Skin in pregnancy — what's available, and what waits

The position

Maintaining, not changing.

The useful way to think about these nine months is that the job is keeping skin comfortable and stable, rather than moving it somewhere new. Almost everything that changes skin meaningfully works by disrupting it, and disruption is the category that gets set aside.

That is not a lesser plan. It is the correct one, and it is also temporary — the things being set aside are being set aside until afterwards, not withdrawn.

The reason for most of the caution is worth understanding, because it is not what people assume. In the majority of cases, harm has not been demonstrated. What has happened is that the studies have not been done, because studies are not run on people who are pregnant. So the evidence is absent rather than bad — and the honest response to absent evidence is to wait, not to reassure you.

We do not run experiments on people who are pregnant. That sentence is the whole of it.

What changes

Common, and largely temporary.

General descriptions of things people commonly report. Not a checklist of what will happen to you, and not a description of you.

Pigment: Darkening across the cheeks, forehead and upper lip is one of the more common changes, and the word people find when they search for it is melasma. Identifying it is a doctor's job. What is worth knowing now is that sun makes it more pronounced, that it very often settles in the months after birth, and that aggressive attempts to shift it during pregnancy tend to go badly. Shade and sunscreen do more here than anything in a clinic.
Breakouts: Frequently in the first months and often around the jaw. Awkward, because several of the usual answers are the ones set aside during pregnancy. Gentle, consistent and boring is generally the available route.
Sensitivity: Products that were unremarkable for years can start to sting. This is common, usually temporary, and the correct response is to simplify a routine rather than to hunt for a product that fixes it.
Dryness and itch: Skin stretching over a changing shape gets dry and often itchy, particularly across the abdomen. Plain, unscented moisture, applied more often than feels necessary. Itching that is intense, widespread or worse at night is a conversation for your GP or midwife, not for us — there are causes of that in pregnancy which matter, and none of them are a skin clinic's to assess.
Stretch marks: Where they appear and how much is largely down to genetics and how quickly skin stretches, and no cream has been shown to prevent them. They fade considerably over the year or two afterwards. Anything sold as prevention is selling certainty that does not exist.
Skin tags and small growths: More of them, commonly around the neck, under the arms and beneath the bust. Usually harmless, frequently persistent afterwards, and not something to have removed during pregnancy. Anything that has changed rather than simply appeared goes to a doctor.

Anything systemic — a rash you cannot explain, severe itching, swelling, blistering — belongs with your GP or midwife. We describe skin. We do not manage pregnancy, and we will say so.

In the clinic

What is available, and what waits.

The general positions here. The decision is still made by the nurse on the day, and the first thing to do is tell us you are pregnant when you book rather than when you arrive.

Microneedling — waits: Not available during pregnancy. It works by creating controlled injury, it is usually done with topical numbing, and neither has been studied in pregnancy. It will still be there afterwards, and skin that has just been through nine months of change is generally a better candidate anyway.
Chemical peels — mostly wait: Set aside for the duration. Peels also carry a real risk of provoking pigment in skin that is already prone to it, which during pregnancy is the outcome most people are actively trying to avoid. [TALIHA: confirm whether any superficial peel remains available, and on what basis]
Hydrating and cleansing facials — generally available: Treatments that hydrate and clean without abrasion or acid are usually available, and are often what suits pregnant skin best regardless. Ninety minutes lying down is not the worst part of it either.
Dermaplaning and microdermabrasion — ask: Mechanical rather than chemical, which changes the question but does not settle it, and the answer depends on how your skin is behaving at the time. [TALIHA: the position on both during pregnancy]
The consultation — available, and worth more now: Ninety minutes, $150, and a written plan — which during pregnancy is largely a plan for what to use at home, and a plan for afterwards. Knowing the order things happen in once the baby arrives is genuinely useful, and this is the calmest time you will have to work it out.

At home

The shorter routine.

Most people are told to stop things and not told what remains, which leaves them either anxious or doing nothing. This is the general shape — your GP, midwife or pharmacist rules on anything specific, and on medication of any kind they rule, not us.

Retinoids — set aside: The whole family, from the ones on a pharmacy shelf to the ones on a prescription. This is the one nearly everybody already knows, and it is the one to get right. If you have been using one and have only just found out you are pregnant, stop and mention it at your next appointment — ask your doctor rather than reading forums about it.
Sunscreen — more important, not less: The single most useful thing available during pregnancy, because pigment change is the most common complaint and sun is what drives it. Daily, properly, and a hat when you can. Unglamorous and it outperforms everything else on this page.
Gentle cleansing and moisture — keep: Simplify rather than elaborate. Skin that has become reactive does better with three products it tolerates than with eight it is negotiating with.
Acids and strong actives — ask first: Some are generally regarded as fine at low strengths and some are not, and it depends on which and how much rather than on the category. Worth a specific conversation rather than a blanket rule in either direction.
Anything you are unsure about: Bring the actual bottle, or a photo of the ingredients, to your consultation or your pharmacist. Guessing from a product name is how people end up either using something they should not or abandoning something perfectly ordinary.

Afterwards

Wait longer than you want to.

A lot settles on its own in the months after birth — pigment frequently fades, breakouts often calm, sensitivity usually returns to normal. Treating skin while it is still doing that means treating a moving target, and paying to change something that was going to change anyway.

Breastfeeding narrows the list again, though less than pregnancy does, and it depends more on what is being used than on the treatment's name.

There is no rush, and anyone suggesting there is has an interest in your hurry. Come in, get looked at, and start with what is worth starting with.

Questions

Asked about skin in pregnancy.

Answered the way they would be answered in the room.

Can you get skin needling when pregnant?

Not here. Microneedling is set aside for the duration of a pregnancy. It works by creating controlled injury and is usually done with topical numbing, and neither has been studied in pregnancy — the evidence is absent rather than bad, and the honest response to absent evidence is to wait. It will still be available afterwards.

Can you do microneedling during pregnancy?

No. This is one of the firmer positions here and it is not a judgement call made on the day. Skin also changes considerably through pregnancy and in the months after birth, so treating it during that period means treating a moving target — most people get a better result from the same course of treatment once things have settled.

Can you get a facial while pregnant?

Usually yes, in a narrower form. Hydrating and cleansing facials without abrasion or acid are generally available; peels and needling are not, and certain ingredients are set aside for the duration. Tell us you are pregnant when you book rather than when you arrive, so the appointment is planned properly rather than adjusted on the spot.

What facial treatments are available during pregnancy?

Generally the hydrating and cleansing treatments — those that clean, hydrate and support the skin without abrading it or using strong acids. Set aside for the duration: microneedling, chemical peels, and treatments using retinoids. The full answer depends on how your skin is behaving, which is what an assessment is for.

Can I use retinol while pregnant?

No — the retinoid family is set aside during pregnancy, from over-the-counter strengths to prescription ones. If you have been using one and have only just found out you are pregnant, stop and raise it with your doctor or midwife rather than searching for reassurance. It is a common situation and it is theirs to advise on, not ours.

Why has my skin gone darker in patches during pregnancy?

Darkening across the cheeks, forehead and upper lip is a common change in pregnancy, and the term people find when they search for it is melasma. Identifying what is happening on your skin is a doctor's job, not ours. Generally: sun makes this kind of change more pronounced, it frequently fades in the months after birth, and attempts to shift it aggressively while pregnant tend to make it worse rather than better.

Can anything prevent stretch marks?

No cream has been shown to prevent them. Where they appear and how many is largely determined by genetics and by how quickly skin stretches, neither of which a product changes. Moisture helps with the itch and the comfort, which is worth doing on its own terms. They also fade substantially over the following year or two.

What about while breastfeeding?

More is available than during pregnancy, but not everything, and it depends more on what is being used than on the treatment's name. It is worth a specific conversation rather than an assumption in either direction. Bring what you are using at home and we will work through it.

Where this leads

The plan for afterwards.

The most useful thing available during these months is a written plan for the ones after them — worked out while you have the time to think about it rather than in the first exhausted year.

The consultation · $150

Ninety minutes and a written plan. During pregnancy that is mostly what to use at home, and the order things happen in once you are through it.

Can I have this?

The rest of the circumstances that change what is available — flares, cold sores, medication, sun. Answered plainly.

Your skin across your cycle

The same hormonal machinery on a shorter timescale, and useful background for what happens afterwards.

The other patterns we see

Ten things people arrive with, described rather than diagnosed.

Skin in pregnancy, and the smaller plan.