The following is an excerpt from the Glow Journal podcast. To listen to the full interview, subscribe now on iTunes or Spotify
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In this instalment of our Ask An Expert series with our friends at Candela Medical, we’re taking YOUR questions to Dr Alice Rudd. A General and Cosmetic Dermatologist affiliated with The Alfred Hospital and The Skin Health Institute, Dr Rudd completed her Medical Degree at Monash University and completed her postgraduate dermatology studies through the Australasian College of Dermatologists. Having founded Skindepth Dermatology six years ago, Dr Rudd was our first port of call when it came to answering YOUR questions on skincare during and after pregnancy.
Away from our regular brand founder conversations, I am frequently asked so many highly specific questions about the skin. Given that I am an educated consumer and by no means an expert, it would be extremely unethical for me to even attempt to address your skin concerns- which is why I have long insisted on taking those questions to a medical doctor. That’s why I sincerely love producing this Ask An Expert series with Candela. Although the series itself is sponsored, doctors legally and ethically have to remain completely objective in interviews like this. For this reason, this series is the single most authentic way for me to integrate branded content into the podcast because it’s giving you, the listeners, completely unbiased expert answers to your most specific skin questions.
GLOW JOURNAL: Based on the questions that were submitted, I thought we might start broad and then hone in a bit. So, to start, what are some of the most common changes that women can see in their skin during pregnancy?
DR ALICE RUDD: I think the most common changes would be an increase in oil production leading to pimples and acne, particularly in the first and third trimesters. Pigmentation, the mask of pregnancy as they call it, or medically as we call it “melasma,” and that can be on the face, but also anywhere on the body, particularly on the tummy and even on other sites. A lot of women experience excessive hair growth or increased hair growth. And I guess the old favourite- stretch marks, predominantly on the belly, but also in other places. And there seems to be an overabundance of lumps and bumps and skin tags and warts and moles and red dots, little growths.
What about during breastfeeding? Am I right in saying that those changes that we might see during pregnancy don’t just disappear the second you give birth?
Thankfully some do. A lot of the little growths that are spurred on by the hormones of the pregnancy will settle, so I often would recommend to patients perhaps waiting to see if they if they do. But there are plenty that don’t. So for instance, the pigmentation often doesn’t settle. The acne can settle, but often doesn’t, but a lot of the growth type things will settle once the hormones have reduced down a little bit.
One listener has asked “Do your skin needs change with each trimester?”
Definitely. As I said, the hormones are most abundant or in high levels in the first trimester and in the final trimester. So that second trimester, we start to feel good. The skin also starts to feel better, but then it all deteriorates again. So certainly the first and third, and that was my experience. The second trimester I was pretty good, but at the start and the end seems to be when it’s at its worst.
I’ve received messages from a number of women who aren’t pregnant yet, but are planning. One listener has asked “Is there anything that I can do pre-pregnancy to prepare my skin for any changes?”
I certainly would get any acne or congestion under control because what looks quite innocent on the skin at that stage can erupt when the hormones go nuts. So I would certainly get any congestion and acne under control.
Pigmentation, if you have existing pigmentation prior to pregnancy, it’s a really good idea to get that under control with things that you can use safely when you’re not pregnant. And I would always start with a sunscreen as you’re trying to conceive, because you don’t want to get any pigmentation that’s more difficult to treat in pregnancy.
On pigmentation, that was definitely the skin change that popped up the most when people were submitting questions. Why is it that so many women suffer from melasma when they’re pregnant?
I don’t think we a hundred percent know the answer to that, but the two main factors are probably hormones which we know contribute to pigmentation, much like many women get melasma on the contraceptive pill, same even when they’re not pregnant, and also there’s an increase in blood flow. We understand now that melasma has a vascular component, which is often why we trade it with the use of a vascular laser, for example. And we understand that, in pregnancy, obviously there’s a high blood flow to all areas of the body and that probably also contributes to the melasma.
A listener has written in saying “I know that vitamin C is a great ingredient to fade pigmentation. Can I use vitamin C while I’m pregnant?”
Anyone who knows me would know that I don’t like vitamin C that much, because I don’t think it’s a great ingredient. And the main reason for that is that it is very unstable and most formulations aren’t made that well, therefore don’t actually do what they say they’re going to do in the skin. So in theory, yes, vitamin C is a wonderful ingredient, but I couldn’t always guarantee that every formulation would actually have an effect on the skin. Having said that, it’s extremely safe in pregnancy and I would definitely encourage its use if you found a formulation that would work.
On that note, what ingredients must be avoided during pregnancy?
It’s a contentious issue, and people read different things in different places. The problem with pregnancy is nobody’s done the clinical trial. Nobody has got together a group of pregnant women and said “You all try topical vitamin A and you other 20 women, you don’t try the Vitamin A,” and no one’s going to stick their hand up to do that trial and no drug company or skincare company is going to perform that trial.
So the answer to what’s safe and what’s not safe in pregnancy, people don’t really know. But we go from first principles. We know that vitamin A, retinol, if given orally in pregnancy potentially has what we call teratogenic effects, aka harmful effects on unborn babies. So we extrapolate that information and we say, right, well, we know orally we can’t take it so probably topically you shouldn’t also use it. You would have to use it in gallons and gallons to get it absorbed, but I guess the party line is we try to avoid, definitely, prescription grade retinol in pregnancy and high strengths of salycilic acid, which are also thought to be teratogenic effects on unborn babies. So they are the definite no-nos.
I was going to ask if there are any ingredients that fall into a bit of a grey area, but I guess there’s a lot because…
All of them fall into a grey area!
Another listener has asked “Is chemical sunscreen safe during pregnancy? I’ve heard it might not be.”
That’s also contentious. We know that chemical sunscreens are what we call endocrine disruptors. So I suspect the listener is referring to that, where the overuse of chemical sunscreen that is absorbed into the skin and therefore potentially into the circulation can actually disrupt hormones. And this is actually more of a problem in the preconception phase. So if you’re trying to get pregnant, particularly if you’re doing IVF etcetera, then you should try to avoid chemical sunscreens if you can. But the actual evidence in pregnancy is very slight, if any, and therefore once you are pregnant an endocrine disruptors is probably not going to be that much of an issue and the pigmentation is likely to be and issue. So I would suggest using any sunscreen and there’s no evidence to suggest that chemicals aren’t safe.
Back to pigmentation and melasma, a few listeners have asked about laser treatments. One of them has asked “Is laser the best course of action for my pregnancy mask and, if so, do I need to wait until I finish breastfeeding?”
Big no! Melasma, whether you’re pregnant or you’re not pregnant or you’re breastfeeding, is usually not treated with laser. And the reason for this is that the laser generally heats the skin, excites the melanocites, and increases pigmentation very often. So most dermatologists would agree that laser is not the gold standard for melasma. The best thing you can do for melasma in pregnancy is keep it out of the sun, so using a sunscreen every single day and reapplying, particularly if you’re pregnant over summer. Laser, as I said earlier in the piece, can be used, but in very well controlled melasma that has been controlled usually with a prescription hydroquinone. It’s safe possibly then to do laser. Skincare and chemical peels are all much better options for treating melasma, and I would be comfortable depending on the chemical peel to do that in pregnancy.
To listen to the full interview with Dr Alice Rudd, subscribe to the Glow Journal podcast now on iTunes or Spotify
