A rosy glow is not all that happens to a pregnant woman’s skin. She might also have to deal with bumps, blotches, masks, and rashes.

You are positively glowing! You must be pregnant!” In real life, expectant moms rarely hear these words from kind strangers.In fact, only a few very lucky women can list radiance as the only dermatological trait they experience during pregnancy.

The vast majority of expectant moms have to put up with dark blotches on the skin, hair growth in unusual areas, thinning hair on their head, rashes, acne, stretch marks, brittle or splitting nails, and worsening of existing skin conditions.

“Pregnant women often do get the rosy glow, but they also get a lot of other things,” says David Leffel, MD, professor of dermatology at Yale School of Medicine in New Haven, Conn. and author of Total Skin.

“When you are pregnant, your body produces an enormous amount of growth factors and has a higher blood flow going through it, so you do get a rosy glow because of increased blood flow to the skin, but that increased blood flow can also lead to broken blood vessels known as spider angiomas,” he says.

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“The body goes through a lot of changes during pregnancy including hormonal fluctuations that can affect the skin, the hair, and the nails,” agrees George Kroumpouzos, MD, PhD, a dermatologist at South Shore Medical Center in Norwell, Mass. and the co-author of “Dermatoses of Pregnancy,” which appeared in the July 2001 issue of the Journal of the American Academy of Dermatology.

“If they are concerned about something on their skin, their hair, or nails during pregnancy, pregnant women should see a dermatologist and see if anything needs to be treated,” Kroumpouzos says.

Here’s the lowdown on what to expect when you are expecting, skin-wise:

Acne

If you thought your days of breaking out ended with your senior prom, think again, says Bruce E. Katz, MD, medical director of the Juva Skin and Laser Center and an associate clinical professor of dermatology at the College of Physicians and Surgeons of Columbia University, both in New York.

“The biggest problem pregnant women have is that their acne gets worse,” says Katz, also director of the Cosmetic Surgery & Laser Clinic at Columbia-Presbyterian Medical Center in New York. “They will break out on their face, chest, or back.”

On the flip side, some women actually report their acne gets better with pregnancy, he tells WebMD. “Acne is a hormonally-driven condition, which is why some women take oral contraceptives to clear up their complexion, so it makes sense that hormone fluctuations during pregnancy would affect acne,” he says.

In addition, oil glands respond to androgen, the male sex hormone that increases during pregnancy, too. This causes the oil glands to produce large quantities of oil called sebum, which clogs the opening of the oil gland and results in a “blackhead.”

But don’t panic, your skin will most likely clear up after pregnancy. “If breakouts are severe while pregnant, there are certain safe medicines we can use during pregnancy including topical antibiotics,” he says.

“Cleansing daily with an over-the-counter cleanser that contains alpha-hydroxy acid can also keep breakouts to a minimum,” he says.

Spider Woman?

Spider angiomas are collections of tiny dilated blood vessels that usually radiate from a central point and resemble the legs of a spider. “They are thought to be related to changes in hormone levels, which is why they can come out during pregnancy,” Katz says.

“Some women develop angiomas during pregnancy on their face, chest, or sometimes on the arms or the abdomen, ” he says. Angiomas may clear up after pregnancy, but if not, they can be treated effectively with lasers, he says.

Stretch Marks

More than 90% of pregnant women will develop stretch marks in response to the pulling and stretching of underlying skin during pregnancy, Kroumpouzos says. Stretch marks are pink or purple bands in the stomach area and sometimes on breasts or thighs.

“Exercise and use of lotions or creams with alpha-hydroxy acids can be used to prevent stretch marks from occurring,” he says.

Mask of Pregnancy?

Chloasma, also known as melasma or the mask of pregnancy, occurs when the sun-exposed skin on the upper cheeks, forehead, and/or upper lip turns a tan, brownish color because excess pigment is deposited in the skin’s upper layers.

“This is a similar phenomenon that occurs when women take oral contraceptives and very often it will go away after pregnancy,” Leffel says. And, “in some cases, it persists and we have to try different treatments including bleaching creams or chemical peels after delivery.”

It’s a good idea to use sunscreen during pregnancy to prevent chloasma from occurring or to prevent existing patches from getting darker, he says.

Hair

“Three months after delivery, a lot of women lose hair on their head,” Katz says. “This shedding is called telogen effluvium, but often it will grow back.”

It should, however, be followed by a dermatologist to make sure there is complete regrowth, he adds.

Hirsutism, which occurs when women grow hair in typical male spots such as the lip and chin, can be triggered by the hormonal changes of pregnancy.

“It is not too severe most of the time and it’s also not permanent and tends to disappear within six months of delivery,” Kroumpouzos says.

Rashes

Pruritic urticarial papules and plaques of pregnancy (PUPPP) is the most common skin condition specific to pregnancy. Women with PUPPP develop small red bumps and hives, and when severe, the bumps form large patches. This rash usually starts on the abdomen and spreads to the thighs, buttocks, breasts, and arms.

“You feel itchy everywhere during the worst and last trimester,” Leffel says. However, he adds, anti-itching topical medications, antihistamines, and topical steroids can control the itching.

Nails

Nails can change during pregnancy, too, Kroumpouzos says. “Women may report splitting or rough surfaces although we are not sure exactly why this occurs,” he says.

Existing Skin Conditions

Skin tags or “benign hanging things around the neck are hormonally related and tend to increase in number during pregnancy,” Katz says. “We don’t know why, but it may be that the increased blood flow to the skin encourages the tissue to proliferate,” he says.

“Skin tags increase in numbers, moles can change color slightly and so can benign tumors, scars can become noticeable — all because the high levels of estrogen have some effect on these tissues,” Kroumpouzos agrees. “They may go away or change back after delivery,” he says.

“Pregnant women with certain skin diseases are more likely to experience an aggravation, or less often, an improvement in their condition,” Kroumpouzos says.

For example, women with atopic dermatitis, a skin disease causing itchy, irritating skin lesions, may experience a worsening during pregnancy. In some cases, atopic dermatitis may develop for the first time during pregnancy, he says.

Psoriasis, a skin condition marked by raised, thickened patches of red skin covered with silvery-white scales, may improve during pregnancy. This improvement may be attributed to the high levels of interleukin-10 in pregnancy, a protein that is released by one cell to regulate the function of another, Kroumpouzos says.

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