Common skin conditions encountered during pregnancy include hormone-related, preexisting, and pregnancy-specific. Hormonal changes during pregnancy can cause benign skin conditions including striae gravidarum (stretch marks); hyper-pigmentation (melasma); as well as hair, nail, and vascular changes. Preexisting skin conditions, such as atopic dermatitis, psoriasis, fungal infections, and cutaneous tumors may change during pregnancy. Pregnancy-specific skin conditions include pruritic urticarial papules and plaques of pregnancy (PUPPP), prurigo of pregnancy, intrahepatic cholestasis of pregnancy, pemphigoid gestationis, impetigo herpetiformis, and pruritic folliculitis of pregnancy. Of these, PUPPP seems to be the most common disorder.1

Striae gravidarum or stretch marks are noted in nearly 90% of pregnant women by the third trimester. Striae usually appear as pink-purple, atrophic lines or bands on the abdomen, buttocks, breasts, thighs, or arms and are commonly seen in younger women, women with larger babies, and women with higher body mass indices. Striae gravidarum may be associated with itching, burning, and discomfort.2

Preexisting skin conditions such as atopic dermatitis, psoriasis, candidal and other fungal infections may change during pregnancy. Atopic dermatitis and psoriasis may worsen or improve during pregnancy. Atopic changes may be related to prurigo of pregnancy and usually worsen during pregnancy. Psoriasis is more likely to improve than worsen during pregnancy.1

True dermatoses of pregnancy include PUPPP, prurigo of pregnancy, intrahepatic cholestasis of pregnancy, pemphigoid gestationis, impetigo herpetiformis, and pruritic folliculitis of pregnancy.1

PUPP usually presents with intensely pruritic urticarial plaques and papules with or without erythematous patches of papules and vesicles. The rash may first appear on abdomen, often along striae and occasionally involves extremities. Prurigo presents with erythematous papules and nodules on the extensor surfaces of the extremities. Intrahepatic cholestasis of pregnancy shows excoriations from scratching, and the distribution is nonspecific. Pemphigoid gestationis presents with pruritic papules, plaques, and vesicles that evolve into generalized vesicles or bullae. Pruritic folliculitis of pregnancy presents with erythematous follicular papules and sterile pustules on the abdomen, arms, chest, and back.1

Antihistamines and corticosteroids are commonly prescribed to manage pruritic skin conditions in pregnancy.1 However, natural herbal formulations also have the potential to manage pruritic skin conditions during pregnancy on account of their antimicrobial, antiseptic, emollient, anti-inflammatory and antipruritic properties.

Aloe has emollient, purgative, antibacterial, antioxidant, antifungal, antiseptic properties and can be used as a skin moisturizer and helps in skin hydration.3,4 Almond oil has anti-inflammatory, immunity-boosting and anti-hepatotoxicity effects. It can effectively treat dry skin conditions such as psoriasis and eczema.5 Chaste tree possesses anti-inflammatory and antioxidant properties.6 Indian Madder has anti-inflammatory, antipyretic, analgesic, antiseptic, rejuvenating and tonic properties. Its application is known to reduce edema, exudation and itching.7 Yashada bhasma (zinc) inhibits bacterial growth on the skin and inflammation.8 It relieves itching, eruption and burning sensation in eczema.9

References

1. Tunzi M, Gray GR. Common Skin Conditions During Pregnancy. Am Fam Physician. 2007 Jan 15;75(2):211-218.
2. Farahnik B, Park K, Kroumpouzos G, Murase J. Striae gravidarum: Risk factors, prevention, and management. International Journal of Women’s Dermatology 2017;3(2):77-85.
3. Khanam N, Sharma GK. A critical review on antioxidant and antimicrobial properties of Aloe vera L. International Journal Of Pharmaceutical Sciences And Research. Available from: http://ijpsr.com/bft-article/a-critical-review-on-antioxidant-and-antimicrobial-properties-of-aloe-vera-l/?view=fulltext. Accessed on April 9, 2018.
4. Bhuvana KB, Hema NG, Patil RT. Review of aloe vera. International Journal of Advanced Research 2014;2(3):677-91.
5. Ahmad Z. The uses and properties of almond oil. Complement Ther Clin Pract. 2010 Feb;16(1):10-2.
6. Tandon VR. Vitex negundo: A Chinese Chaste Tree. Natural Product Radiance 2005;4(3):162-5.
7. Devi Priya M, Siril EA. Traditional and Modern Use of Indian Madder (Rubia cordifolia L.): An Overview. Int J Pharm Sci Rev Res. 2014;25(1):154-64.
8. Verma SR, Sultana S, Thiyagarajan OS, et al. Yashad bhasma (Zinc calx) and Tankana (Borax) inhibit Propionibacterium acne and suppresses acne induced inflammation in vitro. Int J Cosmet Sci. 2014 Aug;36(4):361-8.
9. Chandran S, Patgiri B, Galib R, Prasanth D. A Review through Therapeutic Attributes of Yashada bhasma. International Journal of Pharmaceutical & Biological Archives 2016;7(5):6-11.