Vestnik dermatologii i venerologiiVestnik dermatologii i venerologii0042-46092313-6294Rossijskoe Obschestvo Dermatovenerologov i Kosmetologov116410.25208/vdv1164-2020-96-4-12-21Review ArticlePhysiological changes of the skin during pregnancyAlbanovaVera I.albanova.v@gmail.comMoscows regional research clinical institute n.a. M.F. Vladimirskiy1711202096412213108202029092020Copyright © 2020, Albanova V.I.2020<p>The appearance of skin changes during pregnancy is inevitable and physiologically determined. This period is characterized by hormonal, immunological and metabolic changes and associated physiological changes in the skin. These include pigmentation (linea nigra, melasma, pseudoacanthosis, growth and appearance of pigmented nevi), changes in connective tissue (striae distensae, skin tags), blood vessels (stellate hemangiomas, erythema of the palms, vasodilatation, edema, cutis marmorata) and skin appendages (increased sebaceous and eccrine glands activity, reduced hair loss and increased hair density, onychodystrophy). It is important to inform women about possible changes, to recognize them in time to reduce the impact of their appearance on the health and course of pregnancy, as well as to avoid unnecessary tests and interventions.</p>pregnancyskinimmunological changeshormonesreceptorsбеременностькожаиммунологические изменениягормонырецепторы[Fernandes LB, Amara WN. Clinical study of skin changes in low and high risk pregnant women. Ann Bras Dermatol. 2015 Nov-Dec;90(6):822–826. doi: 10.1590/abd1806-4841.20153570.][Kannambal K, Tharini GK. A Screening Study on Dermatoses in Pregnancy. J Clin Diagn Res. 2017 May;11(5):WC01–WC05.][Panicker VV, Riyaz N, Balachandran PK. A Clinical Study of Cutaneous Changes in Pregnancy. J Epidemiol Glob Health. 2017 Mar;7(1):63–70. doi: 10.1016/j.jegh.2016.10.002.][Rathore SP, Gupta S, Gupta V. Pattern and prevalence of physiological cutaneous changes in pregnancy: A study of 2000 antenatal women. Indian J Dermatol Venereol Leprol. 2011;77:402.][Tunzi M, Gray GR. Common skin conditions during pregnancy. Am Fam Physician. 2007;75:211–218.][Nussbaum R, Benedetto AV. Cosmetic aspects of pregnancy. Clin Dermatol. 2006 Mar-Apr;24(2):133–141. doi: 10.1016/j.clindermatol.2005.10.007.][Zachary C, Fackler N, Juhasz M, Pham C, Mesinkovska NA. Catamenial dermatoses associated with autoimmune, inflammatory, and systemic diseases: A systematic review. Int J Womens Dermatol. 2019 Oct 25;5(5):361–367. doi: 10.1016/j.ijwd.2019.09.008.][Thornton MJ, Taylor AH, Mulligan K, Al-Azzawi F, Lyon CC, O'Driscoll J, Messenger AG. Oestrogen receptor beta is the predominant oestrogen receptor in human scalp skin. Exp Dermatol 2003;12:181–190.][Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol. 2010 Jun;63(6):425–433.][doi: 10.1111/j.1600-0897.2010.00836.x.][Ghaebi M, Nouri M, Ghasemzadeh A, Farzadi L, Jadidi-Niaragh F, Ahmadi M, Yousefi M. Immune Regulatory Network in Successful Pregnancy and Reproductive Failures. Biomed Pharmacother. 2017 Apr;88:61–73.][doi: 10.1016/j.biopha.2017.01.016.][Kar S, Krishnan A, Shivkumar PV. Pregnancy and Skin. J Obstet Gynaecol India. 2012 Jun;62(3):268–275. doi: 10.1007/s13224-012-0179-z.][Zeng Z, Liu F, Li S. Metabolic Adaptations in Pregnancy: A Review. Ann Nutr Metab. 2017;70(1):59–65. doi: 10.1159/000459633.][Herrera E. Lipid metabolism in pregnancy and its consequences in the fetus and newborn. Endocrine. 2002;19:43–55.][Kumari R, Jaisankar TJ, Thappa DM. A clinical study of skin changes in pregnancy. Indian J Dermatol Venereol Leprol. 2007;73:141.][doi: 10.4103/0378-6323.31910.][Muzaffar F, Hussain I, Haroon TS. Physiologic skin changes during pregnancy: a study of 140 cases. Int J Dermatol. 1998;37:429–431.][Dabette KL, Bijayanti DTh, Hafi BNA, Singh Rl. Skin Changes During Pregnancy: A Study From Northeast India. Indian Dermatol Online J. Nov-Dec 2018;9(6):455–457. doi: 10.4103/idoj.IDOJ_352_17.][Chang ALS., Agredano YZ, Kimball AB. Risk Factors Associated With Striae Gravidarum. J Am Acad Dermatol. 2004 Dec;51(6):881–885.][doi: 10.1016/j.jaad.2004.05.030.][Raj S, Khopkar U, Kapasi A, Wadhwa SL. Skin in pregnancy. Indian J Dermatol Venereol Leprol, 1992;58:84–88.][Cui R, Widlund HR, Feige E, Lin JY, Wilensky DL, Igras VE, D'Orazio J, Fung CY, Schanbacher CF, Granter SR, Fisher DE. Central role of p53 in the suntan response and pathologic hyperpigmentation. Cell. 2007;128:853–864. doi: 10.1016/j.cell.2006.12.045.][Natale CA, Duperret EK, Zhang J, Sadeghi R, Dahal A, O'Brien KT, Cookson R, Winkler JD, Ridky TW. Sex steroids regulate skin pigmentation through nonclassical membrane-bound receptors. Elife. 2016 Apr 26;5:e15104. doi: 10.7554/eLife.15104.][Beisher NA, Wein P. Linea alba pigmentation and umbilical deviation in nulliparous pregnancy: the ligamentum teres sign. Obstet Gynecol, 1996;87:254–256.][Barankin B, Silver SG, Carruthers A. The skin in pregnancy. J Cutan Med Surg. 2002;6:236–240.][Aktürk AS, Bilen N, Bayrämgürler D, Demirsoy EO, Erdogan S, Kiran RJ. Dermoscopy is a suitable method for the observation of the pregnancy-related changes in melanocytic nevi. Eur Acad Dermatol Venereol. 2007 Sep;21(8):1086–1090. doi: 10.1111/j.1468-083.2007.02204.x.][Friedman EB, Scolyer RA, Thompson JF. Management of pigmented skin lesions during pregnancy. Aust J Gen Pract. 2019 Sep;48(9):621–624. doi: 10.31128/AJGP-04-19-48952.][Foucar E, Bentley TJ, Laube DW, Rosai J. A histopathologic evaluation of nevocellular nevi in pregnancy. Arch Dermatol. 1985 Mar;121(3):350–354.][Still R, Brennecke S. Melanoma in pregnancy. Obstet Med. 2017 Sep;10(3):107–112. doi: 10.1177/1753495X17695001.][Bieber AK, Martires KJ, Driscoll MS, Grant-Kels JM, Pomeranz MK, Stein JA. Nevi and pregnancy. J Am Acad Dermatol. 2016;75:661–666.][Farahnik B, Park K, Kroumpouzos G, Murase J. Striae gravidarum: Risk factors, prevention, and management. Int J Womens Dermatol. 2016 Dec 6;3(2):77–85. doi: 10.1016/j.ijwd.2016.11.001.][Thomas RG, Liston WA. Clinical associations of striae gravidarum. J Obstet Gynaecol. 2004;24:270–271.][Vora RV, Gupta R, Mehta MJ, Chaudhari AH, Pilani AP, Patel N. Pregnancy and Skin. J Family Med Prim Care. 2014 Oct-Dec; 3(4):318–324. doi: 10.4103/2249-4863.148099.][Muallem MM, Rubeiz N. Physiological and biological skin changes in pregnancy. G. Clin Dermatol. 2006 Mar-Apr;24(2):80–83.][doi: 10.1016/j.clindermatol.2005.10.002.][Motosko CC, Bieber AK, Pomeranz MK, Stein JA, Martires KJ. Physiologic changes of pregnancy: A review of the literature. Int J Womens Dermatol. 2017 Dec;3(4):219–224. doi: 10.1016/j.ijwd.2017.09.003.][Wong RC, Ellis CN. Physiologic skin changes in pregnancy. J Am Acad Dermatol. 1984;10:929–940.][Martin AG, Leal-Khouri S. Physiologic skin changes associated with pregnancy. Int J Dermatol. 1992;31:375–378.][Lynfield YL. Effect of pregnancy on the human hair cycle. J Invest Dermatol, 1960;35:323–327.][Erpolat S, Eser A, Kaygusuz I, Balci H, Kosus A, Kosus N. Nail alterations during pregnancy: A clinical study. Int J Dermatol. 2016;55:1172–1175.][Higgins HW, Jenkins J, Horn TD, Kroumpouzos G. Pregnancy-associated hyperkeratosis of the nipple: A report of 25 cases. JAMA Dermatol. 2013;149:722–726.][Ghasemi A, Gorouhi F, Rashighi-Firoozabadi M, Jafarian S, Firooz A. Striae gravidarum: Associated factors. J Eur Acad Dermatol Venereol. 2007;21:743–746.]