Today I decided to dig a bit more into the world of eczema for us pregnant folk.
I started by watching a podcast done by Abby Lai (of Prime Physique Nutrition) in which she talked with Dr. Peter Lio (he’s done a few National Eczema Association webinars). Link to Abby’s podcast is here.
The major points were:
- It’s not really understood why but about 1/2 of pregnant women have worsened symptoms and 1/2 have bettered symptoms. Dr. Lio likened it to how some women get nausea during pregnancy.
- You can have a flare in one pregnancy, but not in the next. Also you can have changes in skin between trimesters.
- Dr. Lio mentioned a few itching conditions that can occur during pregnancy such as cholestasis (when liver and gall bladder slow down their bile flow which causes a terrible itch), atopic eruption of pregnancy, PUPPP (or pruritic urticarial papules and plaques of pregnancy which usually occurs during the 3rd trimester).
He and Abby then talked about treatments used during pregnancy including such as:
- how topical steroids are okay but not most potent ones. The goal is to keep body surface area that you apply the topical steroids to relatively low (so not WHOLE body), because topical steroids go in blood if they are used long enough or over large surface areas.
- light/phototherapy
- Benadryl and other anti-histamines
- wet wraps, icing, moisturizers (see my post on products I’ve tried here)
- anti-itch creams in small amounts (such as camphor and menthol)
- natural oils like coconut and sunflower seed oil (if not allergic)
- dilute bleach baths (he also mentioned a recent paper shows it’s anti-inflammatory and anti-itch directly, as well as being antibacterial)
- topical vitamin B 12 (water soluble) – pink magic
The takeaway advice he gave was don’t be afraid to use medicine so long as you have a doctor helping you.
I was having trouble finding full access studies but I did stumble across a PDF from the National Eczema Association about getting pregnancy, skin tips during pregnancy, and after pregnancy advice. It also talked about the likelihood of the baby getting eczema and things to hopefully prevent it. The same PDF also mentioned that avoiding soap can also help decrease the disruption to the skin barrier (which is not something I’ve heard said often; normally it was just to not use antibacterial soap specifically because the bacteria can adapt over time and we’ll be stuck with pathogens that can’t be killed as easily).
In regards to when the mothers are postpartum, such as how there can be challenges with breastfeeding if the mother develops eczema around the area. In that case, the study said low to moderate potency topical steroids can be used so long as they are washed off before the next breastfeeding.
Updated: The National Eczema Association posted a new article May 2018 called Oh baby! Eczema from pregnancy to menopause that goes into more detail about why women may experience more incidences of eczema during pregnancy. It mentions how a researcher at the University of California-San Francisco (Dr. Jenny Murase) found that when a woman is pregnant, her body shifts from Th1-dominant to Th2-dominant immunity in order to protect the fetus (because Th1 attacks foreign material that get into our cells, aka it would attack the fetus since they have half of the father’s cells). Th2-dominant immunity means the mom’s body attacks allergens and whatnot that are flowing around outside her cells, protecting the fetus, but not helping when it comes to eczema. The blog post said that the shift from Th1 to Th2 is driven by the surge of estrogen. Perhaps that is also why women generally have higher rates of eczema than men? Unfortunately I couldn’t find the study that the NEA article cited so I can’t follow up with more, though I did find an abstract from Dr. Murase et al, that mentioned how psoriasis tends to improve during pregnancy correlating with those higher estrogen levels… so maybe one of the immunity-linked causes of eczema and psoriasis are opposite in origin?
My personal experience with being pregnant while having eczema has been that I have to be more mindful about how I treat my eczema relative to general lifestyle changes too. For example, no longer can I go and drink tons of kombucha (due to varying alcohol content and the light risk of bacteria), enjoy whatever random herbs I feel will help me heal, go jump into a hot yoga class unprepared (because getting dizzy affects another being besides myself), eat whatever fish I want whenever (I am a tuna fan and enjoy sushi when not pregnant), run and jump into a hot springs all willy nilly, etc. I have to be more mindful about sharing my body and not just jumping into whatever new protocol or thing I want to try out to help my skin. I can’t decide to just go on a particularly aggressive dietary change that involves caloric restrictions or drastic nutritional adjustments.
That being said, being pregnant has also had a lot of changes that might be helping my skin. In my first trimester I was very sugar and meat adverse, so I ended up eating a lot more veggies. When I wrote this piece in my third trimester I tended to crave veggies as a way to keep my guts feeling good, and to keep indigestion at bay. I also ate smaller meals more frequently, and didn’t really accidentally binge eat big meals mindlessly, which was great because it meant that my body wasn’t overtaxed in digestion (which meant more time to heal the skin!). Pregnancy had me feeling a bit more tired (and much like with a flare, also avoiding high intensity activities), so I tended to stick to lower impact, longer duration activities like going for walks for miles or remembering to get in 100 modified push-ups a day.
Anyway, I’ll stop there and leave you with a current photo of me when I wrote this post. I was about 31 weeks pregnant now and you can see my arms and hands in particular were especially topically-challenged.
REFERENCES
Crane, Margaret W. Oh, baby! Eczema from pregnancy to menopause. National Eczema Association, https://nationaleczema.org/oh-baby-eczema/. Accessed 30 Apr 2018.
Lawton, Sandra. “Pregnancy and eczema”. Exchange, https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=20&ved=0ahUKEwj3hO2D-9jaAhWmc98KHRNhAusQFgjGATAT&url=http%3A%2F%2Fwww.eczema.org%2Fdocuments%2F711&usg=AOvVaw2fS6lrX7fvyosOV1imHE4p. Accessed 30 Apr 2018.
Murase JE, Chan KK, Garite TJ, Cooper DM, Weinstein GD. Hormonal effect on psoriasis in pregnancy and post partum. Arch Dermatol. 2015 May;141(5):601-606.
Silverberg JI, Hanifin JM. Adult eczema prevalence and associations with asthma and other health demographic factors: a US population-based study. J Allergy Clin Immunol. 2013 Nov;132(5):1132-1138.
sporadic itch 