Pregnancy Skin Changes: What to Expect and What's Normal

Pregnancy changes your body in ways you expect — the bump, the weight gain, the fatigue. It also changes your skin in ways that most people don't see coming. The dark line running down your abdomen. The patches of pigmentation across your cheeks. The acne that arrived in your thirties with no prior warning. The itching that seems to have no visible cause.

Most pregnancy skin changes are completely normal, temporary, and driven by the same hormonal and physiological shifts that are responsible for everything else that happens during pregnancy. A small number are worth knowing about because they have specific management strategies that help, and one warrants medical attention. This guide covers all of them.

Linea nigra

The linea nigra is a dark vertical line that runs from the navel downward toward the pubic area, and sometimes upward toward the ribcage. It is one of the most common pregnancy skin changes and appears in the majority of pregnant women, typically from the second trimester onwards.

It is caused by increased melanin production driven by rising levels of oestrogen and the melanocyte-stimulating hormone during pregnancy. The line was always there — it is called the linea alba, meaning white line, before pregnancy darkens it. The darkening is simply the pregnancy-related increase in pigmentation making a pre-existing structure visible.

The linea nigra fades after birth, typically within a few months. It does not require treatment and there is nothing you need to do about it. Sun protection over the abdomen during pregnancy may reduce how dark it becomes, since UV exposure intensifies melanin production, but this is a minor consideration rather than a management strategy.

Melasma

Melasma — also called chloasma or the mask of pregnancy — is a pattern of darker pigmentation that appears on the face, most commonly across the cheeks, forehead, upper lip, and nose. It appears in a significant proportion of pregnant women and is more common in women with darker skin tones and in those who spend more time in the sun.

Like the linea nigra, melasma is caused by increased melanin production during pregnancy. Sun exposure significantly worsens it — UV light triggers additional melanin production in already-sensitised skin, making existing patches darker and potentially producing new ones.

The most effective management strategy for melasma during pregnancy is consistent broad-spectrum sunscreen, SPF 50 or higher, applied daily to the face regardless of cloud cover or season. A wide-brimmed hat when outdoors adds additional protection. Many topical treatments used for melasma outside of pregnancy including retinoids and hydroquinone are not safe during pregnancy — confirm the safety of any skincare product with your GP or pharmacist before using it.

Melasma typically improves significantly after birth as hormone levels normalise. For some women it fades completely. For others, particularly those with ongoing sun exposure, some residual pigmentation may persist. Dermatological treatment after birth is an option if fading is incomplete.

Stretch marks

Stretch marks are perhaps the most widely known pregnancy skin change and the one surrounded by the most product marketing. They appear as pink, red, or purple lines on the skin, most commonly on the abdomen, breasts, thighs, and hips, and fade over time to silvery-white marks.

They develop when the skin stretches rapidly — faster than collagen production can keep pace with — causing the dermis to tear microscopically. Genetics play the largest role in whether you develop stretch marks and how extensive they are. If your mother developed significant stretch marks during pregnancy, you are more likely to as well. Skin tone, body composition, and the rate of weight gain also contribute.

The honest truth about stretch mark creams, oils, and serums is that there is no product with strong evidence for preventing stretch marks. Keeping skin well moisturised helps with the itching that accompanies skin stretching and may support skin elasticity to a minor degree, but no topical product prevents the dermal tearing that causes stretch marks in women who are genetically predisposed to them.

What does help is managing the rate of weight gain within the guidelines appropriate for your pre-pregnancy weight — not to avoid stretch marks specifically, but because excessive rapid weight gain increases skin stretching beyond what is necessary. Staying well hydrated supports skin health generally.

Stretch marks fade significantly after birth, though they do not disappear entirely. They are a normal and extremely common consequence of pregnancy, not a sign of inadequate self-care.

Pregnancy acne

Acne during pregnancy is common and can appear in women who have never had significant acne before, or worsen in women who have managed it successfully for years. It most commonly appears in the first trimester when hormonal fluctuations are most pronounced, but can persist or develop at any stage.

The mechanism is the same as adolescent acne — increased androgen activity drives increased sebum production, which combined with the skin cell turnover changes of pregnancy creates the conditions for blocked pores and breakouts.

Safe management of pregnancy acne is limited compared to standard acne treatment because many effective topical and oral treatments are not safe during pregnancy. Topical treatments generally considered safe during pregnancy in Australia include azelaic acid, benzoyl peroxide at low concentrations, and topical erythromycin. Topical retinoids including tretinoin are not safe during pregnancy. Oral isotretinoin is absolutely contraindicated during pregnancy and requires effective contraception when used outside of pregnancy.

Before using any product for acne management during pregnancy, confirm its safety with your GP or pharmacist. A dermatologist referral is appropriate if acne is severe or significantly affecting your skin health and wellbeing.

For most women, pregnancy acne improves significantly after the first trimester and resolves or reduces after birth as hormone levels normalise.

Skin sensitivity and changes in existing conditions

Pregnancy alters the immune system in ways that affect inflammatory skin conditions. Eczema, psoriasis, and rosacea may improve during pregnancy for some women and worsen for others — individual responses vary considerably and are not fully predictable.

Skin sensitivity generally increases during pregnancy. Products and fabrics that were previously tolerable may cause irritation. Switching to fragrance-free skincare, gentle cleansers, and natural fibre clothing reduces irritation for many women. If you have a diagnosed skin condition, discuss management during pregnancy with your GP or dermatologist early rather than managing independently, as some standard treatments require substitution.

Varicose veins and spider veins

Increased blood volume and progesterone-related relaxation of vein walls combine to produce varicose veins and spider veins during pregnancy, most commonly in the legs, vulva, and lower abdomen. Varicose veins are enlarged, bulging veins visible beneath the skin. Spider veins are smaller, more superficial networks of dilated capillaries.

Both are common during pregnancy and improve after birth in the majority of women as blood volume reduces and vein wall tone returns. Wearing compression stockings during the day reduces discomfort and swelling from varicose veins. Elevating your legs when resting and avoiding prolonged standing in one position help manage symptoms.

If varicose veins are painful, cause significant swelling, or are accompanied by redness, warmth, or hardness along the affected vein, contact your GP promptly as these can occasionally indicate a superficial thrombophlebitis that warrants assessment.

Skin tags

Small, soft skin growths called skin tags commonly develop during pregnancy, particularly in areas of friction including the neck, underarms, and beneath the breasts. They are entirely benign and caused by the increased growth factors and hormone levels of pregnancy.

They do not require treatment during pregnancy. Many reduce or disappear after birth. Those that persist can be removed by a GP or dermatologist postpartum if they are a concern.

Changes to moles and existing pigmented lesions

The increased melanin production of pregnancy can cause existing moles and pigmented lesions to darken or appear to change. This can be alarming but is usually a normal consequence of the same hormonal changes that produce the linea nigra and melasma.

However, any mole or pigmented lesion that changes significantly during pregnancy — growing rapidly, developing irregular borders, changing colour unevenly, or beginning to bleed — should be assessed by a GP or dermatologist promptly rather than attributed to normal pregnancy pigmentation changes. Melanoma can occur during pregnancy and prompt assessment of concerning skin changes is always appropriate.

If you had moles or pigmented lesions checked before pregnancy, have any new or changed lesions assessed during pregnancy. Skin cancer screening is safe and appropriate during pregnancy.

The one skin change worth contacting your midwife about

Intrahepatic cholestasis of pregnancy, sometimes called ICP or obstetric cholestasis, is a liver condition specific to pregnancy that causes intense, generalised itching — typically on the palms of the hands and soles of the feet but sometimes across the whole body — without a visible rash.

It is distinct from the general skin itching that occurs as the skin stretches to accommodate a growing bump, which is common and benign. The itching of ICP is typically more intense, often worse at night, and not relieved by moisturising or antihistamines.

ICP is associated with an increased risk of preterm birth and, in severe cases, adverse fetal outcomes, which is why it requires prompt medical assessment rather than home management. It is treated with medication that reduces bile acid levels and, depending on severity and gestation, may prompt earlier planned birth.

If you experience intense itching, particularly on your palms and soles, contact your midwife or GP rather than assuming it is a normal skin change. A blood test measuring bile acid levels confirms or rules out ICP.