Itchy skin

One of many common side effects of pregnancy is itchy skin. And unless you've experienced this first hand you may wonder why it's even worth mentioning what's a little itchiness you may ask yourself? 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 itch 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.
The skin on the breasts and abdomen stretching and tightening.
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.
Cholestasis of Pregnancy.

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

Depending on the cause of the itch, treatment options vary. But it can help to take a simple approach to begin with and then, if there is no improvement, change what you are doing.

• Avoid using harsh soaps and body washes. Look for hypoallergenic, non perfumed options.
• Try not to have long, hot showers or soaking baths (see next point). 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 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 driving you mad. Check here for more information.
• Wear natural fibres next to your skin. Nylon and artificial blends can aggravate skin itching.
• You may find wool is particularly irritating in contact with your skin, so wear a cotton layer between wool fibres and your skin. Check here for more information.
• If you are itching at night, it may help to double rinse your sheets and bed linen. This will help to remove all residue of detergent from the fibres. And check that your sheets are 100% cotton rather than a polyester/cotton blend. Artificial fibres can be intensely irritating.
• Moisturise your skin at least twice a day and 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 you workstation to act as reminders.
• Calamine lotion can be very soothing. Although it's an oldie it's still a goodie ; it's cheap, readily available, has a long expiry period and doesn t smell too bad either.
• Cool, wet washers placed on itchy skin can help. Keep a few washers 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. So err on the side of keeping your cool.
• Wear loose fitting clothing which allows air to circulate around you. Rubbing and brushing of fibres against the skin can be intensely irritating so go for the Boho look and channel your inner Earth Goddess with lots of flowing, loose, easy fabrics.
• Shower as frequently as you need to, to help 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/pool chemicals aggravate your skin itch. So shower off immediately when you get out of the pool.
• Speak with your doctor or a pharmacist to see if it's safe for you to use steroid cream or anti-histamine 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 localised 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 when skin is aggravated and itchy.
• Avoid overheating in bed. Consider using a couple of lighter weight, cotton cellular blankets for warmth rather than a heavy doona. Check here for more information.
• If your partner generates a lot of heat when they sleep, you may need to consider sleeping separately. At least for a little while!
• If you use an electric blanket, a warm rather than hot setting may help you not itch as much.
• If you have pets in the household, make sure they are fleaed and wormed regularly. Brush them 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 brand and type of deodorant you are using. Some women develop extra sensitive skin during their pregnancy and find they cannot use their regular brands of toiletries.
• Reconsider your laundry detergent. Buying one for sensitive skin, with low or no perfumes can be helpful. 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 of pregnancy

An extreme form of itchy skin during pregnancy is caused by a condition known as Cholestasis. This occurs when the bile salts which are formed in the liver and stored in the gall bladder do not drain away as they normally do. The bile salts then spill over into the bloodstream and are responsible for causing the intense itching. Pregnancy hormones are responsible for changing this process.

Some women describe the sensation of itching as ants crawling all over me , or spiders under my skin . However, other than the itching, there may be no other 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

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

For women who are really suffering and becoming sleep deprived because of the itch, treatment options are available. Creams, oral medications and medicated washes with specific medication all help to reduce the concentration of bile salts.

For more information about Cholestasis in pregnancy check: www.huggies.com.au/pregnancy/complications/cholestasis

It is important that your baby is monitored carefully if you have been diagnosed with Cholestasis. If it becomes severe there is a risk to the baby of 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 (let's just call it PUPP for everyone's sake), is another one of those 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 and it would be worthwhile for you to see your doctor to be correctly diagnosed. This condition tends to appear first on the tummy in or around the stretch marks. From there it can spread reasonably quickly to the legs, bottom, back and sometimes the arms and legs.

Just because it sounds pretty impressive, 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 a doctor.

This condition, whilst 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 whilst 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 . But it is important to have a health professional monitoring the itch and accompanying rash (if present).

• 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, have no appetite and feel exhausted, these symptoms are concerning and you need to see a doctor.