CANADIAN
Skin Changes ASSOCIATED WITH PREGNANCY
By Zahra Rehan, MD, M.Sc.
Pregnancy brings many profound changes in a person’s body. These changes go beyond a growing belly; the skin changes can range from radiating skin to striking stretch marks, darkening of the skin, and development of enlarged and leaky veins. It is important for expectant people to understand common skin changes as they navigate pregnancy.
Pregnancy glow
One welcoming skin change during pregnancy is the “pregnancy glow,” a result of increased blood flow and elevated levels of hormones. During pregnancy, a person’s body increases blood volume by up to
50%, which enhances blood flow and circulation, making the skin appear brighter and flushed. The influx of hormones stimulates the glands to produce more oil, giving the face a shiny, or dewy appearance.
Adversely, excess oil production can lead to acne breakouts. For individuals who already struggle with acne, pregnancy can worsen this condition. The common prescription treatments, such as isotretinoin and tretinoin, cause birth defects and should never be used in pregnancy. In pregnancy, most over-the-counter acne cleansers and treatments are safe to use but it is best to check with a healthcare provider before starting any new products.
Hyperpigmentation and melasma
Another common skin change during pregnancy is hyperpigmentation, which refers to darkening of the skin. The darkening skin is usually noticeable on the nipples, areolas, and the linea nigra –a dark line which forms vertically along the center of the abdomen from the belly button to the pubic bone. Often, freckles, moles and recent scars may darken and increase in size during pregnancy. These pigment changes occur due to elevated levels of estrogen, progesterone, and melatonin-stimulating hormone.
Another condition, melasma, commonly called “the mask of pregnancy,” is a form of hyperpigmentation that affects the face. These areas can appear on the forehead,
cheeks, nose, upper lip, and chin. Sun exposure can exacerbate melasma; it is important to wear sunscreen and a widebrimmed hat outdoors, and decrease the amount of time spent in the sun. The dark spots gradually fade and resolve after pregnancy. Hyperpigmentation and melasma are more common in individuals with darker skin tones.
Stretch marks
A well-known skin change during pregnancy is stretch marks, caused by rapid stretching of the skin to accommodate the growing baby. These stripes are often pink, red, or purple in colour, depending on a person’s skin tone. The stretch marks can appear on the abdomen, breasts, arms, thighs, and buttocks. Most stretch marks fade and become lighter over time but they rarely disappear completely. Although it is impossible to completely prevent stretch marks, a healthy weight gain during pregnancy and use of moisturizers may help minimize their appearance.
Spider veins and varicose veins
The changes in blood circulation, blood pressure, and hormones lead to the appearance of spider veins and varicose veins during pregnancy. Spider veins are small, red, or purple branching vessels that appear on the skin, commonly on the face, neck, upper chest, and arms. The redness should fade after the baby is delivered. Varicose veins are larger and can be swollen or painful veins that develop in the legs and pelvic area. These develop as a result of the growing uterus which places pressure on the veins in the lower half of the body. These often diminish after pregnancy, but appearance and discomfort can be managed during pregnancy by wearing compression stockings, elevating legs, avoiding prolonged sitting or standing, and maintaining light physical activity.
Skin tags
Skin tags are small, soft, flesh-coloured growths of the skin that can develop during pregnancy. Common areas of occurrence are the face, neck, armpits, upper chest, and under the breasts. These growths are harmless and usually result from increased hormone levels and skin friction. They disappear or shrink after pregnancy but can also be easily removed by a dermatologist.
Hair changes
During pregnancy, many people experience thicker and healthier hair because of an increase in estrogen, which prolongs the hair’s growth phase. Sometimes, these hormones cause excess hair growth in other places, like the face, neck, chest, or abdomen. Most hair-removal methods are safe in pregnancy, including waxing, tweezing, and shaving. The excess hair growth usually resolves after delivery.
After delivery, hormone levels return to normal, causing many women and gestational parents to experience postpartum hair shedding. The hair shedding may be generalized but can be more marked in the frontal and temporal regions. In most cases, hair will completely grow back and recover within six months to two years.
Nail changes
Nails may grow faster during pregnancy. They can also become brittle and susceptible to splitting and breaking. The cause of nail changes is unknown, but these are harmless and usually do not require treatment. It can help to keep short nails and avoid nail cosmetics. These are just some of the common skin, hair, and nail changes during pregnancy. Understanding these normal changes is important in helping expectant mothers and parents navigate skin-related aspects of pregnancy. With any alarming or concerning changes, always consult a healthcare professional.
References
1. Vora RV, Gupta R, Mehta MJ, Chaudhari AH, Pilani AP, Patel N. Pregnancy and skin. J Family Med Prim Care. 2014;3(4):318-324. doi:10.4103/2249-4863.148099
2. Tyler, KH. Physiological Skin Changes During Pregnancy. Clinical Obstetrics and Gynecology 58(1):p 119-124, March 2015. | DOI: 10.1097/GRF.0000000000000077
3. Barankin B, Silver SG, Carruthers A. The skin in pregnancy. J Cutan Med Surg. 2002;6(3):236-240. doi:10.1177/120347540200600308
4. The American College of Obstetricians and Gynecologists. Skin Conditions During Pregnancy. Updated July 31, 2022. Accessed September 10, 2024. www.acog.org/womens-health/faqs/skinconditions-during-pregnancy
5. John Hopkins Medicine. Pregnancy and Skin Changes. Accessed September 11, 2024. www.hopkinsmedicine.org/health/ conditions-and-diseases/staying-healthy-during-pregnancy/ pregnancy-and-skin-changes#:~:text=Increased%20 blood%20 flow%20and%20oil,and%20oil%2Dfree%20can%20help
Zahra Rehan is a family medicine resident and clinical epidemiologist with a special interest in inflammatory skin conditions, training at University of Calgary in Calgary, Alberta.
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Empowering
By Sabrina Ribau, Omar Sharife, and Dr. Harvey Lui
Up until recently, there have been few options for people seeking support and treatments for vitiligo in Canada. With few options comes gaps in understanding, gaps in access, and gaps in support for people with vitiligo and their families, leaving unmet medical, psychological, emotional, and social needs. Fortunately, 2024 has been a big year for vitiligo in Canada with Vitiligo Voices Canada, a vitiligo patient-led group, finding their voice this year and working toward meaningful changes for the vitiligo community.
Vitiligo Voices Canada grew organically from a small Facebook support group started by Omar Sharife. The group evolved with encouragement from Global Vitiligo Foundation to strengthen and amplify support for the Canadian vitiligo community, and Sharife was connected with Parsa Abdi, a medical student in Nova Scotia, and they then brought in two others, Shahnawaz Towheed and Oana Durcau, to create Vitiligo Voices Canada. In June 2024, they launched their Instagram account (@vitiligovoicescanada) with a successful Vitiligo Awareness Month campaign and lit up 19 landmarks purple across Canada, putting vitiligo and Vitiligo Voices Canada on the map. Vitiligo Voices Canada aims to connect people across Canada with vitiligo through support groups, inform the public and raise awareness around what’s happening in Canada on vitiligo, and create meet-ups to provide spaces for people with vitiligo to come together with their peers.
Omar and his team run regularly monthly meetings with the community where they discuss the day-to-day impacts of living with vitiligo and talk about how people can interact with and support those in the vitiligo community. “Often there are allies, parents of kids with vitiligo. The kids don’t yet have a voice, so parents will come and ask how to support,” Omar shared, explaining, “we don’t want
Minimal disease activity in atopic dermatitis: Using standardized measuring tools and patient reported outcomes
By Anne-Sophie Groleau
Atopic dermatitis (AD) is a very common chronic inflammatory skin condition. It has a wide range of presentations, from slightly to severely itchy skin. Research has shown that the more severe the AD presentation, the higher the impact on quality of life.3
Unfortunately, there are no specific tests or laboratory markers to help healthcare professionals determine the severity of AD of their patient.1,2 In the past, patients were often dissatisfied with their treatments because of the difficulty to tailor treatment to a specific patient’s needs. AD has been a hot topic in research and because of this, an abundance of new medications have been marketed. Healthcare professionals can now have a patientspecific approach to treatment and strive to achieve minimal disease activity (MDA).
The concept of MDA defines an ultimate treatment goal of a satisfactory state of disease activity with minimal impact on quality of life and complete or near complete resolution of AD and its symptoms.4,5 To achieve MDA, healthcare professionals must use standardized measures and tools to evaluate the severity of AD before starting a new treatment and to evaluate the response to a specific medication. These standardized measures are used every day because access to costly therapies depend on AD severity.1,3
There are two types of tools that healthcare professionals must use when evaluating the severity of AD for a specific patient. First, a validated
objective measure such as the Eczema Area and Severity Index (EASI) score is used to measure disease activity. This score evaluates the extent of eczema on four body regions and the severity of four eczema signs: erythema (redness), edema (swelling), excoriation (superficial wounds or scratches from rubbing or scratching the skin) and lichenification (thickened or hard areas of skin from rubbing or scratching). For MDA, an improvement of 90% in the EASI score (EASI90) is nowadays used as a treatment target. Second, because AD symptoms can waxand-wane, healthcare professionals must evaluate the burden of this skin condition in a patient’s everyday life.3 Patient reported outcomes (PRO) tools, such as the Dermatology Life Quality Index (DLQI), which evaluate the impact of AD on a patients’ quality of life, are incorporated. Thus, to achieve MDA, both the perspective of the healthcare professional and the patient are included in a shared-decision making process with a treat-to-target approach. Patient participation is thus crucial in the process of choosing the appropriate treatment regimen for that patient.
To conclude, using objective and PRO measures to achieve MDA is a new approach allowing for shared decision making and a patient tailored approach to treatment.3
References
1. Chopra R, Silverberg JI. Assessing the severity of atopic dermatitis in clinical trials and practice. Clin Dermatol. 2018 SepOct;36(5):606-615. doi: 10.1016/j.clindermatol.2018.05.012. Epub 2018 Jun 1. PMID: 30217273.
2. Gooderham MJ, Bissonnette R, Grewal P, Lansang P, Papp KA, Hong CH. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section II: Tools for Assessing the Severity of Atopic Dermatitis. J Cutan Med Surg. 2018 Nov/Dec;22(1_suppl):10S-16S. doi: 10.1177/1203475418803628. PMID: 30439297.
3. Maintz L, Bieber T, Bissonnette R, Jack C. Measuring Atopic Dermatitis Disease Severity: The Potential for Electronic Tools to Benefit Clinical Care. J Allergy Clin Immunol Pract. 2021 Apr;9(4):1473-1486.e2. doi: 10.1016/j.jaip.2021.02.027. PMID: 33838840.
4. Silverberg JI, Gooderham M, Katoh N, Aoki V, Pink AE, Binamer Y, Wollenberg A. 327 Optimizing the management of atopic dermatitis with a new minimal disease activity concept and criteria and consensus-based recommendations for systemic therapy, British Journal of Dermatology, Volume 188, Issue Supplement_2, February 2023, ljac140.022, https://doi. org/10.1093/bjd/ljac140.022
5. Silverberg JI, Gooderham M, Katoh N, Aoki V, Pink AE, Binamer Y, Rademaker M, Fomina D, Gutermuth J, Ahn J, Valenzuela F, Ameen M, Steinho M, Kirchhof MG, Lio P, Wollenberg A. Combining treat-to-target principles and shared decisionmaking: International expert consensus-based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis. J Eur Acad Dermatol Venereol. 2024 Jul 11. doi: 10.1111/jdv.20229. Epub ahead of print. PMID: 38989857.
Anne-Sophie Groleau, PGY2, is a dermatology resident at the Université de Montréal.
Pemphigus
By Prince Mathew
When it started it was just a small spot, but it spread quickly. Pemphigus is a rare autoimmune condition that causes blisters on the skin and mucous membranes from the body mistakenly attacking the top layer of the skin. I was able to see a dermatologist quickly, and after a small biopsy, they were able to figure out what I had and started treatment immediately.
I’ve lived with pemphigus for two years now, and it has deeply impacted every area of my life. The way my skin reacts to being touched by different surfaces changed the way I live my life. The skin is very loose, and so I change the bed sheets a couple times a day because the skin can stick to it. It’s also difficult to sleep at night, and there is discharge as well. Even while sitting on the couch, I put a sheet over it because I don’t want it to get to the couches. I can’t take showers because of the sores, so I use a cotton cloth to wipe my body. I also can’t go out of the house and do activities – I’ve been inside the house for six months or so, just watching movies and eating. Inside the house I was kind of sore and weak.
Last week I had an appointment with the doctor, and he said that I’m doing really well, and I can now stop the medication I’ve been on for two years now (many people use it long term as it is as autoimmune disease). I was on antibiotic creams from the doctor, as well as oral medication for three or four months, which helped it to subside gradually. I was very happy about the news and am thrilled that I’ll be able to start regaining my life again. I need to do some more activities outside of the house and it’s been nice being able to look at my options. I’m looking into some educational courses and maybe a home-based business to give me some
Even now there are marks on my body from pemphigus, but I’m looking forward to this next chapter and exploring my life again.
freedom to work while still comfortably managing my condition. When it starts to appear, go and see the skin specialist, the dermatologist, immediately. My doctor has been incredibly supportive throughout this journey, as well as other doctors I’ve seen since my diagnosis. Most of all,
my wife has supported me and helped me with self-care, applying medications, helping with food, and I’m so appreciative for the support I have from my wife and kids. Even now there are marks on my body from pemphigus, but I’m looking forward to this next chapter and exploring my life again.
CSPA IN ACTION
For the past few months, I have been busy getting to know our community through an abundance of informative events and meetings. I am excited and honoured to take on the position of executive director with CSPA and thank the Board of Directors for this opportunity. I recognize there is a lot to learn and am committed to investing the time, care, and dedication to ensure we continue to provide value to patients living with skin, hair, and nail conditions.
I am beyond excited to share that CSPA is celebrating our 15th anniversary of publishing Canadian Skin magazine. Did you know that we have published an astounding 48 issues since inception? Our subscriber base is growing and as we look to the future of the magazine, we will be
A spotlight on our latest activities, events and other information of importance to skin patients in Canada
moving to a digital landscape for our subscribers in 2025. Please ensure you provide an email and resubscribe to the magazine (https:// canadianskin.ca/magazine/get-themagazine) to keep receiving a digital copy going forward. Thank you for all the love you’ve shown the magazine over the last 15 years, and we’re excited to continue sharing more stories with you through Canadian Skin!
We remain focused on advocacy efforts and providing educational tools and resources and, of course, we intend to serve up new programming and refresh others. With thousands of different skin conditions – and more than 1,000 rare skin diseases –we will continue bridging the gaps among the public, patients and their
We remain focused on advocacy efforts and providing educational tools and resources and, of course, we intend to serve up new programming and refresh others.
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is the Founding Sponsor of the Canadian Skin magazine and an ongoing supporter of CSPA's publications
loved ones, healthcare professionals, and researchers.
Our new registered charity status allows you to claim a tax credit on your annual return. If you like our magazine and would like to contribute to the impactful work of CSPA, please consider making a donation today (https:// canadianskin.ca/get-involved/donate).
We encourage you to get involved with CSPA. Whether you’re a patient, a caregiver, a student, or a health professional, there are many ways to get involved. Check out our website at canadianskin.ca for more information and our events page. We recently hosted our second annual Breaking Barriers Symposium on bolstering mental health and as we plan for our third annual workshop, we hope you will join us. I look forward to collaborating and advocating to improve the lives of people affected by skin, hair, and nail conditions and I invite you to connect with me at executivedirector@canadianskin.ca.
Dana Gies Executive Director
These sponsors are not providing editorial support for the magazine. CSPA is responsible for the final content featured in Canadian Skin
CANADIAN SKIN MEDICAL ADVISORS + BOARD MEMBERS + VOLUNTEERS
Thank you to the medical advisors, board members, and volunteers who support the work of CSPA. For an updated list of names, visit canadianskin.ca/about-us.
AbbVie
2023 Dermatologist of the Year
Congratulations Dr. Asiniwasis!
The Canadian Skin Patient Alliance (CSPA) is thrilled to announce Dr. Rachel Asiniwasis as our 2023 Dermatologist of the Year!
Dr. Asiniwasis is recognized for her incredible dedication to supporting the patients and families of both her local region of Regina, SK and the remote and northern Indigenous communities she and her small team have made it their mission to serve.
She is an accomplished dermatologist and up-and-coming researcher who works to improve the lives of the communities she serves. With a Plains Cree and Saulteaux background on her father’s side; one of her passions is learning more about healthcare challenges in remote and First Nations populations and developing proactive approaches to these challenges through a Truth and Reconciliation framework. To better understand and represent these communities, she returned to school for a Master of Health Science in clinical and translational research and hopes that her work may help as a foundational base to further inform regional and national priorities for Indigenous skin health.
The CSPA team has sincerely appreciated working with Dr. Asiniwasis through 2023 on a variety of projects, namely on an important Indigenous skin health article for Canadian Skin magazine and as our keynote speaker for CSPA’s inaugural Breaking Barriers event. We look forward to continuing this collaboration to improve the future for all skin patients residing in Canada. Thank you for your compassion and commitment, your positive effect on others, and for your outstanding patient care!
We gratefully acknowledge Dr. Asiniwasis and all the healthcare professionals who continue to support the efforts of CSPA in informing, educating, and advocating on behalf of the skin patient community. Thank you!
