Rash during pregnancy – a physiological change or a disease?

A skin rash during pregnancy usually appears in the form of hives, often occurring on the abdomen. These changes are generally caused by hormonal factors and are not dangerous. However, in some cases, hives can be a symptom of an underlying illness. When should a rash during pregnancy be a cause for concern? And how is it treated?

Skin changes are a common complaint among pregnant women. They occur as a natural, physiological response of the body to changes that are partly hormonal and metabolic in nature. The dermatoses that develop have varying causes and courses. In most cases, a skin rash poses no danger to the health of either the child or the mother.

Hives during pregnancy

So-called pregnancy-related hives are among the most common skin changes in expectant mothers. They are caused by immune system disturbances. An allergic reaction to certain foods or hypersensitivity of the skin to sunlight can also trigger dermatoses. The rash appears as characteristic, raised small nodules. In some cases, it may also appear as blisters filled with serous fluid and resemble a nettle sting.

These dermatoses are accompanied by intense itching and burning. The changes typically appear on the abdomen but may also spread to the hands, feet, buttocks, back, and face. Pregnancy-related hives usually occur in the third trimester and often affect women during their first pregnancy. Although these dermatoses do not pose a danger to the child, they can be very distressing for the mother.

Even though the rash usually disappears on its own after childbirth, symptomatic treatment with antihistamines or local corticosteroids is recommended to relieve the unpleasant itching. However, pregnant women should not take any medication on their own – not even over-the-counter ones. A consultation with a doctor is absolutely necessary.

Itchy polymorphic eruption of pregnancy

Itchy polymorphic eruption of pregnancy occurs in the third trimester and usually follows a mild course. The exact cause is unknown. It is presumed that the skin changes are due to skin stretching, which causes mechanical damage to connective tissue.

The rash appears as skin nodules, often located near stretch marks on the abdomen, buttocks, thighs, and hull. Women who are overweight or who had skin allergies (including eczema) before pregnancy are particularly at risk. Polymorphic dermatosis does not require specific treatment. However, if itching is severe, symptomatic therapy with local corticosteroids and antihistamines may be used.

Atopic eruption of pregnancy

Atopic eruption of pregnancy is a mild form of skin condition that appears at the beginning of the third trimester or toward the end of the second trimester. The skin changes present as small nodules on the hull, limbs, arms, neck, and even the face. As with classic eczema, there can be intense local itching, flaking, skin fissures, and redness in response to external stimuli (e.g. cold).

Most women have a genetic predisposition to atopic diseases within the family.

Treatment is symptomatic. Inflammatory processes of the skin can be alleviated with local antihistamines and corticosteroids. Skincare products for atopic skin also provide relief. Regular use of emollients improves skin hydration, prevents water loss and excessive dryness, and helps reduce itching.

Prurigo of pregnancy

So-called prurigo of pregnancy (Besnier’s prurigo) is a condition of unclear origin. Unlike other pregnancy dermatoses, it can occur as early as the first trimester. Women with allergic conditions such as asthma, eczema, or allergic rhinitis are particularly at risk. A family history of atopic diseases is also a risk factor.

Clinically, the disease resembles classic eczema. The skin becomes excessively dry, starts to flake, and shows partially reddened lesions. In severe cases, dryness can lead to skin fissures and erosions. Treatment is symptomatic and primarily involves the use of emollients for atopic skin. For more severe symptoms, anti-inflammatory topical treatments may be required. Antihistamines relieve the persistent itching.