← #skinthusiast: the podcast
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- [00:00]
A
So there was a study they had women use almond oil paired with massage and those who paired it with massage saw a reduction in stretch marks. There's also some small data about centella asiatica hyaluronic acid. Whether or not they could potentially be helpful. I don't think anything is a slam dunk. Most of the creams out there that are marketed towards that are not actually going to prevent stretch marks. It's mostly genetics. However, I do think there's some validity to keeping the skin moisturized, if for anything it's just to reduce that tight, itchy, uncomfortable feeling. So I always recommend really massaging in your creams or your oils. Welcome to Hashtag skenthusiasthepodcast, a place for listeners to hear from the experts and soak in tangible tips to get that glow from the inside out. I'm Amy, a skincare educator, practicing dermatology, PA and beauty creator who bridges the gap between the consumer and the industry. Listening to the industry's top experts on everything from the best way to spot treat a pimple to the Holy Grail hair products you didn't know you needed to the drugstore finds that are better than luxury price tags. We cover it all here. Dermatologists, beauty and wellness experts, brand founders and thought leaders share their tips and tricks for all things beauty, skincare and wellness. Think of Hashtag Skusiasts like the coffee. Chat with the beauty gurus whose brains you've always wanted to pick. You won't get this kind of insight anywhere else. I don't know what is in the water lately, but I have had such a large increase in DMS regarding Pregnancy Safe skincare, Pregnancy Safe practices. So so I wanted to post an episode this week that I did a little while back with Brooke Devart who is expecting her second baby. She asked me for her community Naked Beauty all about Pregnancy Safe Skin Care and we really delve into some of the concerns surrounding skincare and pregnancy. It's going to be a short episode but so so valuable. So if you are pregnant, if you are thinking of becoming pregnant in the next year, or if you have friends or family members that are pregnant and have questions about their skin health, this is such a good episode for you to listen to and without further ado, let's chat with Brooke.
- [02:00]
B
Amy, welcome back. We had a fabulous chat about everything that you have to pay attention to and what you can totally ignore when it comes to purchasing skincare. But now I really want to go deep with you on pregnancy and skin care. What changes in our skin as we're pregnant and how we have to change our buying habits. Is this something that you've encountered or you've studied?
- [02:22]
A
Yeah. So I think one of the biggest misconceptions when it comes to pregnancy skincare is, is that you have to go out and get a whole new routine. I think people are so afraid of using the products they're already using. And I understand that. Right. I've been pregnant. I know how it feels to want to do everything you possibly can to make sure that this pregnancy is perfect, that you're doing, making all the right healthy choices for your baby. So I totally understand that. But you can rest assured that the majority of what you're using is actually safe for you and for your baby.
- [02:51]
B
Yes, yes. Well, I am five months along in my pregnancy and I have made, you know, some adjustments. I think the biggest adjustments assessment that I've made is saying goodbye to my beloved tretinoin prescription. Goodbye retinol. Because we know that prescription retinol, or even just over the counter retinol is not pregnancy safe. Is that correct?
- [03:11]
A
That's correct. So you've probably heard of the oral form called isotretinoin, which we use to treat various conditions actually, but it's most commonly known for the treatment of acne. And that one has a documented adverse effect black box warning that it can cause birth defects in a developing baby. So for that reason, we also say that the topical versions of those retinoids are off limits now. It's more concerning with the higher strength, the really high strength prescriptions. It's less concerning with the over the counter retinol. So I always tell people, like, even if you've been using your tretinoin and, you know, most people don't know they're pregnant right away or maybe they weren't trying so they didn't stop those products. Don't panic. That's the first thing. Don't panic. It's not that big of a deal. Just stop when you find out you're pregnant. And when it comes to the over the counter retinoids or the retinols that we have in these big box beauty retailers, the cosmetic formulations, it's really an abundance of caution when we say don't use it, but it's that theoretical risk that we're not willing to take. Right. Because it's, it's a baby, it's the most precious thing, so we want to protect it.
- [04:14]
B
Yes. I'm so happy you mentioned, like, if you were doing things before you knew you were pregnant, because for My first pregnancy, I found out. I don't know, I just, I just wasn't expecting to get pregnant so quickly. We were like kind of trying, but it was like, first try. I got pregnant and I remember learning that I was like, I don't know, three or four weeks along and I wasn't aware of it and I was like, I've been drinking and I've been eating sushi and I've been using retinol. My doctor was like, take a deep breath, calm down, you are fine. The baby is fine.
- [04:46]
A
Exactly.
- [04:47]
B
Everything's. She was like, people find out that they're pregnant like three months, like, everything is fine.
- [04:52]
A
Yeah.
- [04:52]
B
So I would just be like, the emotions are already very heightened. It feels like the stakes are so high already. So the fear mongering towards pregnant women, it's just like everyone can take a deep exhale, like, everything's going to be fine.
- [05:05]
A
Yeah, absolutely. Wait, so you just said sushi? It reminded me of a couple of my favorite books. Have you ever read Expecting Better by Emily Oster?
- [05:12]
B
I. I hear about this book probably every week of my life now, which means it's a sign that I just need to buy it. But I. So my first pregnancy, I was like, I wouldn't even eat something that was cooked in wine. Like, I was just like, yeah. So I was just. Yeah, I. You know, by the book. By the book. The only thing I'm not. Alcohol is not a big part of my life. So I'm. I'm fine to forego it. But the only thing that I really, really love is sushi. So I asked my obgyn, I have a very cool ob gyn. She's like a millennial ob gyn, which is also very interesting to me to have a doctor like close to my age. But I was like, can I eat sushi? And she was like, yeah. She was like, if you're at Nobu, like, have some sushi. She was like, if. If you're at like a food truck that you know a place that you've never tried their sushi, like, yeah. Then like, don't risk it because it's not. Having food poisoning while pregnant is not something that you want to experience.
- [06:06]
A
Exactly.
- [06:06]
B
But she was like, if you're at a reputable place, like, have sushi. Women in Japan for centuries have been consuming sushi while pregnant. It is fine. So I am having sushi this pregnancy. And from what I understand, that is something that is a topic in this book.
- [06:20]
A
It is. And there's also. So I eat sushi with my. My pregnancy as well. There's also a really great book. I just interviewed the. The author. Her name is Lily Nichols. You can also follow her on Instagram. She's amazing. She's a registered dietitian. Her book is called Real Food for Pregnancy. I actually had gestational diabetes with my first pregnancy, so I found my book. Yeah, I had that. I had pregnancy. You did?
- [06:42]
B
Yes.
- [06:43]
A
Okay, so she has a famous.
- [06:44]
B
You had preeclampsia too?
- [06:46]
A
Yeah, I did, unfortunately.
- [06:47]
B
Oh, my gosh.
- [06:48]
A
Yeah.
- [06:48]
B
Pregnancy twins. You did. Suffered the same. Yes. Horrible.
- [06:53]
A
Did you have to deliver early?
- [06:54]
B
I did. I had to get induced. And I also, I mean, just the gestational diabetes was like, when I had to start, like pricking my finger and doing the test, it was like every. People would give these, like, oh, have like a fruit salad. Like, I could. I was one of those people that couldn't even have like a banana because it would, like, spike.
- [07:11]
A
Yes.
- [07:12]
B
I was just like. So I ate so many eggs and like, it was. It was a tough. It was a tough time. And I have my gestational diabetes test coming up soon. And I'm like, please, not again. Not again.
- [07:24]
A
Oh, my gosh. Then you need this book. Real Food for Pregnancy. It is like my bible. She is so evidence based. It's a little dry. I bought it for my best friend who's pregnant and she's like, Amy, I saw the COVID I thought it was going to be like this beautiful pregnancy cookbook. She's like, this is so boring. But now she's, like, hooked. She's like, oh, my gosh. There's so many things I would have done differently. So. So we hope to get pregnant with a second child this year. And I'm like reading it now. I'm like, let me just set myself up because the last thing I want to do. The GD was tough for the gd honestly didn't bother me that much. It was the preeclampsia that scared the crap out of me. So that I'm trying to avoid at all costs. And there's so many tips in this book. Again, it's all evidence based. I know we're going off topic here, but since I know there's a lot of pregnant ladies listening to this, it's. That book absolutely changed my life. It changed how I ate after I was pregnant too.
- [08:13]
B
So, okay, so give. Give us some top tips, like, what are the things that we should be mindful of when we're eating while pregnant or preparing to get pregnant?
- [08:21]
A
So she has she actually has a book for fertility, too. So if you're in that boat, that would probably be a better option, but it's so dense. There's so much in here but, like, prioritizing protein. So one thing I didn't realize is that a vegetarian diet is linked with an increased risk of preeclampsia. And I was vegetarian during the first half of my pregnancy. I had been for three. So now I know. And. And one thing that she educates us on is that you can. You can meet your protein requirements as a vegetarian. However, the bioavailability of that protein and those amino acids is so much different than when you're eating animal products. So I. I'm like, I'm so. I grew up on a Mediterranean diet. I didn't eat a ton of meat growing up. So it's like, this is like a very hard pre. Program for me to. To kind of reprogram my brain. But I have started eating a little bit more meat. It's still not the majority of my diet, but I do eat some from really good sources. Of course, she talks a lot about eating collagen and how that's beneficial when we're pregnant. So things like bone broth. What else? Like, how, you know, really, a lower carb diet is healthful during a pregnancy, which for so many years we were. We were taught that, like, you really need high carbs. I don't know about you, but when I got the little handout from my doctor when I was diagnosed with gd, she's like, don't even look at this. She's like, this is probably worse than you eat now. And I did. And I was like. I even, like, I'm not a nutritionist, but I know enough to know that this. If I ate this meal right now, you'd probably have to put me on insulin. So it's just very interesting. The guidelines are so behind. The recommended daily values that allowances that we need of these nutrients and vitamins are a lot lower than what's optimal. Right. There's a difference between what we need to survive and for our baby to survive and what's actually going to give us an optimal pregnancy. So. Fantastic book. I highly recommend it.
- [10:06]
B
I. I wish that I could say that I was one of the people that was eating well and just like, it was like, oh, shock. I have gestational diabetes. I was drinking juice every day. I was having chai iced chai lattes, which, like, as soon as I had to meet with the, you know, you have to get a Meeting with the dietitian or nutritionist, like through the. Once you get. And so she was like, do your food log. And I was like, every morning, starting with like an iced chai latte. She was like, this is insane. I was like, I. Now I know I know better. Like, I, I'm actually one of the people that it's, it's not shocking, looking at my diet, that I had gestational diabetes. So I'm trying to do better this time around. But I also think that, you know the first trimester when you're nauseous and you have like, it's like, some days it's like, I just want Mac and cheese for lunch.
- [10:49]
A
Yes.
- [10:50]
B
I just want a baguette with butter. And I'm sorry, I know that that's not a protein dense, nutrient dense meal, but the thought of having a kale salad makes me want to gag right now.
- [11:00]
A
Yeah, I totally understand that. And I actually was lucky enough I never had morning sickness. But all my friends who did say the same thing, they're like, I can only stomach like carby foods. You know, that's the only thing I can get down. She does have a section on that too. So if you're someone who's suffering with that, she has a little. She has a whole chapter on like, what to do. And the first thing she says, which is why I love her, is like, don't get down on yourself. Right? Like, eat what you can eat. That's the most important. Don't worry about meeting these requirements. But she does have some tips that can kind of help you stomach some of the more healthful foods.
- [11:31]
B
Okay, good to know, Good to know. Going back to skin care for a moment, we know that we're not using our retinols. What are the other products? Because I know there are some acids that aren't necessarily pregnancy safe. And then I want to come to sunscreen. But before we get to sunscreen, what other Just kind of like day to day topical skin care ingredients should we look to phase out of our routine once pregnant?
- [11:51]
A
So we already touched on the biggest one, which is retinoids. If you are using a hydroquinone, you want to stop that. We know that that's not pregnancy safe. You mentioned acids. Most, most of the acids that you can get in, in formulations like at big box beauty retailers or at drugstores are going to be okay. So I usually say like 2% or under of salicylic acid, 10% or under of glycolic acid. I always say if you're nervous. A cleanser is a really nice way to get in your acids. That's how I use them. Often I'll just lather it on my face, let it sit for 60 seconds and rinse it off. That way you know it's not sitting on the skin overnight or all day long. So that might help you feel a little bit better so that you don't have to completely give up your salicylic acid especially because that's one of those ingredients that can really help with acne, especially for women who get acne during pregnancy. So a nice.
- [12:44]
B
I'm going to pause you there because I just want to be very clear. BHA and aha and lactic acid, all.
- [12:51]
A
Safe to use during pregnancy at certain concentrations. So you want to. Most of the products that you can get over the counter. Like I wouldn't do a high strength peel product and don't go get a peel. But obviously your esthetician will know this. But you're not gonna wanna go get a peel with a high strength acid in clinic. But like a formulation, a spot treatment, even a leave on serum or a cleanser is gonna usually have concentrations under what is safe.
- [13:17]
B
Got it, Got it. Oh yeah. And you said glycolic acid under 10% now. And so for salicylic acid, which we know is great for fighting acne, your recommendation is to get it in a cleanser so it's not sitting on your face overnight.
- [13:28]
A
That's really just for the people who are like nervous nellies about it. It's not saying that salacid serum is unsafe. It's just, you know, if you're someone who's nervous about using it, that's a way that you can kind of calm your mind a little bit.
- [13:40]
B
Got it, Got it.
- [13:41]
A
And some people have a higher threshold of glycolic acid. I tend to like err on the very safe side of things.
- [13:46]
B
Yes. And I mean that's, that's the other complicated thing about this. You know we talk about studies and pregnant women. It is you. It is basically impossible, right. To do tests on pregnant women. Because. And I was actually, I was really challenging a friend of mine about this. Like why don't they do more tests on pregnant. And this was a doctor friend of mine and they were saying, well, because you have like a non consenting person.
- [14:09]
A
Exactly. That's exactly right. Right. It's unethical to test on a, on a patient that can't consent. So. Oh yeah, we can't make that decision for, for our child. Well, you know, that's a whole other argument. But yes, for ethical reasons, we don't, we don't test on pregnant women.
- [14:24]
B
Right, Right. So it's like, there a lot of this stuff we're kind of like in the dark about in terms of, like, what's safe, what's not safe. So that's why people just really air on the side of caution.
- [14:34]
A
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- [15:21]
B
So for some screens now, I was just in Turkey, you know, swimming every day, and my favorite waterproof sunscreen for face and body is a chemical sunscreen from Shiseido that I love. And I was using it every day and I got a few DMs from people being like, is this a mineral sunscreen? Is this pregnancy seed? And I said, you know, I talked to my doctor and my doctor said that, you know, it's okay to use chemical sunscreen. I use a mix. I use sometimes mineral sunscreen, sometimes chemical sunscreen. I haven't found a mineral sunscreen that I can apply over my entire body while still swimming all day that won't make me look like Casper the Ghost, Like, I'm just not. That's not how I. That's not how I'm choosing to enjoy my vacation. Yes. And so I felt comfortable with the risks. But how, both in, in your practice and what you've seen in terms of research, chemical sunscreen for pregnancy, is it okay or is it something that doctors really say you should avoid?
- [16:17]
A
I would say the majority of derm providers say it's okay to use and the ones who don't again are acting out of an abundance of caution based on some data that came years, it's been years. Now that which we already knew that chemical sunscreens were absorbed into the blood. Also, nanoparticles of non chemical sunscreens are absorbed into blood too, but that doesn't mean that they're causing any harm. There are plenty of ingredients that are found in our blood from products that we use because the way that we test is so incredible and amazing. Now we can find the tiny, tiny tiniest little particles in blood. So does it mean it's causing any harm? Probably not. They are still doing more testing on that. I personally use chemical sunscreens when I'm pregnant. I tell my patients the same thing. If you're more comfortable, use mineral, but that's not always feasible. So don't ever feel bad for using a chemical sunscreen. You're not doing harm to yourself or your baby. And I can tell you I'm a nervous nelly like I am. I will always err on the side of caution and I'm 100% comfortable using them during my pregnancy.
- [17:17]
B
Yes. And then there are some kind of like more old school things that I feel like. I don't know if you hear about them as much, but like some people avoid dyeing their hair while they're pregnant. Have you heard this?
- [17:26]
A
Yeah, I have. And I think this, I actually, this is kind of something I did a deep dive on during my pregnancy. And there are some studies showing that it could potentially be harmful. But I don't think the studies are, are very valid. I think it's a personal choice. I did mine when I was pregnant. Again, if you're someone who's nervous about it, you can always ask them to like avoid the root when they're doing these things. You know, there's, there's different techniques they can use. I wouldn't like box dye my hair, but I was absolutely comfortable. See my stylist for her to do it.
- [17:59]
B
Yes, yes. Now in terms of cosmetic procedures and like injectables, you can't really do lasers. You definitely can't do Botox or fillers, but you can do prp, which is something that we both did. And I was excited because I was telling Dr. Vanessa Lee, I'm really excited to try PRP because it's also pregnancy safe. And it's like, you know, I'm using my own biomaterial. Are there any other kind of like skin enhancing treatments you can undergo while pregnant. Obviously you can get like a nice facial.
- [18:33]
A
Yeah, this is, this is interesting too, because you will find providers who won't do prp. You'll find providers who won't do anything when you're pregnant, Some who are more comfortable with things. Microneedling is one of those things that can go either way. Some providers will do it, some won't. In my practice, most of the providers don't because of that risk of what if you end up with a superficial skin infection? Then we have to treat with an antibiotic. All of that. You know, it's this, like, cascade of events. But generally I would liken it to a PRP where there's no, there's no reason the, the procedure itself couldn't be done during pregnancy. You're just gonna have to talk to your provider about it because some will be cool with it, some won't be. No lasers. Most peels are off limits.
- [19:17]
B
Injectors, can you use, can you do red light therapy?
- [19:20]
A
So that one hasn't been studied. Actually, I was just talking to a colleague about that and we unfortunately don't have the data to say it's 100% safe. That's my answer on that.
- [19:32]
B
Okay. Okay. Okay. And in your practice in Miami, do you see a lot of people, like, women coming in, being like, I'm planning to get pregnant soon, so can you just give me a lot of Botox now?
- [19:43]
A
Yes. And people also ask too, like, when is it safe if you're trying. And I always say, like, it's, it's the same as retinol. Don't freak out. If you realize you had your Botox before you realize you were pregnant, it's absolutely fine. But you're going to be fine. There's not going to be any issues. However, if you're someone who's planning to get pregnant, I always say, get your Botox between period and ovulation so you know for sure you're not pregnant. And then, you know otherwise, just wait until. If pregnancy doesn't occur that month, wait till the next month. So, yes, I do have patients who come in and they're like, light me up. So I'm good to go. But unfortunately, it still only lasts, you know, three, four, five months if you're lucky. So it's not gonna last the whole.
- [20:23]
B
Time, but it's not gonna last the whole pregnancy.
- [20:25]
A
Yeah, I, I actually interviewed Sam Ellis, Dr. Sam Ellis, on my podcast, and she was saying one thing she tells her patients who are super disappointed, like, oh, no, like what am I gonna do. I can't use my, my, you know, my ingredients or my Botox. She's like, save that money you would have spent on your Botox. Go take yourself out to lunch, get a massage, and you just worry about it after, like, nine to 10 months is such a short time in the grand scheme of things. Like, it's going to be fine.
- [20:49]
B
Yes, yes, absolutely. And I'm, I'm not on the Botox train, so it's not something I'm missing either way. But if you are, you know, really, you know, some people are very diligent about their Botox appointments. How soon is it. Is it even safe while breastfeeding?
- [21:05]
A
Yes. So the data says yes. Again, that's one of those things that you have to talk to your own provider about. Most of them won't do it. I. Even for my patients, and I'm very open with them. I'm like, it's. It hasn't been found in breast milk. There was even a case study of a woman who had actual, actual botulism toxin. Not from, not from the Botox, but she actually had the disease because it's a purified toxin. You know, when people say, like, don't eat honey or don't eat cans that are popped up, that's. That's botulinum toxin and it can be deadly. So she had the illness from eating something and it still wasn't found in her breast milk. So it is safe with the. According to the data that we had, even if you look at lactimed, which is like the database that we use to decide or to. To basically get the yes or no of what is okay to use during breastfeeding, it's fine. But I will tell my patients, like, if they're a nervous patient, I will tell them it's okay, but I'm going to recommend it again against it for you, because if something happens, if your baby gets sick, if they have a delayed something or other, you're always going to wonder, was it the Botox? And that's not worth it. Just wait. But yes, it is safe.
- [22:11]
B
Yes. It's never worth it. It's interesting that you bring up breast milk because something that I learned recently is that women that are breastfeeding are recommended not to, like, drink a lot, not because of the alcohol and the breast milk, but just because it's actually, like, unsafe to be handling a newborn drunk. Like, it's actually like, that's, that's actually where the big risk is. It's not that, like, you'll have, you know, the cocktail and then that alcohol is going to go into the breast milk and your baby's going to have brain damage. They actually just really have shown through studies that it's like, very unsafe to like, be around and handle a newborn while intoxicated, which is why breastfeeding mothers are recommended to drink, not so much to the point of getting really inebriated.
- [22:54]
A
Yeah. And actually that, that first book I mentioned, she talks about that a lot. Emily Oster's book, Expecting Better. Hers is more kind of like about debunking the myths of pregnancy and breastfeeding. But that what they have shown is that the level of alcohol and breast milk is similar to the level of alcohol in your blood. So whatever your blood alcohol level is, is probably the level in your, your milk. So you can imagine that by the time it gets, you know, into your infant, it's probably not an issue. But yeah, it's, it's very interesting. I'm not an expert on breast milk, but that's a really, really good book to read. If you're kind of wondering, like, can I breastfeed after a glass of wine? I think it's, it's a good read.
- [23:34]
B
Yes. And so you said that you were a sushi eater during your pregnancy. Did you also have the occasional glass of wine?
- [23:40]
A
Yeah. Let me just say first, let me just say this is not medical advice. Always ask your doctor if you're listening to this. Please, please ask your doctor. Don't take any of this advice. You know, you have to make your own decisions and you have to talk to your physician. But I would have the occasional glass of wine at like a party. I would always make sure I ate first and usually I wouldn't even end up drinking the whole thing. But yeah, I think I went to a wedding while I was pregnant of my best friend. I think I had a glass of champagne after dinner. So occasionally I did. Yes.
- [24:10]
B
Okay. And. And again, I feel like people have very. It's a very personal choice.
- [24:16]
A
Yes. Very polarizing, too.
- [24:18]
B
Very polarizing. Yes. I like starting even before I was pregnant, like kind of at the top of this year, just kind of phased out drinking more and more from my life. So it's been a very easy transition into non drinking. But let's talk about the good parts of pregnancy for skincare, because I have not, in these past five months, I have not had a single breakout. I have not had a single blemish. I feel like I have pregnancy. The pregnancy glow that they talk about. I mean, I really haven't had. And I know I shouldn't, you know, brag because tomorrow. Tomorrow the acne could start, you know, But I haven't had acne. Any breakouts since being pregnant.
- [24:55]
A
Yeah. So it goes one of two ways. I was in the opposite camp. I was someone who was. My skin was perfectly clear for years before I got pregnant. And then once I got pregnant, I started to get the occasional breakout. So we do see with those change in hormones that we see a change in hormonal breakouts on one side of the coin or the other. Yes, yes, But. But it's not uncommon. And then, you know, also we also see melasma, which is pretty common. But I will say that most people do feel like their skin has a little bit of a glow. And I will say my favor. Part of my skin when I was pregnant was like the volume in my face and the volume in my lips. When I look back at videos, I was like, oh, if I could just bottle that youthful, like, plump face. I loved it.
- [25:35]
B
Oh, my gosh. Yes. I mean, with. With weight gain comes the appearance of, like, just like a natural filler.
- [25:42]
A
Like, I feel like it just looks much better.
- [25:44]
B
Yes. I. I really feel like I've gotten with my. With my doctor was like, looking at my chart, she's like, so you've gained £9 in one month. We're going to want to slow that down a bit. I was like, you know, okay, I'll try. But I'm like, but the fullness in my face is really nice.
- [25:59]
A
Yes. My. I remember Dr. Bauman would always say, like, at some point as you age, you have to pick between your face and your ass. And it's so true. It's so true. And now that I am getting older, I see it, like, when I'm like, really good with my fitness routine and my diet is on point. My face, I'm like, oh, man, I need some help. But when I gain a few pounds, I'm like, oh, my face looks. Looks great.
- [26:21]
B
Yes. Yes. I'm not. Not mad at the extra weight on. On the face. And you mentioned melasma. Explain melasma. And if there's anything that can be done for it. And then we're gonna get to the last final section, which is the actual bump in stretch marks and body care for pregnant women. But let's first talk about melasma.
- [26:39]
A
Yeah. So melasma is a condition that can happen whether you're pregnant or not, but it's often associated with the pregnancy hormones. It's often called the Mask of pregnancy, if you've seen that. So it's usually a combination of hormones and sun exposure. However, even if you're the most diligent with, with avoiding the sun, you can still develop melasma. And we most commonly see it starting in women who are pregnant. But it's a lifelong condition. There's no cure. It will, it'll kind of flare and then you'll have some remission of it and all flare and go down, flare and go down throughout your life for various reasons. But I personally had melasma present for the first time when I was in my 20s on birth control, which is also a common cause. And then it was under great control. And then of course in pregnancy it flared, which it always does. I always tell my patients if you have a known history of melasma, it's going to flare. So don't be hard on yourself. It's nothing that you did. Of course, our gold standard treatments like hydroquinone and retinoids can't be used while pregnant. But the biggest thing you can do is sun protection and avoiding the sun, also avoiding heat, like avoiding, which most of us do in pregnancy anyways. You're not going to hot yoga, you're not doing saunas, things like that. But for me, I live in Miami, Unla like it gets pretty hot, so he can also exacerbate it. Azelaic acid is a good option. I always say it's like a jack of all trades, but a master of none. It helps with evening the skin tone, it can help with hyperpigmentation like melasma. It can help with acne, but it's not doing any of that. Better than like our tried and two retinoids and hydroquinone. But it is pregnancy safe. So I always use that morning and night during pregnancy.
- [28:15]
B
Okay. Okay. Very helpful to hear. And of course there is a huge market for stretch mark cream and all of these things that you can rub on to your stomach to. And I always feel if there was something that really made stretch marks not happen, then no one would have stretch marks. Is kind of how I feel. Right.
- [28:38]
A
That is absolutely so accurate.
- [28:40]
B
Right. Like then it, you know, if it was as simple as buying a lotion, then no one would have stretch marks. I though feel like I, I didn't really have a lot of stretch marks with my first pregnancy. And I am someone that is very diligent about rubbing in lotions, oils, creams. I use shea butter on my stomach just because that skin is stretching. But I don't know if that's why I'm not having stretch marks.
- [29:04]
A
It's so interesting that you say that because. So there was a study that showed they had women use almond oil, and then they had women use almond oil paired with massage. And those who paired it with massage saw a reduction in stretch marks. So you might be onto something there. There's also some small data about centella asiatica hyaluronic acid. Whether or not they could potentially be helpful. I don't think anything is a slam dunk. Most of the creams out there that are marketed towards that are not actually going to prevent stretch marks. It's mostly genetics. However, I do think there's some validity to keeping the skin moisturized. If for anything, it's just to reduce that tight, itchy, uncomfortable feeling. So I always recommend really massaging in your creams or your oils. But you might be onto something without massage. It's a little. Hopefully they're going to do more studies on that so we can have a definitive answer. But I always reference that study. I'm like, if you really want to be proactive, you can get some bitter almond oil and massage it in. And then after, when you're no longer pregnant. We do know that tretinoin can be helpful for the treatment of stretch marks. When they're still red, definitely see your dorm provider, because we can laser them with a vascular laser. Once they turn white, they're harder to treat. And in that case, we would do retinoids and like a micro needling or a resurfacing laser. But when they're still red, you can treat them with a vascular laser and they're a little bit more easy to treat.
- [30:22]
B
Interesting. Okay, that's helpful to know. And I guess also for women of color, I guess it wouldn't be red. It would be more of like a dark color, right?
- [30:29]
A
Yes. So in that case, you wouldn't be using the vascular laser. Exactly. So you would use a tretinoin. And you can do things like microneedling or you could use a hydroquinone if it's already. If you already have that post inflammatory hyperpigmentation set in.
- [30:41]
B
Okay. Wow. I never knew that. You know, a friend of mine who is not pregnant and is not a mother asked me. She was like, so after your stomach stretches, like, does it ever go back to normal? Like, does it ever go back to how it was? And I said, well, you know, of course, depends on the person. Some people, especially young, young, you know, young people that get pregnant and, you know, just snap back and, like, it looks like, they never had a child. I mean, that can happen for people at any age. I was like, it's very dependent. But I was like, usually when your skin is stretching that much to accommodate for a human being and then retracting back, the skin is not going to be as tight as it once was. That being said, I do feel like over time, I mean, my son is three, three and a half now, over time, it does kind of like, go back, but in my personal experience, it's never the same.
- [31:30]
A
I agree completely. I don't think it's ever completely the same. Even myself, when I see myself, I feel like I look the same, but then I can just tell the integrity of the skin is different. You know, like when you bend. And of course, everybody, like, it's natural to have creases and rolls when you bend. But I noticed that there's just a difference in that skin integrity when I bend over and things like that, which is fine. I made a human. Right. That's totally fine. But I do definitely notice that with subsequent pregnancies, it. It takes a little bit longer to bounce back, which I'm not looking forward to. But that's the reality of. Of growing a little human in there.
- [32:05]
B
Yes. I mean, that's. That's the real headline for this whole episode. You're. You're making life. You're creating a human. Every time I'm hard on myself for, like, not doing enough, I'm like, I'm literally growing a liver and toenails and eyelashes. So, like, even if I am just sitting down on the couch doing nothing, I am doing a lot. Yes, Agreed. And you just have to give yourself a lot of grace during this time period. So for all of the pregnant women listening, even if you're doing nothing, you're doing everything. And also, don't freak out about changing your whole routine, but also try to eat healthy. We're going to check out those books you recommended. Try to be mindful about what you consume. And I think the other thing that we didn't mention, the most important part of pregnancy that every single doctor will tell you, is to keep your stress low.
- [32:50]
A
Yes. Which is so much easier said than done, right?
- [32:54]
B
Yeah, so much easier said than done. But thank you so much for giving the full rundown and all the things we need to know for healthy, happy skin during pregnancy. Really appreciate you, Amy.
- [33:03]
A
Absolutely. Thank you so much for having me. I hope you guys enjoyed this little mini episode with Brooke Devard, all about pregnancy safe skincare. I also have a whole resource page on my website. If you go to skenthusiast.com pregnancy you can get this for yourself if you're pregnant, if you're planning to become pregnant. Or you can get the guide and send it over to a friend who might be in that boat. I think that we often get very overwhelmed at this time. We think that so many things are harmful for our baby, and while there are some things we need to steer clear of, there's a lot that we can safely use and we don't necessarily need to re haul or overhaul everything. So I hope that this information puts you at ease a little bit. And again, if you want those resources, it's skinthusiast. Com Pregnancy and I'll talk to you next week. Skinthusiasts.