Caring For Postpartum Skin

by Teresa Fu, M.D.

Everything changes after you have a baby, and your skin is no exception. The skin on your face, stomach, and everywhere in between could show signs that you’re a new mom. Changes in hormones, blood flow, and skin glands, lack of sleep, metabolism, and immune system all affect your skin’s health and appearance. New moms may also experience dry, saggy, itchy, and/or oily skin, redness, puffiness, stretch marks, and postpartum hives.

It can take a while for your skin to rebound after pregnancy, and we’re not just talking about your stretched-out belly. Dark patches across your forehead, nose, and cheeks? It’s called melasma and it’s really common. Pregnancy acne? That can happen too. Fortunately, blemishes and other skin changes that arise during your pregnancy will mostly resolve during the postpartum period but some of the changes may persist after birth.

As a result of these changes, the products and skincare routines that worked before your pregnancy might not work as well now. Luckily, in addition to a healthy lifestyle, including a healthy diet, exercise, and plenty of water and sleep, there are many ways to combat these challenges.

What Causes Postpartum Skin Changes?

Your body’s largest organ, your skin, went through a big transformation during pregnancy—stretching and morphing to accommodate your newborn. Is it any wonder that your skin is acting up? Pregnancy-related skin changes arise for a number of reasons, including hormonal swings, vascular change, glandular changes, structural changes in your skin, and pre-existing skin conditions that worsen (or sometimes improve) during pregnancy.

Postpartum skin changes are mostly the continuation of pregnancy-related issues, but occasionally certain conditions like acne only crop up after giving birth. Give it time. It may take a while for the effects of pregnancy to wear off and your skin to return to normal.

Don’t worry too much about your skin’s texture or appearance after childbirth. Your body has been put through the mill, and the fact that you’re not sleeping very much doesn’t help matters. In many cases, your skin issues will resolve with the passage of time and some TLC! Below are some common issues and how you might address them at home.

Postpartum Acne

Acne is annoying but very common. During pregnancy, your sebaceous glands kick into overdrive. These glands produce the oily wax, called sebum, that keeps your skin moist. Excess sebum can clog pores, leading to acne breakouts.

• If you’re still experiencing this postpartum, here’s what you can do:

• Wash your face twice daily. Use a mild cleanser and warm water.

• Resist the urge to pick or squeeze. That could cause scarring.

• Consult your doctor. Ask about which topical treatments to try.

Postpartum Dry Skin

Hormonal changes in pregnancy can leave your body parched, especially your face. To treat dry, flaky skin that persists after you’ve delivered, maintain a moisturizing routine:

• Gently cleanse. In other words, no harsh soaps. Wash with a non-soap cleanser once a day and plain water the rest of the time.

• Moisturize right after showering and before bed.

• Avoid long, hot soaks or showers. You don’t want to strip your skin of its natural oils. Instead, take a 10- to 15-minute shower or bath (perhaps with added bath oil) in warm water.

• Hydrate from within. Drinking plenty of fluids and including healthy, omega-3 fatty acids in your diet can help to keep your skin supple.

• Use a humidifier (to add moisture to your environment). If you use one, make sure you’re cleaning it regularly.

• Protect your skin from the sun. Apply a 30-or-greater SPF broad-spectrum sunscreen each day.

Remember that there can be other reasons your skin is dry. For example, about 5 to 10 percent of women in the U.S. develop inflammation of the thyroid gland after pregnancy (a condition called postpartum thyroiditis). In postpartum thyroiditis, your thyroid hormone levels will spike, causing anxiety, insomnia, fast heart rate, fatigue, weight loss or irritability. In a matter of months, thyroid levels then plummet, and new symptoms surface, such as weight gain, constipation, depression, and dry skin. It often resolves in 12 to 18 months, but as many as 20 percent of women may continue to have low thyroid levels. Your doctor can order a blood test to check thyroid function.

Postpartum Oily Skin

You can thank increased hormones during pregnancy for stimulating oil-producing glands, giving that pregnancy glow. However, if you are still feeling extra oily postpartum, gentle cleansing ought to be part of your daily routine. Other steps you can take for oily skin include:

• Choosing products that are not oil-based.

• Clean your makeup brushes. They can harbor bacteria that can worsen your breakout.

• Consult a dermatologist. If the problem persists, ask about possible treatments.

Postpartum Loose Skin

If your skin’s not snapping back after giving birth, don’t sweat it. It just endured a nine-month stretch to accommodate a growing baby.

For the time being, focus on healing your body with a healthy diet, hydration, physical activity and shut-eye. Give it at least six months before you pursue more aggressive measures.

Ultimately, if diet and exercise aren’t fixing the sagging skin, some women may explore getting a tummy tuck, or an “abdominoplasty.” However, if you plan to have more children or lose more weight, you may want to wait on surgical reconstruction. As always, consult a doctor to see if this is a good option for you.

Postpartum Hives

If you develop a rash of small, red and itchy bumps across your abdomen, it’s a good bet it’s PUPPP (pruritic urticarial papules and plaques of pregnancy), also known as PEP (polymorphic eruption of pregnancy). It is the most common pregnancy-related skin condition.

PUPPP often develops late in pregnancy, during the third trimester, or early in the postpartum period. It’s much more common in women having their first child or multiples. The theory is that abdominal skin-stretching damages the underlying connective tissue. That, in turn, sets off an inflammatory reaction, itchy rash erupts across your stomach. It can also spread to your thighs, buttocks, and arms. Your doctor may suggest taking antihistamines or applying a topical steroid to calm your urge to scratch.

Melasma

Also known as the “mask of pregnancy,” melasma leaves darker-hued splotches across a woman’s face. A rise in hormone levels plus exposure to the sun’s UVA and UVB rays cause hyperpigmentation. It’s more common in women of color. Fortunately, these patches of discoloration usually fade over time, although sun exposure can make it worse. As a preventive measure, wear broad-spectrum sunscreen of at least an SPF 30, and stay out of the sun when rays are strongest, between 10 a.m. and 4 p.m. If the dark spots persist, a dermatologist may prescribe topical creams or ointments that may lighten or even out skin tone.

Linea Nigra

Latin for “black line,” the linea nigra is literally a darkening of the vertical band of fibrous connective tissue that runs from your navel to your pubic region. Again, this type of pigmentation is due to hormonal changes. The tell-tale line usually fades within months.

Stretch Marks

Moms-to-be know all about the red, brown, or purple lines that streak their bellies during pregnancy. Thighs, hips, and breasts can get stretch marks too. They are thought to be the result of both hormonal and physical changes (due to stretching and pulling of the skin). Unfortunately, no products have been shown to be effective at eliminating stretch marks. However, stretch marks will often fade, becoming more flesh-toned and less noticeable over time.

What Skin Care Products Should You Avoid If Breastfeeding?

Many medications are safe to use while nursing, and that includes most topical products. In fact, the American Academy of Pediatrics (AAP) cites only “rare circumstances in which breastfeeding should be discontinued” when a mother is taking medication for a condition.

Topical tretinoin, a retinoid treatment for acne, hasn’t been studied in moms who nurse, although little of it is thought to reach breast milk. Likewise for other many other acne treatments, such as benzoyl peroxide or salicylic acid. Just be sure the treatment dries on your skin before baby’s skin comes into contact with it.

There’s little research on the use of topical corticosteroids by breastfeeding moms. Still, you would likely have to use a strong medication over a large area of your body for it to make its way into your breast milk. If you apply a steroid cream on your breasts, make sure to cleanse the area before baby’s mouth and skin come into contact with it.

The American College of Obstetricians and Gynecologists (ACOG) has more information on over-the-counter ingredients that can be used during pregnancy and beyond. However, it’s always best to check with your doctor before using any medication or new product while breastfeeding.