Skip to Main Content

INTRODUCTION

KEY POINTS

  • Striae gravidarum, keloids, melasma, and intrahepatic cholestasis of pregnancy have a predilection for pregnant women of color.

  • Seventy percent of the world’s patients with human immunodeficiency virus/acquired immunodeficiency virus live in sub-Saharan Africa, and African women of childbearing age have a heightened susceptibility for acquiring this infection.

  • Mycosis fungoides, sarcoidosis, scleroderma, and lupus erythematosus are more aggressive and confer a poorer prognosis in pregnant women of color.

  • It is important that patients understand that the risks associated with these diseases during pregnancy are largely due to poorly controlled disease.

  • Planning a pregnancy 6 months after the disease has been controlled can help ensure the safety of the mother and child.

  • It is important to stress contraception to patients whose disease is currently active or has been in remission for less than 6 months.

Pregnant women of color constitute a unique population. It is important to note that there are dermatologic conditions that are seen exclusively in this group. Furthermore, there are special considerations when selecting and instituting therapies for pregnant women of color who have common dermatologic conditions.

DERMATOLOGIC CONDITIONS IN PREGNANT WOMEN OF COLOR

Connective Tissue Changes

Striae Gravidarum Striae gravidarum (SG) are striae distensae (SD), or stretch marks, that occur during pregnancy and are the most common connective tissue change observed during gestation. A risk factor for SG is race, specifically individuals of African American, Hispanic, East Asian, and South Asian descent.1 Family history of striae, younger maternal age, maternal weight gain, premature birth, and newborn size are also factors.2,3

SG can appear in primigravidas or alternatively develop for the first time in subsequent pregnancies in any trimester, although they most commonly appear in the second and third trimesters. SG occurs most often on the abdomen and breasts. Initially, they appear as striae rubra and become longer, wider, and raised over time. They then become striae alba, or mature striae, which are wrinkled, white, and atrophic [Figure 86-1]. SG can be associated with pruritus, burning, and discomfort. SD in darker skin types are sometimes referred to as striae nigrae.4 A mechanobiologic process is likely to activate or inhibit melanogenesis in this population, but there is no evidence of any topical preparation that would prevent SG.5 However, topical vitamin A therapy with tretinoin (retinoic acid) 0.1% improves SG, but no study has been done exclusively in skin of color.6 Combined therapies may improve striae alba in skin types I to V.7

FIGURE 86-1.

Stretch marks on an East Indian woman postpartum after her first pregnancy. In this patient, both striae rubra and evolving striae alba are present.

Although not studied specifically for SG, various lasers have proved helpful for SD, including pregnancy-related striae. Fractional ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.