Pregnancy is a time when for some, everything with their skin falls into place and they get that rosy, healthy glow. Unfortunately that’s not the case for all women and it can also be a time where skin goes a little out of control. During pregnancy there is a real shift in hormone production, primarily relating to skin, there is an increase in the female sex hormones oestrogen and progesterone while also some androgens can elevate. Hormones are produced to aid in fetal growth and our body’s ability to relax to accommodate the growing fetus and placenta while also gifting the flexibility for delivery. Hormones for bonding and milk supply are also plentiful. So what does this mean for skin concerns in pregnancy and what are safe alternative therapies available for skin management in this delicate time?
Hormonal changes during pregnancy can influence acne in different ways, when talking about pregnancy acne we’re almost always talking about hormonal acne. When talking about hormonal acne we are talking about excess androgen production primarily and then oestrogen and progesterone play supportive roles. The placenta produces a type of androgen called DHEA while Testosterone, our most famous androgen, does also rise during pregnancy.
Alongside these androgens a compound called sex hormone binding globulin or SHBG is also supposed to increase equally, as is the enzyme aromatase. SHBG binds up androgens preventing them from eliciting an effect on our tissues, while the enzyme aromatase converts testosterone into oestrogen, both of which neutralizes increases in androgens. So for women who may have the increase in androgens without adequate SHBG or aromatase production, may just find them selves with pregnancy acne.
Another factor for why some women and not others, is the way in which our androgens can convert to each other. This depends on factors like nutrient status and genetics. DHEA and Testosterone aren’t the strongest most negative androgens for acne, but they can convert to stronger more aggressive androgens, and the rate at which they convert varies for different women’s bodies, this is true in pregnancy times also.
For the lucky women who see their hormonal acne disappear in pregnancy, we can presume that they may have had low progesterone prior to pregnancy, then during their pregnancy experience the benefit of higher progesterone. Progesterone of which is a natural anti-androgen, can clear some women’s acne up. This coupled with adequate SHBG and aromatase activity, just could be the perfect combination for acne oblivion. Not drinking alcohol can also improve skin issues, for those who were previously over indulging. That’s not to say hormonal acne is caused by alcohol consumption.
Pregnancy Friendly Acne Treatments
Supplements -Zinc 35-40mg/day with food, in divided doses can be easier, anti-androgen, wound healing and healthy shedding of dead skin cells -Omega-3 in 2-3grams of omega-3 from really clean fish oil or for veg and vegans flaxseed oil, this is also needed for bubs brain and nervous system development -Myo-Inositol 2 grams twice daily, to reduce excess androgens and help with blood sugar regulation, which can also come into androgen imbalance, inositol also prevents gestational diabetes
Diet -Avoiding dairy (veg use B12), eat seeds, leafy greens, legumes, almonds and small canned fish like sardines and mackerel with bones for your calcium needs. -Avoid processed sugar, very important if you have a sweet tooth or family history of diabetes.
In pregnancy we see excess skin oil production and excess oestrogen production, both of which provide a perfect environment for yeast (candida) to over grow, this is one factor for peri-oral dermatitis or POD occurring or worsening at this time. The other issue is that elevated inflammatory oestrogens are sometimes a factor in POD in general. Other considerations include over use of steroid creams, immune and gut dysbiosis related dysfunction.
Pregnancy POD Treatment Topical -Avoid applying all oils -Avoid active skincare on the area -Herbal creams that are anti-inflammatory and antifungal or other interventions from your dermal therapists.
Supplements -Sacharomyces barloudii or SB probiotic 500mg twice daily, balances yeast, immune function and dysbiosis. -Lactobacillus rhamnosus and Lactobacillus reuteri combination probiotic, balances yeast, immune function and dysbiosis.
Melasma pigment formation is a very common skin issue in pregnancy. Increases in oestrogen, increases melanin production by melanocytes, through an enzyme called tyrosinase. For some women this can fade on it’s own, for some it will not. To ensure negative oestrogen processing in the liver isn’t creating excess harsh oestrogens and optimize oestrogen detoxification, you need methylation support and glutathione support. Methylated B’s or activated B’s specifically B12, folate and B6, are used for methylation support. Methylation is a detox pathway in the liver that clears excess oestrogen and methyl donors are in high demand in pregnancy. Good prenatal and pregnancy multivitamin formulas will include these, but they are not the stock standard pharmacy kind. The antioxidant glutathione is also needed for liver elimination of excess or toxic oestrogen. Glutathione is not definitively pregnancy safe, so we use n-acetyl Cysteine or NAC to support glutathione status, which thankfully also works well.
Pregnancy Melasma Treatment Topical -Zinc sulfate, licorice, niacinamide and vitamin C, azelaic acid or suggested products from your dermal therapist (may or may not include these ingredients).
Pregnancy Melasma Supplements -Methylated B’s or activated B group multi-vitamin 1-2 a day with meals, depending on the formula. -N-acetyl cysteine or NAC at 1-1.2grams per day with food (single or divided dose).
How to manage the postpartum hormone drop
So as I’m sure many of you know, progesterone and estrogen drop off dramatically after birthing the placenta. This can feel like a little menopause or contributes to post partum depression. Ideally getting some phytoestrogens in to support estrogen levels helps. Flax or linseeds and organic soy products are the strongest. Phytoestrogens are also galactogogues, so help with breast milk supply. Another remedy that also helps with breast milk supply is maca root, maca can be taken as 1 teaspoon in food or water in the morning. Maca is an adaptogenic herb that improves, energy, mood, and hormonal regulation post partum, by improving hormone parameters.