The highest frequency is leukonychia (24.4%), followed by foot nail ingrown (9%) and onychoschizia (9%) which commonly found in third trimester. found that 62.4% of healthy pregnant women experience one or two nail lesions. Nail changes during pregnancy include hyperkeratosis subungual, distal onycholysis, transverse grooving, and fragile nail ( Table 1). 9, 10, 13 In addition, homogenous thinning of hair affects some women during late pregnancy due to the inhibition of anagen phase. 12 Aside from that, mild frontoparietal recession during pregnancy, resembling androgenetic alopecia, may happen and will not grow back to normal after delivery. 7, 11 Although complete hair growth eventually occurs, it seldom regains its previous thickness. 7, 9, 10 This condition persists for 1 to 5 months, and up to 15 months in some cases. Furthermore, telogen effluvium is common among this population due to elongation of anagen phase during pregnancy and increased number of hairs in telogen phase within 70 to 80 days post delivery. Other than that, hair changes such as hirsutism are found frequently on the face and sometimes on extremities and back of pregnant women. 6 Therefore, the latest and comprehensive information about the efficacy and safety profile of topical products during pregnancy are necessary. Safety profile data of topical products are either difficult to be obtained or not listed comprehensively in single reference guideline. However, some topical products have not been approved and categorized according to the fetomaternal risk by this worldwide known classification. 5 These categories can guide the physican and health practitioner in providing safe skin treatment for pregnant women. Food and Drug Administration of United States of America (US FDA) has classified 5 categories (A, B,C, D, X) in order to describe the drug potency for inducing congenital defects if it is used during pregnancy. Although most of treatments are recommended to be used only after delivery, there are some alternative therapies to prevent and treat skin lesions during pregnancy. Clinical trials and systematic review regarding the safety profile of topical products in pregnancy are very limited due to ethical issue. Dermatologists are often asked regarding the safety of prescribed topical and systemic drugs during pregnancy. In general, there are some concerns regarding the safety profile of the skin care products for pregnant population. 3 Therefore, treatments options with good safety profiles, especially topical products, become an important issue among pregnant women. Skin pigmentation is the most common problem during pregnancy, followed by vascular changes, stretch mark, and acne vulgaris. 2 A descriptive study by Urasaki revealed that 91.1 percent of pregnant women developed skin lesions associated with pregnancy and about 67.2 percent of the skin changes has been affecting their confidence and health. 1 One of the prominent physiological changes during pregnancy is the increase of androgens, which induce progression or worsening of acne vulgaris and increasing of hair growth in several body parts. All of these conditions are associated with alteration in hormones, vascular, metabolism, and immunologic conditions during pregnancy.
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