Eczema, also known as atopic dermatitis, is a common inflammatory skin condition characterized by dry, itchy, and inflamed patches. Pregnancy introduces profound physiological changes, including significant hormonal shifts and immune system adjustments, which frequently affect skin health. Many individuals notice alterations in their skin during gestation, ranging from the development of the “pregnancy glow” to the onset or worsening of existing dermatological issues. This article examines how pregnancy influences the body and how these internal shifts relate to the activity of eczema.
How Pregnancy Alters Skin Health
Gestation requires a temporary alteration of the maternal immune system to ensure the fetus is not rejected. The body shifts its immune response away from T helper type 1 (Th1) dominance, which handles cell-mediated immunity, toward a T helper type 2 (Th2) dominance. This Th2-skewed environment, associated with antibody production and allergic responses, is essential for maintaining the pregnancy.
The consequence of this immune shift is increased susceptibility to Th2-driven conditions, such as asthma, allergies, and eczema. High levels of hormones like estrogen, which increase dramatically during pregnancy, contribute to this immune rebalancing. These hormonal spikes also affect the skin barrier, influencing its hydration and integrity. Changes in skin elasticity and moisture levels can make the skin more sensitive to irritants and more prone to the dryness and cracking typical of eczema.
The Link Between Pregnancy and Eczema Activity
Eczema is the most common inflammatory skin condition observed during pregnancy. The physiological changes can lead to the de novo onset of the condition or the exacerbation of a pre-existing case.
For those without a prior history, eczema can appear for the first time during gestation, categorized as Atopic Eruption of Pregnancy (AEP). This new-onset eczema accounts for an estimated 60% to 80% of all eczema cases diagnosed during pregnancy. Symptoms frequently emerge early, often within the first two trimesters.
The more common scenario for individuals with existing atopic dermatitis is a change in severity. Research suggests that 50% to 60% of pregnant individuals with pre-existing eczema experience a flare-up or worsening of symptoms. This worsening is most frequently reported during the first or second trimester, though flares can occur at any point.
While over half of patients experience worsening, about 25% to 30% of women report an improvement in their eczema symptoms during pregnancy. When eczema flares, it presents as intensely itchy, red, and scaly patches. These frequently appear on the face, neck, upper chest, and flexural surfaces like the elbows and knees. These flares do not typically pose a risk to the developing fetus, but severe, uncontrolled cases should be managed to prevent infection.
Safe Strategies for Managing Eczema During Pregnancy
Management focuses on controlling symptoms while prioritizing the safety of both the mother and the fetus. The first line of defense involves non-pharmacological strategies aimed at maintaining skin barrier function and avoiding known triggers. This includes frequent and liberal application of thick moisturizers, such as high lipid content ointments or creams, often several times a day.
It is beneficial to take short, tepid baths or showers and avoid harsh, drying soaps that strip the skin of its natural oils. Identifying and reducing exposure to personal triggers, such as certain fabrics, detergents, or excessive heat, minimizes flare-ups. If these measures are insufficient to control itching and inflammation, pharmacological options may be considered under medical supervision.
Topical corticosteroids are generally considered safe for use during pregnancy, particularly low-to-medium potency formulations applied to localized areas. Although very high cumulative doses may be linked to a slightly higher incidence of low birth weight, the amount needed to treat eczema flares is typically below this threshold. Certain oral antihistamines, such as cetirizine or loratadine, are commonly prescribed to manage severe itching and improve sleep quality. Before initiating any treatment, consult with both a dermatologist and an obstetrician. This ensures the treatment plan is appropriate for the stage of pregnancy and helps rule out other serious rashes that may mimic eczema.