The skin undergoes changes during pregnancy, and there are specific skin conditions that occur only in pregnant women. Additionally, other changes in the pregnant body can trigger itching on their own. Many pregnant women seek medical help due to skin problems and specifically itching skin. This article describes the causes and treatment of itch during pregnancy.
The most common group of itchy skin diseases among pregnant women (> 50%) are called atopic pregnancy dermatoses. Pregnancy eczema and pregnancy itch are examples of these. Such skin conditions occur in about 1 in 20 pregnancies and manifest as the onset/worsening of eczema-like skin disorders.
Pregnant women often have a background history of previous eczema, allergies, and/or asthma. 75% of cases start during the 1st or 2nd trimester and often last throughout the entire pregnancy. They rarely pose a risk to the fetus and often recur in subsequent pregnancies. In cases of pregnancy itch, pregnant women often experience itch in the scalp, genital area, or around the anus.
In the 3rd trimester, the itch is often localized to the abdomen. Many experience hives-like skin changes where the skin itches.
Polymorphic pregnancy dermatosis is another relatively common inflammatory condition of the skin in pregnant women. It typically occurs late in the third trimester, most commonly among primiparous women (over 2/3 of cases). This skin condition presents as very itchy, eczema-like skin changes at the edges of stretch marks on the abdomen. The eczema changes can have different appearances and later spread to the chest, back, arms, and legs. The condition is self-limiting and usually lasts 4-6 weeks. It disappears 1-2 weeks after delivery. The exact cause is unknown, but it is suspected that stretching of the skin (caused by the growing abdomen) can trigger the inflammation. Polymorphic pregnancy dermatosis is not associated with increased disease in the mother or fetus.
Intrahepatic cholestasis of pregnancy is a relatively rare condition among pregnant women. It is caused by the accumulation of bile acids in the body. The exact cause is uncertain and likely triggered by multiple factors (genes, environment, hormones).
Intrahepatic cholestasis of pregnancy is not harmful to the pregnant woman, but it can pose a greater risk to the fetus. It manifests as pronounced itch in normal skin, but over time, the pregnant woman will scratch herself. The diagnosis is confirmed by blood tests showing elevated liver and bile tests. In rare cases, the pregnant woman's skin may become slightly yellowish due to the rising bile acids (called jaundice). The condition is treated in the hospital.
Pemphigoid gestationis and pustular psoriasis in pregnancy are very rare skin diseases among pregnant women that can cause itch. In these cases, there are wide spread skin changes.
The majority of cases of itch during pregnancy are harmless. The treatment for these is symptomatic relief/itch reduction and consists of moisturizing creams, cortisone creams, and antihistamines ("allergy tablets"). Some pregnant women experience a good itch-relieving effect from oatmeal baths. Light therapy with a dermatologist and sunlight can also help.
