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Itchy Skin During Pregnancy

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One of the many common side effects of pregnancy is itchy skin. And unless you've experienced this firsthand, you may wonder why it's even worth mentioning. What's a little itchiness? But itchy skin during pregnancy has the potential to create a lot of distress because it can be so unrelenting.

What causes itchy skin during pregnancy?

There is no one cause for pregnancy skin itchiness and generally there is a range of reasons why it happens. Some of the more common causes are:

Pregnancy hormones and their effect on skin.
Dry skin which is not as hydrated and nourished as it could otherwise be.
Eczema. Some women experience an increase or a decrease in their eczema symptoms during pregnancy.

What can I do to help stop my skin itching during pregnancy?

Depending on the cause of the itch, treatment options vary. It can help to take a simple approach to begin with. You can always change your approach if it’s not working. A few tips include:

Avoid using harsh soaps and body washes. Look for hypoallergenic and non-perfumed options.
Try not to have long, hot showers or soaking baths. Water and heat dry out skin, so aim for a comfortably warm water temperature.
You may find that an oatmeal bath is very soothing. Speak with a pharmacist about products with colloidal oatmeal. These are very finely ground oats which are dispersed into the bathwater.
When rinsing shampoo out of your hair, try to avoid the water flowing down the rest of your body. Direct the shower spray so that the water is directed into the drain rather than over you.
Avoid sitting directly in front of radiator or fan heaters.
You may need to consider going braless for a couple of hours each day if the straps are causing itchy skin.
Wear natural fibers next to your skin. Nylon and artificial blends can aggravate skin itching.
If you are itching at night, it may help to double rinse your sheets and bed linens. This will help to remove all residue of detergent from the fibers. Check that your sheets are 100% cotton rather than a polyester and cotton blend. Artificial fibers can be intensely irritating.
Moisturize your skin at least twice a day or as often as possible. The best time to do this is when your skin is still warm and slightly damp after showering. Keep lotions in the bathroom, next to your bed, and at your workstation to act as reminders.
Calamine lotion can be very soothing. It might seem like an old-fashioned product but it works for a reason. Plus, it's cheap, readily available, has a long expiry period, and doesn’t smell bad.
Placing a cool, wet washcloth on your itchy skin can help. Keep a few washcloths in the fridge so you can rotate them as needed.
If the weather is hot, use fans and air-conditioning to reduce the ambient temperature. Pregnancy itching is worse when aggravated by sweating.
Wear loose-fitting clothing which will allow air to circulate around you. When fibers brush or rub against the skin it can be irritating.
Shower as frequently as you need to if it helps you cool off. During summer, let the water evaporate from your skin rather than towel drying.
You may find that if you go swimming the chlorine, salt, and pool chemicals aggravate your skin itch. Shower off immediately when you get out of the pool.
Speak with your provider or a pharmacist to see if it's safe for you to use steroid cream or antihistamine medications.
Consider if yoga, meditation and or relaxation classes would help. If you are feeling anxious and apprehensive about the itching, then guided relaxation may help.

What else can I do to reduce my skin itching?

Keep your fingernails cut short and avoid sharp edges. File your nails so they are smooth. This will help to reduce localized skin trauma if you do need to scratch.
If you are scratching your skin when you are asleep, put socks on your hands to reduce skin breakage from scratching.
If you really have to scratch, try rubbing your skin or stroking it instead.
Change your bed linen frequently. Cool, fresh sheets are very soothing.
Avoid overheating in bed. Consider using a couple of lightweight cotton cellular blankets for warmth rather than a heavy comforter.
If your partner generates a lot of heat when they sleep, you may need to consider sleeping separately for a while.
If you use an electric blanket, use a warm not hot setting.
If you have pets in the household, make sure they are treated for fleas and worms regularly. Brush them out every couple of days and dispose of their hair carefully. Animal dander is made up of skin cells which can add to human skin irritation.
Think about the brands you are using. Some women develop extra sensitive skin during their pregnancy and find they cannot use their regular brands of toiletries, such a deodorant and lotion.
Reconsider your laundry detergent—you might need one for sensitive skin. It may also help to make it your standard practice to double rinse all clothing which you are going to wear directly against your skin.

Cholestasis during pregnancy

An extreme form of itchy skin during pregnancy is caused by a condition known as cholestasis. This occurs when bile salts—which are formed in the liver and stored in the gallbladder—do not drain away as they normally do. The bile salts then spill over into the bloodstream and are responsible for the intense itching. Pregnancy hormones are to blame. Some women describe the sensation of itching as ants crawling all over them, or spiders under their skin. However, other than the itching, there may be no visible symptoms except for some red lines where scratching has occurred. Cholestasis is more common in the third trimester when pregnancy hormone concentration is at its highest. Women from Swedish and Chilean ethnic groups are more at risk of developing cholestasis.

Symptoms of cholestasis in pregnancy

Generalized widespread itching or itching on the soles of the feet and palms of the hands.
Dark-colored urine and light-colored bowel motions.
Tiredness, exhaustion, and fatigue.
Loss of appetite and disinterest in food.
Nausea.
Feeling low in mood or depressed.
Insomnia due to itching.
Yellowing of the skin, known as jaundice.

For women who are really suffering and are sleep deprived because of the itch, treatment options are available. Creams, oral medications, and medicated washes all help to reduce the concentration of bile salts. It is important that your baby is monitored carefully if you have been diagnosed with cholestasis. If it becomes severe, there is a risk of the baby being born prematurely or even stillborn.

What is pruritic urticarial papules and plagues (PUPP)?

Not all itching during pregnancy can be attributed to skin stretching and dryness. Pruritic urticarial papules and plagues (PUPP) is another unique to pregnancy conditions. Around 1% of women develop PUPP and it is generally limited to the third trimester. For women carrying a boy, multiples, or those having their first baby, PUPP is more common. If your skin is red and itchy with raised patches and or bumps which look like hives, then you may have PUPP. It would be worthwhile for you to see your provider to be correctly diagnosed. This condition tends to appear first on the abdomen in or around the stretch marks. From there it can spread reasonably quickly to the legs, bottom, back, and sometimes the arms and legs. PUPP is short-lived and will go away after your baby is born. If you cannot bear the itching and it is affecting your quality of life and enjoyment of your pregnancy, there are treatments which can be prescribed by your provider. This condition, while incredibly annoying, does not pose a risk to the mother or her baby. Once the baby is born, the symptoms of PUPP tend to resolve, though may hang around for a few weeks.

Psoriasis during pregnancy

If you normally suffer from psoriasis, you are likely to find a lessening of symptoms while you are pregnant. This is due to pregnancy hormones having a positive effect on the usual processes which influence psoriasis.

When should I worry about my itchy skin during pregnancy?

If you are worried, this is reason enough to speak with your maternity care provider. It's important to see a health professional about any itching you have so a correct diagnosis can be made. Sometimes there is no obvious cause, and the reason is put down simply to pregnancy alone. It is important to have a health professional monitoring of the itch and accompanying rash, if present. Seek help if:

If you are becoming distressed by the itching and it is affecting your quality of life.
If you have a rash which is spreading to other parts of your body, neck stiffness, sensitivity to lights and or an elevated temperature.
If you have a rash which appears infected. Redness, streaking, pain, pus, or oozing fluid from a rash always needs medical assessment.
If your quality of sleep is being affected.
If you are being driven crazy by the itch and unable to focus on anything else.
If you experience severe itching, particularly on your hands and feet, and you are in the later stages of your pregnancy, then medical assessment is important.
If your urine becomes very dark and your bowel motions pale, you feel nauseated and are vomiting, or have no appetite and feel exhausted. These symptoms are concerning, and you need to call your provider right away.

The information of this article has been reviewed by nursing experts of the Association of Women’s Health, Obstetric, & Neonatal Nurses (AWHONN). The content should not substitute medical advice from your personal healthcare provider. Please consult your healthcare provider for recommendations/diagnosis or treatment. For more advice from AWHONN nurses, visit Healthy Mom&Baby at health4mom.org.