Itchy shins pregnancy

Itching and intrahepatic cholestasis of pregnancy

Itching is common in pregnancy. Usually it's thought to be caused by raised levels of certain chemicals in the blood, such as hormones.

Later, as your bump grows, the skin of your tummy (abdomen) is stretched and this may also feel itchy.

However, itching can be a symptom of a liver condition called intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC).

ICP needs medical attention. It affects 1 in 140 pregnant women in the UK.

Symptoms of ICP

The main symptom is itching, usually without a rash. For many women with ICP, the itching is often:

more noticeable on the hands and feet, but can be all over the body
worse at night

Other symptoms can include:

dark urine
pale poo
yellowing of the skin and whites of the eyes (jaundice), but this is less common

Symptoms of ICP typically start from around 30 weeks of pregnancy, but it's possible to develop the condition as early as 8 weeks.

Non-urgent advice: Call your midwife or GP if you have itching that's:

mild or distressing, possibly worse at night
anywhere on your body, but may be worse on the palms of your hands and soles of your feet

Feeling itchy like this can be a sign of ICP and needs to be checked.

Mild itching

Wearing loose clothes may help prevent itching, as your clothes are less likely to rub against your skin and cause irritation.

You may also want to avoid synthetic materials and opt for natural ones, such as cotton, instead. These are "breathable" and allow the air to circulate close to your skin.

You may find having a cool bath or applying lotion or moisturiser can help soothe the itching.

Some women find that products with strong perfumes can irritate their skin, so you could try using unperfumed lotion or soap.

Mild itching is not usually harmful to you or your baby, but it can sometimes be a sign of a more serious condition, particularly if you notice it more in the evenings or at night.

Let your midwife or doctor know if you are experiencing itching so they can decide whether you need to have any further investigations.

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a potentially serious liver disorder that can develop in pregnancy.

Normally, bile acids flow from your liver to your gut to help you digest food.

In ICP, the bile acids do not flow properly and build up in your body instead. There's no cure for ICP, but it should go once you've had your baby.

ICP seems to run in families, but it can happen even if there is no family history. It is more common in women of south Asian origin, affecting around 1 in 70 to 80 pregnancies.

If you have had ICP in a previous pregnancy, you have a high chance of developing it again in another pregnancy.

Some studies have found that babies whose mothers have ICP have a higher chance of being born prematurely or stillborn.

Because of the link with stillbirth, you may be offered induction of labour. This could be any time from 35 weeks, depending on the level of bile acids in your blood.

If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team.

Diagnosis and treatment of ICP

ICP is diagnosed by excluding other causes of the itch. Your doctor will probably talk to you about your medical and family history and order a variety of blood tests.

These will include tests to check your liver function (LFT) and measure your bile acid levels (BA).

Monitoring your condition

If you are diagnosed with ICP, you will have regular liver function tests so your doctor can monitor your condition.

There is no agreed guideline on how often these tests should happen, but the Royal College of Obstetricians & Gynaecologists (RCOG) and the British Liver Trust advise weekly tests.

ICP Support, the UK's largest research group investigating ICP, also recommends weekly bile acid measurements. These readings help doctors recommend when your baby should be born.

If your LFTs and bile acids are normal and you continue to have severe itching, the blood tests should be repeated every week or 2, to keep an eye on them.

Creams and medicines for ICP

Creams, such as aqueous cream with menthol, are safe to use in pregnancy and can provide some relief from itching.

There are some medicines, such as ursodeoxycholic acid (UDCA), that help reduce bile acids and ease itching.

UDCA is considered safe to take in pregnancy, although it is prescribed on what is known as an "informed consent" basis as it has not been properly tested in pregnancy.

You may also be offered a vitamin K supplement. This is because ICP can affect your absorption of vitamin K, which is important for healthy blood clotting.

Most experts on ICP only prescribe vitamin K if the mother-to-be reports pale stools, has a known blood clotting problem, or has very severe ICP from early in pregnancy.

If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you.

Further information

The Royal College of Obstetricians & Gynaecologists (RCOG) has more information about obstetric cholestasis, including what it means for you and your baby, and the treatment that's available. You can also get information about ICP from the British Liver Trust.

The charity ICP Support provides information about ICP. You can also watch their video about ICP featuring mums and clinical experts.

Community content from HealthUnlocked

Causes, Treatments, When to See Your OB

Scratch, scratch, scratch. All of a sudden it feels like all you can think about it how much you itch. Your pregnancy may have brought on a whole host of new “fun” experiences: dizziness, nausea, heartburn, or even trouble breathing.

You’d likely been warned about all of these from other pregnant women and weren’t shocked when you hit these milestones in your pregnancy journey. The last thing you imagined you’d be feeling though was itchy!

You hadn’t heard about intense itching during pregnancy from a lot of your friends, so now you’re wondering: What’s causing this? Is this normal? Should I be worried?

Although we can’t diagnose the exact cause of your itchiness, we’ve compiled a list of some common reasons pregnant women may be feeling the urge to scratch — and some signs you should head in to see your doctor.

There are many reasons why you may feel itchy during pregnancy. These might include:

Stretching skin. First pregnancies and pregnancies with multiples tend to cause skin to stretch quite a bit more than it is used to.
Dryness. Hormone changes in pregnancy can cause itchy, flaky dry skin.
Perfumes or fabrics. Different materials and chemicals can literally rub you the wrong way.
Hormones. The hormonal changes you experience in pregnancy can affect everything from mood to circulation to, yes, itchiness.
Cholestasis. This is a liver disorder that can result in the buildup of bile acids in the blood that cause feelings of itchiness.
Pruritic urticarial papules and plaques of pregnancy (PUPPP). This is an itchy rash that occurs around stretch marks during late pregnancy.
Prurigo. These crusty, itchy bumps on the arms, legs, or abdomen that can appear in any trimester.

It’s important to consider where on your body you are experiencing itching. Most pregnancies will involve some itching belly and itching breasts because the skin in these areas is going through so many changes.

Itching around your stretch marks may be a result of PUPPP, while itchy arm and leg areas are more likely to be a result of fabrics rubbing you the wrong way or prurigo.

Occasionally feeling slight itchiness is normal, but intense itching of the abdomen, arms, and legs can be a sign that your body needs some attention. Some people also experience vaginal itching during pregnancy, which may require treatment. In addition, sometimes there may be rashes associated with pregnancy itching.

Itching is not generally considered an early pregnancy symptom. In fact, many types of rashes typically only appear later in pregnancy and some may not resolve until after your baby is born.

That said, any time intense or prolonged itching appears during the course of your pregnancy it should be reported to your doctor.

Just as there are many potential causes for itchiness in pregnancy, there are a variety of ways to help alleviate any itching that you may be feeling. Consider these natural remedies you can try at home:

Change perfumes or detergents. You may even consider making your own soap/perfumes/detergents to avoid chemicals in commercial products that irritate your skin.
Wear loose clothing made from natural fabrics. (This will help keep potentially irritating fabrics away from your skin AND help keep you cool to avoid any heat-related rashes!)
Take an oatmeal bath or use a yogurt skin treatment. Lathering up with pine tar soap is a common home remedy for PUPPP.
Use a moisturizer to help with dry skin. Olive oil and coconut oil are both very moisturizing as are shea and coconut butter.
Apply some calamine lotion. This chalky pink liquid isn’t just for bug bites and poison ivy!
Increase your water intake and make sure that you’re staying hydrated. Don’t forget to include electrolytes in your hydration. Making sure to include some coconut water or a water with electrolytes added will help your body to make the most of the water that you’re providing it.
Turn on your humidifier and/or a fan. Keeping the air moist and cool will help with dry skin and itchy heat-related rashes.

Remember: If itching doesn’t improve or gets worse, it’s time to make plans to visit your doctor!

You should see your doctor if you have any of the following.

Signs of cholestasis

jaundice (a yellowing of the skin and the white area of the eye)
dark urine
lack of appetite
nausea
light stool
depression
intense itchiness, including itching feet

Cholestasis is a liver condition that results in a build-up of bile acids in the blood. There is not usually a rash, but the skin may develop a more yellow tone. In pregnancy, the condition, if it does appear, occurs in the third trimester.

Your doctor will diagnosis cholestasis with a blood test. A medical history will also typically be taken, because cholestasis can be an inherited condition and is more common if your mother or sister also had it during one of their pregnancies.

Many over-the-counter anti-itch medications will not be effective if cholestasis is the cause of your itch, but your doctor may be able to prescribe other drugs that can help alleviate some of the itchiness and reduce the amount of bile acid in the blood.

Ultimately, the solution to cholestasis is delivering the baby, and the itch will usually clear up within a few days of giving birth.

Because there is an increased chance of stillbirth, fetal distress, and preterm delivery, your doctor may want to discuss an earlier induction or more frequent monitoring during your pregnancy (and for a period after delivery) if you are diagnosed with cholestasis.

Signs of PUPPP

rash made up of small, pimple-like dots, typically spreading from stretch mark areas and not extending beyond the breasts
blisters around the rash
feeling extra itchy at night

Typically, your doctor will diagnose PUPPP through a skin examination. In rare cases a skin biopsy may be ordered. Blood work to rule out an infection may be done as well.

The ultimate cure for PUPPP is to deliver the baby, and the rash will usually be gone within a few weeks of delivery. Moisturizers, steroid creams, and antihistamines prescribed by your doctor, as well as itch relieving baths, can help to temporarily relieve itchiness until your due date.

Signs of prurigo

itchy, crusty bumps on the arms, legs, or abdomen

While moisturizers may help with the itch from prurigo, treatment typically involves topical steroids and oral antihistamines. If you’ve had prurigo during one pregnancy, there’s an increased chance that you’ll experience it in future pregnancies. While it may clear up shortly after giving birth, it can also unfortunately last for weeks or even months after giving birth.

If you feel intensely itchy or itchy for a prolonged time during your pregnancy, it’s a good idea to check in with your OB or midwife. They can prescribe medications, rule out various illnesses, and make sure that you and your little one are safe.

That intense itch you’re feeling during pregnancy could be due to many different things. It’s important to think about any other symptoms you’re experiencing, the timeline of your itchiness, and even just your daily activities to figure out how to solve this uncomfortable problem.

Because itchiness can be a symptom of a more serious condition, it’s important to consult with your doctor if it continues or any other symptoms appear.

After all, you don’t want your itching to distract you from experiencing the morning sickness, heartburn, and frequent trips to the bathroom you’ve been warned about from other pregnant women!

Why does the skin itch during pregnancy?

Skin itching during pregnancy is not a very common phenomenon. Most often, the skin begins to itch unbearably (as after mosquito bites) in the evening, closer to night, which can provoke insomnia and generally worsen a woman’s mood. Usually itching does not harm the baby and goes away after childbirth. However, it is still worth consulting with a gynecologist and dermatologist.

What does it come from? nine0005

The cause of itching during pregnancy in most cases is a violation of the liver: the production and outflow of bile, a general increase in the level of bilirubin in the blood. This is due to a hormonal failure in the body of the expectant mother - a violation of estrogen synthesis, as well as due to fetal pressure on the bile ducts. Fatty acids produced in large quantities enter the woman's skin with the bloodstream and irritate the nerve endings, causing excruciating itching. Similar phenomena associated with stagnation of bile in the body can make themselves felt in the third trimester of pregnancy. Sometimes itching is accompanied by such dangerous diseases as diabetes mellitus. nine0003

Who is predisposed?

Itching during pregnancy is usually observed in women with chronic diseases of the biliary tract and with high levels of cholesterol in the blood. Such future mothers need to regularly (at least once a month) do a biochemical blood test to exclude toxic effects on liver cells.

How to fight?

A pregnant woman should tell her gynecologist about the discomfort associated with skin itching. In some cases, itching can be a sign of the development of such a dangerous disease as hepatitis. The doctor will conduct appropriate examinations. If, according to an objective examination, itching does not pose any danger, it is often possible to get rid of discomfort simply by following a diet aimed at lowering cholesterol levels, limiting the intake of fatty, spicy and salty foods that prevent the liver from coping with the function of bile secretion, as well as drinking plenty of water - it is necessary to eliminate dry skin. If the diet does not help, the doctor may prescribe choleretic drugs suitable for pregnant women. nine0003

It is important to find the cause of the bothersome itching, excluding a whole group of skin diseases that can occur during pregnancy.

Itching in the abdomen and chest

This itch is worth mentioning separately. As a rule, the skin on the abdomen or chest itches in the second and third trimesters due to its stretching, because it is these parts of the body that increase in volume during pregnancy. In this case, it is very important not to scratch the skin - this will lead to the appearance of stretch marks, which, unlike itching, will not go away after childbirth. Regularly use moisturizing creams, special products for stretch marks, do a light massage of the chest and abdomen with circular movements of your fingers and do not take hot showers. nine0003

You can get answers to any questions about pregnancy and childbirth from leading EMC experts in the classes of the School of Moms.

Subscribe to our Instagram. You will find useful information about pregnancy and childbirth from leading EMC obstetricians and gynecologists.

Itchy skin during pregnancy: causes and remedies

Itching of the skin during pregnancy can be psychogenic. In this case, itching is a consequence of stress, an early symptom of multiple sclerosis. nine0003

In the early stages, itching occurs due to loss of skin elasticity caused by hormonal changes and excessive dryness of the skin. In the second and third trimester, the reasons may be the rapid weight gain of the expectant mother, the developing stretching of the skin of the abdomen as it increases.

Some expectant mothers experience intimate itching. It is provoked by genital infections, urological and proctological diseases.

The causes of skin itching also include dermatoses of pregnant women (atopic dermatitis, cholestasis of pregnancy). They are provoked by hereditary predisposition, decreased immunity, physiological changes (stretching of the skin with damage to the connective tissue).

Atopic dermatitis is the most common cause of itching during pregnancy. A specific condition is caused by hormonal immune restructuring of the whole organism. In 80% of cases, the disease manifests itself exclusively during pregnancy, and all signs disappear after childbirth without specific treatment. nine0003

Atopic dermatitis is more common in nulliparous women in the early stages and in the second trimester. Itching is caused by papular and exametic rashes localized on the face, neck, limbs, elbows, palms.

Atopic dermatitis is the most benign form of dermatosis of pregnancy and usually does not adversely affect the fetus. However, children born to mothers who suffered from this disease at the stage of gestation are also prone to allergic skin diseases. nine0003

Itching of the skin, as a symptom of cholestasis, is provoked by intrahepatic stagnation of bile as a reaction to increased estrogen production. The disease occurs at the end of the second - beginning of the third trimester, closer to the date of birth. A pregnant woman experiences severe itching in the abdomen, back, palms, legs.

Cholestasis is dangerous for the health of the mother and unborn child in severe cases of the disease. There is a risk of fetal hypoxia, delayed development and even premature birth. nine0003

Symptoms

The main sign of pathological changes is the appearance of irritating-itchy sensations in different parts of the body. Locally, a woman may also feel a tingling and burning sensation.

Other symptoms include:

blistering or eruption of blistering character;
peeling, irritation and redness of the skin;
formation of scaly spots;
sores and sores caused by scratching; nine0057
deterioration in general condition caused by sleep disorders and emotional depression.

In most cases, itching of the skin during pregnancy does not pose a real danger to the intrauterine development of the fetus, but significantly worsens the quality of life of the expectant mother, acts depressingly on the state of her nervous system and general well-being.

Diagnostics

In order to successfully deal with itching, it is necessary to establish the cause of it. The choice of diagnostic methods is determined based on the degree of intensity and localization of itching, the presence of concomitant symptoms and chronic diseases, the duration of pregnancy, and the individual characteristics of the health of the expectant mother. nine0003

Treatment is prescribed only after the exact cause of the itching is established.

At the initial examination, the doctor listens to the patient's complaints, examines the condition of the skin, paying attention to the appearance of rashes or spots. This allows you to draw a preliminary conclusion and determine what laboratory tests and instrumental studies will be needed.

The main diagnostic measures for itchy skin in pregnant women include: nine0003

general urine and blood tests;
biochemical blood test;
studies of hormone levels - if endocrine pathologies are suspected;
analysis of vaginal smear for microflora;
skin scraping examination;
allergy testing;
Ultrasound of the digestive tract, liver and kidneys;
histological examination;
analysis of feces for the detection of helminth eggs. nine0057

The choice of research methods is determined individually. In some cases, a pregnant woman is shown a consultation with an endocrinologist, urologist, gastroenterologist, venereologist.

Identification of atopic dermatitis is usually not difficult. In addition to the general examination, such types of diagnostics as dermatoscopy and examination under the Voodoo lamp are carried out.

If itching in a pregnant woman is allergic in nature, a mandatory diagnostic measure is the determination of the allergen (causative agent). nine0003

Treatment of itching

Although itching during pregnancy is not dangerous in many cases, it should not be tolerated either. You need to tell the gynecologist about unpleasant sensations, who will determine the diagnostic methods and, if necessary, give a referral to other specialists. Treatment of itching during pregnancy is carried out by the attending gynecologist together with a dermatologist.

You can not self-medicate and use medicines without the approval of a doctor. Many of them have contraindications and can cause severe side effects. A pregnant woman should remember the prohibition of scratching itchy places. This leads to a violation of the integrity of the skin, the appearance of wounds and abrasions, which will become places of infection. nine0003

The treatment regimen depends on the disease that causes itching. When choosing drug therapy, the risks of negative effects on the fetus are taken into account. This is especially true in the case of the appointment of antibiotics, hormonal and antifungal drugs. Self-medication is unacceptable!

In the treatment of itching during pregnancy, the following types of drugs can be prescribed:

antihistamines - to eliminate itching caused by dermatitis, urticaria; nine0057
glucocorticoids - used to treat dermatitis;
emollients - have a moisturizing and regenerating effect in case of excessive dryness and dehydration of the skin;
adsorbents and hepatoprotectors - to normalize the liver;
choleretic preparations - for the correction of the state of the digestive tract;
sedatives - to normalize the state of the nervous system, if a pregnant woman has signs of increased anxiety and sleep disturbances. nine0057

With moderate itching, a pregnant woman is shown taking baths with a decoction of a string or oatmeal. An oatmeal bath is effective for itching caused by stretch marks, eczema, or psoriasis. To prepare it, crushed oatmeal is mixed with baking soda and a little milk is added, the mixture is poured into a warm bath.

Lotions on herbal decoctions can be applied to itchy areas of the skin. Chamomile, succession or St. John's wort is poured with boiling water and insisted. After a few hours, the decoction for lotions is ready for use. nine0003

To eliminate itching of the genital organs, medicinal suppositories with local action are prescribed. Of great benefit are sitz baths of decoctions of sage or chamomile.

Itching in the abdomen, caused by skin tension, can cause stretch marks. To prevent aesthetic imperfections, it is necessary to moisturize the skin with special means.

To reduce itching, a pregnant woman should only wear clothes made from natural fabrics, preferably cotton. Natural fabrics allow the skin to breathe freely. It is useful for future mothers to take a cool shower without the use of soaps or bathing gels. The skin needs to be effectively protected from external aggressive factors: sun, frost and wind. nine0003

When itching of the skin appears, it is better to refuse the use of perfumes, take the choice of cosmetics very responsibly.

Prophylaxis

Itching during pregnancy can be prevented if you follow the doctor's recommendations and preventive measures. Tips for expectant mothers:

carefully observe body hygiene, take regular showers or baths without the use of fragrances;
refuse underwear and clothes made of synthetic fabrics; nine0057
after taking a shower or bath, moisturize the skin of the body with special products, with a neutral pH level, creams, lotions, emulsions are suitable for this;
use phosphate-free laundry detergents;
wear loose clothing that does not restrict movement;
avoid stuffy rooms or open places under the scorching summer sun;
exclude intense physical activity that provokes increased sweating; nine0057
provide the expectant mother with a plentiful drinking regimen that prevents dehydration of the body;
avoid stressful situations, get positive impressions.

Proper nutrition plays an important role in the prevention of itching of the skin. This is especially important if itching is provoked by various foods. The woman is recommended a hypoallergenic diet, with the exception of fast food, smoked, salty and pickled foods, as well as foods with preservatives, emulsifiers and artificial flavors. The diet of the future mother should be rich in vitamins, minerals, fatty acids, antioxidants. To do this, the menu includes sour-milk products, meat and fish of low-fat varieties, vegetable dishes, fruits. nine0003

Itching during pregnancy when following medical recommendations has a favorable prognosis and is not an obstacle to natural childbirth.

If a woman had signs of atopic dermatitis during her first pregnancy, the likelihood of a recurrence of the disease during subsequent pregnancies is high. At the stage of planning a child, it is necessary to visit a dermatologist.

Itching

A series of products "Emolium" effectively eliminates the symptoms of skin diseases, including itching, peeling, irritability. They are prescribed to moisturize the skin, eliminate dryness and tightness in atopic dermatitis, psoriasis, eczema, and allergies. Means of the Emolium series are used in the complex treatment of these and other diseases that provoke itching. nine0003

The main advantages of the series:

have a mild anti-inflammatory effect;
ensure the normal functioning of the skin;
restore skin structure;
retain moisture in cells and intercellular space;
restore the water-lipid layer;
relieve irritation and itching.

The delicate and delicate consistency of the products makes it easy to apply and distribute them over the entire surface of the affected areas. nine0003

With severe itching of pregnant women, a triactive series is recommended, taking care of atopic and damaged skin. Triactive cream enriched with rapeseed oil and sodium hyaluronate has anti-inflammatory, antibacterial and antipruritic effects.