁾
• Mupirocin cream (for staphylococcal skin infections) ⁽⁵⁸⁾
• Witch hazel lotion (astringent that may shrink hemorrhoids) ^(41).

PROBABLY SAFE MOISTURIZERS, but speak with your doctor before use:

• Emollients (salves, which soften the skin) ⁽⁵³⁾. Common ingredients: stearic, linoleic, linolenic, oleic and lauric acid, isopropyl myristate, palmitate or stearate, ceramides, almond oil, castor oil, cholesterol, pine tar, beeswax.
• Humectants (hold water in the skin). Common ingredients: glycerin (glycerine, glycerol), glycolic acid ⁽⁵⁶⁾, honey, hyaluronic acid, lactic acid ⁽⁵⁶⁾, sorbitol.

POSSIBLE PROBLEMS with some skin products:

• Dimethicone cream (skin softener) may cause itching or burning ⁽⁴³⁾.
• Lanolin or wool fat (skin barrier) may cause eczema ⁽⁵⁹⁾.
• Mineral oils (skin barrier, aqueous cream, petroleum jelly or petrolatum, sorbolene) may cause itching, folliculitis ^(52,61).
• Practically any skin product may trigger an allergic reaction.

PROBABLY INEFFECTIVE in relieving itch:

There is insufficient evidence about effectiveness of aloe vera, calendula (marigold) lotion, primrose oil, tea tree oil in relieving itch. There is no evidence about effectiveness of oral vitamin C, D, E, K or vitamin creams in relieving itch in individuals with normal blood vitamin levels.

Pregnancy Category C Anti-Itch Medications

Pregnancy category C drugs are drugs that had harmful effects in studies on the animal fetuses, but no harmful effects on the human fetuses were found, mainly due to lack of studies. So, the category C drugs are not proven harmful for the fetus, but the harm cannot be excluded. Do not use pills or skin products that contain the following category C substances (a non-complete list) without speaking with your doctor:

• Amonium lactate ( in creams for dry, scaly skin) ⁽⁶²⁾
• Benzocaine cream (local anesthetic) ⁽³⁵⁾
  
• Butoconazole vaginal (anti-fungal cream for vaginal yeast infection) ⁽⁵⁴⁾
• Calcipotriene cream (for psoriasis) ⁽⁴⁰⁾
• Camphor ointment (topical analgesic for painful and itchy skin) ⁽²⁷⁾
• Coal tar (for psoriasis) ⁽⁵⁵⁾
• Gabapentin (pills, for shingles, herpes) ⁽⁶³⁾
• Pimecrolimus cream (for eczema) ⁽¹¹⁾
• Pramoxine cream (local anesthetic) ⁽³²⁾
• Steroids:
  • Mild:
    • Hydrocortisone cream (0.5-1%) is a mild steroid for skin inflammation, such as eczema. When you use it for a localized rash, you do not need to expect any significant side effects (except eventual contact dermatitis) ⁽⁶⁵⁾. It is available over-the-counter.
    • Hydrocortisone rectal (cream, ointment, suppository). Side effects may include rectal burning, increased hair grow ^(66).
  • Moderate:
    • Triamcinolone topical ⁽³⁴⁾. Side effects may include blurred vision, irregular heartbeats, mood changes, insomnia, weight gain, feeling tired, skin peeling or thinning, stretch marks, acne-like rash ⁽³⁴⁾.
  • Strong:
    • Betamethasone topical ⁽⁶⁴⁾. Side effects as in triamcinolone (see above).
    • Prednisone pills ⁽³³⁾. Side effects as in moderate steroids (see above) plus possible swelling, high blood pressure, headache, nausea, deposition of fat in your face and waist, increased facial hair. The risk of side effects increases with the duration of treatment. Possible harms for the baby: pre-term delivery, low-birth weight ⁽¹¹⁾.
• Tacrolimus cream (for eczema) ⁽¹¹⁾
• Tretinoine cream (for acne) ⁽³⁷⁾
• Urea cream (for eczema, psoriasis) ⁽⁵⁷⁾
• Zinc oxide (paste, for hemorrhoids) ⁽⁵⁰⁾

Red and Itchy Palms (Palmar Erythema) and Feet In Pregnancy

• Red and, sometimes, itchy palms (palmar erythema) and soles of the feet appearing at any time during pregnancy are probably caused by elevated blood estrogen levels ⁽¹⁾. This condition, which is not harmful, may become worse in late pregnancy, but usually goes away shortly after delivery ⁽¹⁾. Picture of palmar erythema. Calamine lotion may help to reduce burning and itching ⁽⁴⁹⁾.
• Red palms (liver palms) may be a symptom of liver disease, leukemia, thyrotoxicosis or other disease ⁽⁵¹⁾.
• Severe itch, but no redness, in the palms and soles of the feet in the last trimester may be caused by intrahepatic cholestasis of pregnancy (see bellow).

Itchy Breasts During Pregnancy

Breasts may start to itch in the first trimester due to hormonal changes and later due to eventual stretch marks. You may try to prevent itchy breasts by wearing a cotton bra and applying emollients (oily moisturizers) to the breasts.

Stretch Marks or Striae During Pregnancy

Stretch marks of the pregnancy or striae gravidarum are bands of flattened skin that may be itchy or not. Skin distension and hormone changes during pregnancy are considered the main causes ^(1,3). To date, there is no known method to prevent stretch marks ^(3,5).

Symptoms:

• Parallel lines, pink and later red, purple or brown, sightly depressed, up to several inches long and 10 millimeters wide ^(1,2). They may appear on the belly, breasts, thighs, hips, buttocks or arms ^(1,3). Picture of stretch marks on the stomach of a pregnant woman.

When:

• In the second half of pregnancy ⁽¹⁾. They usually fade and shrink within a year after delivery, but usually not completely ^(1,3).

Treatment:

Remedies that may relieve itch, but not remove stretch marks (anecdotal reports):

• Emollients: cocoa butter oil, cream or spray, olive oil, almond oil
• Colloidal oatmeal bath
• Baking soda bath
• Baking soda paste for severe itch

Do NOT use tretinoin or other retinoid cream for stretch marks during pregnancy ⁽³⁷⁾.

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) or Polymorphic Eruption of Pregnancy (PEP)

PUPPP (“pups” or pupps” rash) or PEP is a rash associated with stretch marks. The exact cause is not known. PUPPP is not harmful for you or your baby ⁽⁷⁾.

Symptoms:

• Itchy, red, slightly raised, hives-like bumps or patches around or in the stretch marks; (Picture 1). The rash usually starts on the stomach and may spread to the arms and legs, but usually not to the face, palms, soles and belly button ⁽⁹⁾.

Picture 1: Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) or
Polymorphic Eruption of Pregnancy (PEP)
(source: Samuel Freire da Silva, M.D., Atlasdermatologico.com.br)

When:

• Usually in the third trimester of the first pregnancy or shortly after delivery ⁽⁷⁾. It spontaneously disappears from few days to several weeks after delivery ⁽⁹⁾. It rarely appears during the subsequent pregnancies ⁽⁹⁾.

Treatment for itch relief in PUPPP ⁽⁸⁾:

• Cool showers
• Pine tar soap, epsom salt bath  (several women reported relief)
• Emollient (skin softening) ointment
• Antihistamine pills or cream
• Steroid creams (prescribed)
• Steroid pills (prescribed)

Acne During Pregnancy

Women who had acne before pregnancy are prone to develop them during pregnancy. On the other hand, the pre-existing acne may disappear during pregnancy ⁽²³⁾.

Symptoms:

• Red bumps arising around the pores on the face, chest or back; may be slightly itchy.

When ⁽²²⁾:

• Acne usually appear early in pregnancy due to elevated progesteron, but often improve in late pregnancy due to elevated estrogen. They usually disappear shortly after delivery.
• May recur in the subsequent pregnancies, before menstruation or after taking contraceptive pills.

Safe Acne Treatment During Pregnancy ^(22,23):

• Benzoyl peroxide gel ⁽²⁴⁾
• Azelaic acid gel ⁽²⁵⁾
• AHA gel (Alpha Hydroxy Acids), such as glycolic acid gel ⁽⁵⁶⁾
• Erythromycin (an antibiotic), in severe cases ⁽²³⁾.

Use oil-free soaps and avoid oil-based topical preparations. Do not use: isotretinoin, retinol and other retinoids, minocycline, doxycycline and other tetracyclines and salycilic acid ⁽²³⁾.

Eczema or Atopic Eruption of Pregnancy (AEP)

Eczema is a chronic recurring rash due to allergic reaction to pollen, environmental pollutants, contact with rough materials, dry skin, stress or other triggers ⁽⁴⁾. Smoking during pregnancy may worsen eczema ⁽¹¹⁾.

Symptoms:

• Red or brown, patchy, scaly, itchy rash with occasional blisters behind the knees, on the inner side of elbow, under the breasts, on the face, neck, upper chest, hands or feet ⁽⁴⁾. Picture of eczema (source: Atlasdermatologico.com.br).

When:

• In some women eczema appears for the first time during pregnancy. In other women eczema worsens before periods and during pregnancies, but in some it gets better during pregnancies ⁽¹¹⁾.

Treatment for eczema itch relief:

^{(4,10,11,44,47)}

• Wet, cool compresses
• Bandage to prevent scratching
• Warm baths with baking soda or oatmeal
• Soaps that are “mild”, “fragrance-free”, “non-irritating” or “hypoallergenic”
• Emollients containing ceramides or pine tar
• Colloidal oatmeal lotion
• A mixture of honey, beeswax and olive oil ⁽¹⁹⁾
• Antihistamine pills
• Steroid creams
• Ultraviolet light (UV-B)
• In severe cases: oral steroids or cyclosporine

There is no cure (permanent healing) for eczema known to date.

Prurigo of Pregnancy or Pruritus Gravidarum

⁽¹⁴⁾

Symptoms:

• Red bumps or under-skin nodules on the outer side of arms and front side of legs that may later spread to the belly.
• Picture of prurigo of pregnancy

When:

• At any time during pregnancy; may persist for few days or as much as three months after delivery.

Treatment:

• Steroid ointments and oral antihistamines
• Creams containing 1-2% menthol
• Oral steroids in severe cases.

Impetigo Herpetiformis During Pregnancy

Impetigo herpetiformis is a form of psoriasis ⁽³⁾. “Herpetiformis” means herpes-like, but this has nothing with a herpes virus.

Symptoms:

• Round red patches covered with small herpes-like painful blisters on the thighs and groin, sometimes genitals; may spread to the trunk and extremities; (Picture 3). Face, hands and feet are not affected. It may or may not cause itching.

Picture 3: Impetigo herpetiformis on the thighs
(source: Samuel Freire da Silva, M.D., Atlasdematologico.com.br)

When:

• The second half of pregnancy. It usually goes away after delivery. It may recur in subsequent pregnancies.

Treatment:

Herpes Gestationis or Pemphigoid Gestationis

Herpes gestationis or pemphigoid gestationis (from Greek pemphig = bubble) is a very itchy rash. The condition is not connected with herpes virus. Pemphigoid gestationins can spread to the unborn baby, but the rash usually clears up within few days ⁽¹³⁾.

Symptoms:

• Red bumps or welts initially appear in the belly button and spread all over the body and may affect palms and soles, but rarely face or neck. Herpes-like blisters that eventually break may be present ⁽¹³⁾; (Picture 4).

Picture 4: Herpes gestationis or Pemphigoid gestationis
(source: Samuel Freire da Silva, M.D., Atlasdermatologico.com.br)

When:

• The second or third trimester or within one month after delivery. The rash spontaneously goes away within several weeks or months after delivery. Pemphigoid gestationis often recurs in subsequent pregnancies. The rash may appear before periods or within few days after starting oral contraceptives.

Treatment:

• Oral steroids are usually effective in few days.
• Steroid ointments help only on the beginning.

Papular Dermatitis of Pregnancy

Papular dermatitis of pregnancy is a rare condition caused by hormonal changes ⁽¹⁷⁾.

Symptoms: red, flat, hives-like bumps all over the body.

When: at any time during pregnancy; goes away soon after delivery.

Treatment: oral steroids.

Pruritic Folliculitis of Pregnancy

Pruritic folliculitis of pregnancy is a very rare condition with an acne-like rash ⁽¹⁵⁾.

Symptoms: moderately itchy acne-like rash on the trunk.

When: The rash may appear at any time during pregnancy and persist as much as one month after delivery.

Treatment: benzoyl peroxide creams, steroid creams, ultraviolet (UV-B) light. AVOID oil-based creams.

Anal Itch Due to Hemorrhoids During Pregnancy

Itchy anus in pregnancy may be due to hemorrhoids.

Symptoms: soft, tender, bluish  mass around the anus, which may itch or burn.

When: at any time, but more often in the second half of pregnancy.

Prevention: Keep stools soft by eating enough fiber rich foods and drinking enough water. Avoid straining at bowel movements. Avoid prolonged sitting.

Treatment to relieve anal itch:

^(38,73)

• Soak the area in plain warm water in a tub (sitz bath) for 10 minutes few times a day.
• Place an ice pack (wrapped in a soft cloth) to hemorrhoids few times a day to reduce swelling.
• You may use pre-moistened wiping tissues.
• Try a mixture of honey, beeswax and olive oil.
• Over-the-counter anti-itch hemorrhoid creams and suppositories are available in pharmacies.
• When hemorrhoids are very painful, bleed severely or protrude out of anus, visit your doctor.

Vaginal Itch, Vaginitis During Pregnancy

Vaginal itch during pregnancy can be caused by:

1. Bacterial Vaginosis

Bacterial vaginosis is an overgrowth of bacteria that are normally found in vagina ⁽⁶⁾. Hormone changes in pregnancy, several sex partners and vaginal irrigation (douching) are main causes. Diagnosis is made by physical examination and tests of a vaginal swab. Vaginal pH is increased (>4.5).

Symptoms: white or grey discharge with fishy odor, no rash, mild itch or no itch.

When: at any time during pregnancy.

Complications may include pelvic inflammatory disease (PID) and preterm delivery.

Prevention: Avoid vaginal irrigation (douching).

Treatment: oral antibiotics metronidazole or clindamycin.

2. Vaginal Yeast Infection, Vaginal Thrush or Vaginal Candidiasis

Causes of vaginal yeast infection in pregnancy include constant moist in the groin due to tight clothes, treatment with steroids or antibiotics, and gestational diabetes. It is not transmitted by a sexual contact ⁽⁶⁾. Measuring vaginal pH may help in diagnosis (pH is <4.5).

Symptoms: vaginal and labial itch, burning during urination, painful sex, redness or swelling of vulva, eventual scaly rash around the vulva, thick cotton cheese-like discharge ⁽⁶⁾.

When: at any time during pregnancy.

Prevention: Wear 100% cotton underwear and keep the area dry, avoid vaginal irrigation (douching).

Treatment: Anti-fungal ointments or suppositories containing clotrimazole. Probably NOT effective: yoghurt, low-sugar diet, natural remedies ⁽⁴²⁾.

3. Elevated Vaginal pH Level (No Discharge)

Normal vaginal pH is lower than 4.5, this is slightly acidic ⁽⁶⁾. Causes of elevated vaginal pH include vaginal irrigation (douching) with soaps, which are usually alkaline, deodorants.

Symptoms: itchy vagina and vulva, no rash, no discharge (in the absence of bacterial infection).

When: at any time during pregnancy.

Self-diagnosis: pH test kits for home use available in pharmacies (pH >4.5).

Treatment: Try baths with added baking soda ⁽¹⁸⁾. Various over-the-counter gels are available.

4. Lactobacillus Overgrowth or Cytolytic Vaginosis

Lactobacillus overgrowth syndrome or cytolytic vaginosis is often wrongly diagnosed as vaginal candidiasis ⁽²¹⁾.

Symptoms: white discharge, vaginal itching, burning during urination, painful sex.

Diagnosis: Elevated Lactobacilli in vaginal swab, low pH (3.5-4.5).

Treatment includes vaginal irrigation with sodium bicarbonate (two tablespoons of baking soda in one liter of water) or sitz baths with baking soda.

Intrahepatic Cholestasis of Pregnancy (ICP) May Cause Severe Itch

Intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis is a general itch associated with a liver disorder triggered by pregnancy ⁽¹²⁾. Blood tests show elevated bile acids and liver enzymes. Often, other women in the family have the history of this condition.

Symptoms: severe itch, no rash, sometimes mild jaundice.

When: the third trimester of pregnancy. Itchiness usually goes away within 48 hours after delivery. Intrahepatic cholestasis may recur in subsequent pregnancies.

Treatment: Ursodeoxycholic acid is effective and safe for both the mother and the baby. Cholestiramine is less effective. Oral antihistamines, dexamethasone, S-adenosyl-L-methionine, epomediol, silymarine, phenobarbital, activated charcoal, guar gum, UV-B light and emollients are only mildly effective.

Other Causes of Itchiness During Pregnancy

Prickly heat rash, hives (urticaria), seborrheic dermatitis, jock itch, ringworm, staph skin infection, shingles, scabies, chicken pox or other itchy skin conditions may also affect pregnant women. Hodgkin lymphoma, leukemia, cancers, celiac disease, Crohn’s disease, intestinal parasites, liver disease, kidney disease, rheumatoid arthritis, systemic sclerosis, Sjögren’s syndrome may cause itch but not necessary rash. If you cannot find the cause of your rash, discuss with your doctor about appropriate tests.