Expecting Eczema When Expecting
Itchy Skin During Pregnancy
The last thing you want to worry about during a pregnancy is itchy skin. But of course, much of a woman's bodily functions are out of her control during this special, life-creating journey. While the stretching of skin can cause itch sensations (and those dreaded stretch marks), another level of itchy skin is all due to the shifting immune responses in a pregnant body.
There are several skin conditions specific to pregnancy:
- Gestational pemphigoid
- Pruritic and urticarial papules and plaques of pregnancy (PUPPP, also known as pruritic eruption of pregnancy and toxemic rash of pregnancy)
- Intrahepatic cholestasis of pregnancy
- Impetigo herpetiformis
- Atopic eruption of pregnancy: encompasses atopic eczema in pregnancy, prurigo of pregnancy, as well as pruritic folliculitis of pregnancy in earlier classifications.
Eczema and Pregnancy
Of all the pregnancy-specific skin conditions, eczema is the most common, accounting for nearly 50% of all cases. On top of that, 80% of these women develop eczema for the first time during their pregnancy (as in, they never had eczema during their childhood). The dry, itchy skin shows up during the first or second trimester, and often in typical atopic areas like behind the knees or in hard-to-reach areas like the trunk and limbs. Now that is something most women don’t expect when expecting! Could pregnancy cause eczema?
The changing maternal immune system seems to be the major player in developing eczema. In order to prevent fetal rejection, an imbalance is created between cellular and humoral immunity. T helper type 2 (Th2) cytokine production is favored over Th1, enhancing humoral immunity and stunting cell-mediated immunity.
- Quick primer on immunity
Humoral immunity and cellular immunity are parts of our adaptive immune system - the type of immunity that adapts to our environment. It is more specific that the non-adaptive immune system, that is composed of cells and tissues that protect us (like our skin's barrier!). Back to adaptive immunity. Two ways our immune system adapts is through the recognition of foreign baddies by either antibodies or by activated cells. Humoral immunity involves antibodies that rapidly recognize and destroy microbes and their toxins. Cellular immunity is leads to a delayed type of hypersensitivity. Th1 cells secrete pro-inflammatory cytokine that kill intracellular bacteria, whereas Th2 cells secrete anti-inflammatory cytokines, and are associated with allergic responses and atopy.
In pregnancy, there is a shift from a Th1 response to a Th2 response, to prevent rejection of the fetus. Some studies even show that having more of the Th1 cell response is linked to premature birth, recurrent miscarriage and preeclampsia. So for the baby's benefit, a bit of an allergic response is favored (can this explain the stuffy noses of pregnancy?). This is why atopy and eczema can show up on a pregnant woman's skin.
Managing itchy skin can be tricky during pregnancy. Most things are contraindicated, like essential oils, and medications like strong steroids and calcineurin inhibitors. Always, always consult your dermatologist if you are pregnant and looking for skin care advice. Here are some helpful tips for you to research and discuss with your doctor:
- Avoid hot showers and soap
- Avoid irritants and allergens
- Look for humectants: Hyaluronic acid is safe during pregnancy and can provide a boost of moisture to the skin
- Use emollient therapy: Ceramides can help reduce TEWL, improving barrier function
- Manage the itch: Colloidal Oatmeal can reduce itch, but the key is to control the scratching. Having a partner that slaps your hand when you scratch helps.
- Layer skincare: start with the water-based serums and increase up to the oils.
- Try a fish-oil supplement
- Control stress: Stress both increases inflammation and dehydrates skin
- Use a humidifier - especially during Fall and Winter months
- Never let your skin dry out! Constant application of moisturizers will prevent the skin from cracking, which leads to scratching and potentially infections.
There isn't a cure-all for eczema. Your body is busy providing the optimal environment for your growing baby, so don't worry too much about the little surprises that you get along the way. Mindfully managing your symptoms will lead to a happier and healthier pregnancy.