Pruritic urticarial papules and plaques of pre...

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An interesting blog post by Dr. Linda Burke-Galloway discussing skin changes during pregnancy.

She discusses stretch marks (striae gravidarum), pregnancy related itching (pruritus gravidarum), skin lesions called spider angiomatas, red palms (palma erythema), rash that is associated with pregnancy, called PUPPPs (Pruritic Urticarial Papules and Plaques of Pregnancy), and the most serious skin disorder in pregnancy called Pemphigoid Gestationis which is a rare, autoimmune disease.

According to Dr. Linda Burke-Galloway, skin rashes during pregnancy should not be ignored or self-treated. At least three skin disorders that are associated with pregnancy can have an adverse effect on the fetus.


In a cesarean birth (C-section), the baby is delivered through an incision in the mother’s abdomen and uterus (womb). C-Section births exceed 30% in USA, Brazil, Italy, Mexico, Turkey, Korea, Portugal, Australia, Thailand, and other countries. China is the only country where C-section births exceed 40%. The number of cesarean sections in the U.S. has risen nearly 46% since 1996.

Every C-Section is a major abdominal surgery that leaves a scar. The size of your C-section scar will depend on several factors: the size and position of the baby, whether the C-section was planned or not, etc. Generally, the C-section scar is around 4-6 inches (10-15 cm) long and 1/8 inch (0.3 cm) wide.

Usually the “bikini cut” incision is used but sometimes the “classical” incision will be made vertically from just below the belly button (naval) to just above the pubic bone. To close the wound, some surgeons prefer to use staples whereas others still use suture; there is little statistical evidence to show that one way or another will increase or decrease the size or the appearance of the scar.

Treatment. Initially, the C-section scar will be red, raised and could itch. After the wound is closed you should start using a silicone based product like Strataderm to make the scar softer, flatter and smoother and to relieve itching. The majority of women will develop “mature” C-section scars by the sixth month after delivery. If you have darker skin and/or are prone to keloids you should consult a physician before the C-Section.

The incidence of new scarring per year in the developed world is estimated to be at least 100 million; a large percentage will be affected by abnormal scarring, which can be categorized mainly as hypertrophic scars and keloids. There is also good evidence to suggest that atrophic scars and striae distensae (or stretch marks) are categories of abnormal scarring.

Abnormal Scar Types

Hypertrophic Scars

Hypertrophic Scars are typically raised, red or pink and sometimes itchy but do not exceed the margins of the original wound. Hypertrophic scars usually subside with time. Histologically, hypertrophic scars have flatter type III collagen bundles, with fibers arranged in a wavy pattern, but predominately oriented parallel to the epithelial surface.

Collagen synthesis is 6 times as great as in normal unscarred skin and the ratio of type I to type II collagen is also higher. Hypertrophic scars also have nodular structures of alpha-smooth muscle actin, which expresses myofibroblasts, small vessels and fine collagen fibers.


Keloids on the other hand range in consistency from soft and doughy to hard and rubbery. They do not infiltrate into the surrounding normal tissue and continue to evolve over time with no regress phase. Histologically, collagen bundles are not present but instead the collagen type I and type III fibers lie in a haphazardly connected loose sheet randomly orientated to the epithelial surface. In addition, the collagen synthesis is approximately 20 times greater as that in normal unscarred skin and the ratio of type I to type II collagen is also higher. Keloids  also have an overproduction of the growth factors TGF-B and PDGF produced by fibroblast proteins.

In comparison to the above two abnormal histological feature, normal skin contains collagen bundles running parallel to the epithelial surface.

In 2002, an International Advisory Panel on Scar Management published Clinical Recommendations on Scar Management, based on a qualitative overview of 300 published references and expert consensus on best practices. Silicone was recommended as first line therapy for prevention of scarring and first line treatment for the initial management of scarring, in addition to the recommended management modality with adjunct therapies for secondary management.


1. Wolfram D et al. Dermatol Surg 2009; 35:171–181

2. Babu M et al. Mol Cell Biol 1989; 9:1642–1650

3. Niessen FB et al. Plast Reconst Surg 1999; 104:1435–1458

4. Haisa M et al. Invest Dermatol 1994; 103:560–563

5. Luo S et al. Plast Reconstr Sugr 2001; 107:87–96

Even though Jessica Alba apparently loves (her) stretch marks not every woman agrees with her. OK, we have to admit we don’t know a single woman who would agree with Jessica’s statement:

“Even though some might consider them a flaw, I’ve learned to love my stretch marks. Pregnancy was the most incredible experience I’ve ever had. So I’ll take the stretch marks.”

Stretch marks (or striae) are a form of scars caused by the pulling and stretching forces in the underlying layers of the skin (dermis). Most women (up to 90%) will develop stretch marks during pregnancy .

Various treatments are available for the purpose of improving the appearance of existing scars or stretch marks, including laser treatments, dermabrasion, prescription retinoids and silicone gels like Strataderm.

There are claims that cocoa butter is effective against stretch marks, however no research studies have shown its ability to either prevent stretch marks, or to reduce their appearance once a stretch mark has already formed. On the contrary –  the studies have clearly shown that the application of cocoa butter does not reduce the likelihood of developing stretch marks

The same applies for products like Bio-Oil® – the UK Advertising Standards Authority has gone as far as to prohibit claims that it helps scars or stretch marks because such claims could not be supported by clinical evidence.