Section : Conference Notes

Appendage abnormalities: Acne and Hair Changes

Appendage abnormalities: Acne and Hair Changes (C. Ambros Rodolph).

During Pregnancy some skin conditions are more frequent:

  • Specific Dermatosis: The 2 most frequent are:
  1. atopic eruption of pregnancy( 41%)
  2. polymorphic urticarial papules and plaques of pregnancy  (PURPP)
  • Non specific dermatoses account for 40% of causes:  of these one third of each are inflammatory and infectious in nature
  • changes during pregnancy:
  1. increased eccrine function: miliara for example
  2. decreased aprocrine function: hidradentis suppurativa (acne inversa, Verneuil’s Disease) improves
  3. increased sebaceous function

Acne Vulgaris


  • in general
  1. androgen induced sebum production
  2. altered keratinization
  3. bacterial colonization and inflammation
  • specific to pregnancy:
  1. LH/FSH increase
  2. vascular changes
  3. Immune alterations which activate inflammation through toll like receptors.

existing acne shows improvement in late pregnancy

new onset acne presents in early pregnancy

acne gravidarum

  • Characteristics
  1. seborrhea
  2. comedones as a primary change. papules and pustules also possible.
  3. localisation on lower part of face
  4. affects other areas then the face: back and torso

Safe Treatments during pregnancy :

  • topicals:
  1. antiseptics
  2. benzoyle peroxide (BP)
  3. azelaic acid
  4. erythromycin (combined with BP)
  5. chemical peels with AHA (alpha hydroxy acids)
  • systemic:
  1. erythromycin
  2. CST (corticosteroids)
  3. lasers
  4. IPL (Intense-Pulse Light)
  5. UVB

Rosacea (Rosacea Fulminans)

  • Rosacea Fulminans can occur in Pregnancy:
  1. Affects women aged 15 to 46
  2. Etiology is unknown
  3. Clinically papulopustules are present but tend to spare the perioral area
  4. Therapy should be corticosteroids and systemic isotretinoin, but the latter is not possible in pregancy

Safe treatments during pregnancy

  • topical:
  1. metronidazole
  2. erythromycin
  3. azelaic acid
  4. permethrin
  5. CST
  6. uv protection
  7. mild washing
  8. avoiding triggers (spices…)
  • systemic:
  1. erythromycin
  2. Corticosteroids (CST)
  3. lasers
  4. IPL (Intense-Pulsed Light)
  • Rosacea Fulminans during pregnancy treatment: An example
  1. erythromycin 500 mg bd
  2. prednisone 50mg in diminishing doses over 2 weeks
  3. sunscreen SPF 50
  4. permethrin and zinc cream

If breastfeeding: allow a pause of 4 hours between CST and breatfeeding

A word about CST usage during pregnancy:

  • 1st trimester: use a maximum of 10-15mg a day as there is a risk for cleft palate
  • 2nd and 3rd Trimester: risk of abnormal maturation and growth retardation

Hair changes

  • Hirsutism
  • Telogen Effluvium occurs because of synchronization at delivery of anagen phase. Hair loss can sometimes be frontal and or temporal. Resolution happens within 1-5 months but may take up to 15 months

Note: Minoxidil is contraindicated during pregnancy and lactation

Source of Information: WS02. Physiological Changes In Pregnancy: A Frequent Event. 2011 (10) – 20th Annual Congress of the EADV (European Academy of Dermatology and Venerology) – Lisbon (Lisboa), Portugal