This article describes the case of a 19-year-old girl with insidious onset hyperpigmentation during her first pregnancy.
She presented to the antenatal clinic concerned about out-of-proportion blackening of her abdominal and areolar regions. According to her, this hyperpigmentation was progressive, gradually involving more and more of her skin. It spread circumferentially around the umbilical and nipple areas and diffusely involved the adjacent skin. However, the girl did not have any other complaints.
On examination, doctors confirmed a longitudinal lie and cephalic presentation of the fetus whose fundal height came out to be 34 weeks. In addition to the linea nigra, the entire abdominal skin was diffusely dark-coloured. Hyperpigmentation also extended around her nipples in a circumferential pattern. The patient did not have any other abnormalities. Her blood pressure and other baseline tests came out completely normal.
Hyperpigmentation: Digging out the Cause
Our patient did not have any history of allergies or skin conditions. She regularly took her antenatal sessions and was only taking iron and folic acid supplements. She was even negative for any history of thyroid dysfunctions.
After carefully analyzing the patient’s condition and ruling out different etiologies, doctors concluded that the hyperpigmentation was likely due to pregnancy and estrogen buildup. They counselled the patient that her condition was harmless and that it would not affect her baby. They did not prescribe her any medicines and only advised her to continue taking her antenatal consultations. The patient completed her course of pregnancy without any complications and gave birth to a 3200g baby girl, all well and healthy.
How Common is Hyperpigmentation During Pregnancy?
Pregnancy causes a multitude of changes in the body including the darkening of the skin. An increase in pigmentation occurs as a result of changes induced by high levels of estrogen, progesterone and melanocyte-stimulating hormone. The Colour of the skin depends upon the pigment melanin produced by cells called melanocytes. These cells are located in the epidermis and impart skin its dark colour. The greater the melanocyte and melanin production, the darker the skin.
Skin changes such as the appearance of linea nigra (black line) in the midline abdomen and darkening around the nipple and areola are very common during pregnancy. However, there are almost no cases of progressive hyperpigmentation extending beyond these areas which makes our case both interesting and unique.
Factors That Affect Skin Darkening
There are multiple factors that can induce excessive skin pigmentation during pregnancy. Some people are genetically predisposed to over-pigmentation. In all such individuals, there is an increase in the concentration of dermal melanocytes resulting in what is known as dermal melanocytosis. Similarly, the intake of drugs such as minocycline, cyclosporine, levodopa etc. can also cause hyperpigmentation. If pregnant females have comorbidities like hyperthyroidism, it increases their incidence of developing excessive skin pigmentation apart from normal streaks that develop over pregnancy.
Should You Worry?
Hyperpigmentation induced during pregnancy tends to be harmless and usually resolves after pregnancy. In most cases, the skin regains its normal colour within a year. Doctors usually do not intervene with any medical prescriptions. At best, they only counsel the patient to wipe off any needless concerns and fears. Rarely, they might employ medicine for resistant pigmentation that does not go away. Whatsoever, skin pigmentation does not affect the growing fetus. The fetus continues to grow healthy as long as the mother’s nutritional status remains adequate.
In our case, the patient completed her pregnancy and gave birth to a term baby. The newborn weighed 3200 grams which is healthier than normal weight. The patient did not develop any post-partum complications and did not show up for any post-natal care sessions. Anyhow, the case highlights that pregnant females can develop excessive blackening of the skin around the umbilicus and breasts. However, such skin changes tend to be benign and usually revert after the baby is born.