Pregnancy and motherhood can change your skin in ways you might not expect, from that much-talked-about pregnancy glow to pigmentation, acne, sensitivity and stretch marks. But which changes are simply part of the journey, and when should you rethink your skincare routine?
We asked women’s health medical and research doctor Dr Jo Mennie to explain what’s really happening to your skin during pregnancy and after birth, which skincare ingredients are safe, what to avoid, and the treatments that can genuinely help. Dr Mennie is also
Co-Founder Women’s Health Supplement LØUCO, and a practitioner at Dr David Jack. From melasma and postpartum breakouts to breastfeeding-friendly skincare, here’s her expert advice for looking after your skin through every stage of motherhood.
What happens to your skin during pregnancy? and what skincare is actually safe for mums?
What are the biggest changes you see in women’s skin during pregnancy, and why do they happen?
The honest answer is that almost every layer of the skin is affected, because pregnancy touches on four different systems in the body at once: your hormones, your immune system, your blood vessels and your metabolism.
From the moment you conceive, oestrogen and progesterone start climbing and keep rising right through to the third trimester. These two hormones drive most of what you’ll notice. Oestrogen increases tyrosinase, the enzyme that controls melanin production, and melanocytes have their own receptors that respond directly to it, which is why pigmentation, linea nigra and melasma are so common. Progesterone works alongside it. There’s also a real vascular story here, your circulating blood volume increases by close to 50 percent, and that extra flow through dilated vessels is what gives many women that flushed, dewy look, alongside spider angiomas and palmar redness for some.
Then there’s the immune system. In the first trimester your body shifts towards what’s called a Th2-dominant, anti-inflammatory state, partly to stop your immune system rejecting the baby. It’s brilliant for the pregnancy, but it also means the skin barrier behaves differently, which is why so many women tell me a product they’d used for years suddenly starts irritating them. Add in a rise in cortisol and some insulin resistance, which can leave more sugar circulating and make skin slightly more prone to infection, and you can see why pregnancy skin needs a different approach rather than just “more of the same.”
Which skincare ingredients should pregnant women avoid? And are there any common “no-nos” that actually aren’t as clear-cut as social media would have us believe?
The clearest one, and the one I never budge on, is oral isotretinoin. That’s a well-established human teratogen, with major malformation rates reported in the region of 20 to 35 percent of exposed pregnancies. I also extend this to topical retinoids to also avoid in pregnancy. Hydroquinone is another I’d avoid, not because harm has been proven, but because topical absorption runs at 35 to 45 percent, which is unusually high for a skincare ingredient, so the precautionary case is strong.
Salicylic acid gets similar over-caution; high-strength peels and oral salicylates are best avoided, but a wash-off cleanser up to 2% is considered low-risk given the brief contact time. Chemical sunscreens sit in the same camp, oxybenzone shows endocrine activity in lab studies, so I default patients to mineral SPF as a precaution.
Is pregnancy acne different from ordinary acne, and how can you treat it safely?
The underlying process is the same, excess sebum, blocked follicles, inflammation and P. acnes, but pregnancy adds two extra drivers. The hormonal surge increases output from your eccrine and sebaceous glands, and that Th2 immune shift I mentioned makes it genuinely harder for the skin to fight off the bacterial component. That’s why pregnancy acne often flares hardest in the third trimester, just as progesterone is at its highest.
For treatment, azelaic acid and benzoyl peroxide are your safest first-line options, both are well studied in pregnancy, azelaic acid has under 4 percent systemic absorption and a trial comparing 20 percent azelaic acid against 4 percent hydroquinone showed comparable results for pigment-related concerns too. Low-strength salicylic acid as a rinse-off cleanser is also considered safe. Blue light therapy is a nice in-clinic addition because it works on the bacteria without any systemic exposure.
Melasma can be incredibly frustrating during pregnancy. What actually helps prevent it, and what can you do once it appears?
Melasma is driven by the same estrogen and progesterone surge, working on melanocytes through receptors that make them far more reactive, not just to UV but to visible light and heat too. That’s important, because it means sitting near a sunny window or standing over the hob can trigger pigment just as much as a beach holiday can.
Prevention really comes down to sun protection, and it needs to be a broad-spectrum mineral SPF50, ideally one with iron oxide, because that’s what blocks visible light rather than just UV. Reapplication matters more than the product itself, most of us apply about half the recommended amount. Once melasma has appeared, azelaic acid at 10 to 20 percent has the strongest pregnancy safety evidence of any pigment-targeting active, and I’ll add in vitamin C and niacinamide, which both have good evidence for calming pigment production without any pregnancy concerns.
Hydroquinone and retinoids stay off the table until you’ve finished breastfeeding. After that, tranexamic acid has become one of the better-evidenced options, meta-analyses of it show a meaningful reduction in melasma severity scores, whether taken orally, injected or used topically, with oral generally outperforming the others. Melasma often does fade in the months after birth as hormones settle, but for a meaningful number of women it lingers for years, so I never promise it’ll simply disappear on its own. For all cases of Melasma, prevention is better than cure, and going into pregnancy with a high quality mineral SPF that is applied daily is the best treatment you can follow.
Does pregnancy really make your skin “glow”, or is that a beauty myth?
It’s real, but it’s not universal, and that’s the nuance that gets lost. The mechanism is genuine, that near-50 percent rise in blood volume dilates the vessels close to the skin’s surface, giving a natural flush, and the same hormones that drive pigmentation also stimulate the sebaceous glands to produce more oil, which reads as a dewy sheen. Skin also holds onto more moisture in pregnancy, which plumps things out and can soften fine lines temporarily.
The catch is that this is exactly the same mechanism behind pregnancy acne. More oil production gives one woman a glow and gives another woman a breakout, depending on her skin type and how her pores respond. So the glow isn’t a myth, but it’s also not guaranteed, and if you don’t get it, there’s nothing wrong with your skin, it’s just responding differently to the same hormonal changes.
What beauty treatments are safe during pregnancy? And which should definitely wait until afterwards?
A good gauge is whether a treatment is topical and gentle, or whether it involves anaesthetic, energy devices or injectables. Hydrating facials and superficial lactic acid peels are generally fine, as long as the products are free from retinol and high-strength salicylic acid. Blue light for acne is safe. Beyond that, the list gets short.
Botox, dermal fillers, laser therapy are all treatments I’d wait on. There isn’t strong evidence of harm for botulinum toxin specifically, and a 2020 safety registry found no increased risk, but the data is still limited, and as such it is not approved in pregnancy. Fillers carry a genuine, separate concern around infection risk in pregnancy, which is why they’re avoided. Medium and deep chemical peels, any laser or microneedling that needs a topical anaesthetic, and electrolysis are also best left until after delivery, both because of the anaesthetic question and because pregnancy skin heals differently and is more prone to post-inflammatory pigmentation.
Why does skin sometimes seem to change dramatically after having a baby? From dryness and sensitivity to breakouts and pigmentation?
This catches a lot of my patients off guard, because they expect skin to simply “revert,” when actually the drop after birth is far more abrupt than the rise was. Oestrogen and progesterone fall sharply within days of delivery, and those hormones had been supporting collagen, elastin and hyaluronic acid production in the skin. When they disappear, the skin barrier loses moisture faster, which is why dryness, tightness and sensitivity are so common in those first few weeks.
Oil glands then have to recalibrate, and depending on your skin type that can go either way, some women find their skin drier than ever, others get a wave of postpartum acne as glands overcorrect, on top of the sleep deprivation and stress that make breakouts worse regardless. Pigmentation from melasma doesn’t switch off overnight either, the melanin that’s already been deposited takes time to fade, and it will get worse again fast if sun protection lapses.
And then there’s the hair, which I get asked about constantly. During pregnancy, high oestrogen holds more hairs than usual in the anagen, or growth, phase, which is why pregnancy hair often feels thicker. After birth, all of those hairs shift into the resting and shedding phases at once, which is what shows up as telogen effluvium around three to four months postpartum. It looks alarming, but it’s universal, temporary, and almost always resolves by six to nine months without any specific treatment.
Is there anything that genuinely helps stretch marks after pregnancy, or are we setting women up for disappointment with expensive creams?
I’ll be straight with you here, because this is the one area where the marketing runs well ahead of the evidence. The Cochrane review on topical preparations for preventing stretch marks found no high-quality evidence that any cream, oil or lotion prevents them forming, and a further review in the British Journal of Dermatology concluded that cocoa butter and olive oil specifically don’t work. There is limited evidence that centella asiatica and massage with almond oil may help, and weak evidence for hyaluronic acid, but nothing that would justify the price tags on some of these products.
Where I’d genuinely direct that money instead is at treating marks that have already appeared, because there the evidence is better. Once you’re no longer pregnant or breastfeeding, topical retinoids have reasonable evidence for improving the appearance of newer, red striae. In clinic, microneedling stimulates collagen and elastin regeneration where the fibres have torn, radiofrequency devices like Forma deliver controlled heat to the same effect with very little downtime, and combination treatments like Morpheus8 that we have in clinic have shown promising results specifically for postpartum abdominal laxity and striae. For marks that are still in that early red or purple stage, IPL can help fade the colour. So no cure, and I wouldn’t want anyone to feel they’ve failed by developing them, they affect up to 90 percent of pregnant women and genetics plays a big role, but once they’re there, there are treatments with real evidence behind them.
For mums who are breastfeeding, are there different considerations when it comes to skincare?
Yes, and the good news is the list of things to avoid is shorter than in pregnancy, but a few carry straight over. Retinoids, hydroquinone and deep chemical peels I’d still hold off on until you’ve finished breastfeeding, simply because we don’t have the safety data to reassure ourselves either way. CBD is another one I’d flag, it’s not recommended, partly because THC exposure has been shown to affect infant brain development, and partly because the supplement industry isn’t well regulated, so you can’t always be certain what’s actually in the product you’re using.
Outside of that, azelaic acid, vitamin C, niacinamide, low-strength salicylic acid and mineral SPF are all fine to continue. The other thing I’d flag is purely practical rather than pharmacological, breastfeeding increases your body’s hydration demands, on top of the postpartum hormone drop, so your skin barrier is working harder than usual. That’s the point to lean into richer, ceramide and hyaluronic acid based moisturisers such as David Jack Skin Cushion rather than pulling back.
And finally, if you only had five minutes a day for skincare as a new mum, what would you prioritise?
Three things, in this order. A gentle cleanser first, because the postpartum barrier is more reactive and anything stripping will only add to the dryness. Then a proper barrier moisturiser with ceramides and hyaluronic acid, this is doing the heavy lifting your own hormones were doing a few weeks ago, so don’t be shy with it. And SPF, every single morning, non-negotiable, particularly if you’ve had any pigmentation in pregnancy, because that’s the one thing that will actively undo months of progress if you skip it.
Everything else, your vitamin C, your azelaic acid, your eventual return to retinoids after breastfeeding, can wait until you have the headspace for a five-step routine again. Those three steps protect and support the skin while it’s doing its own repair work, and that’s really all it needs from you in those early weeks.
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