Current Cosmetic Treatments in Pregnancy

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 Abstract—The goal of this work is to report the main
dermatological alterations occurring during pregnancy and actual
cosmetic protocols available and recommended for safe use.
Throughout pregnancy, woman's body undergoes many
transformations such as hormonal changes and weight gain. These
alterations can result in undesirable skin aspects that end up affecting
the future mother's life. The main complaints of pregnant women
involve melasma advent, varicose veins, edema, and natural skin
aging. Even if most of the time is recommended to wait for the birth
to use cosmetics, there are some alternatives to prevent and to treat
these alterations during pregnancy. For all these cases, there is a need
to update information about safety and efficacy of new actives and
technologies in cosmetic products. The purpose of this study was to
conduct a literature review about the main skin alterations during
pregnancy and actual recommended treatments, according to the
current legislation.
Keywords—Pregnancy, cosmetic, treatment, physiological
changes.
I. INTRODUCTION
OSMETICS are defined as preparations made from
natural or synthetic substances for external use: skin, hair,
nails, lips, teeth and mucous membranes of the oral cavity and
external genital organs; in order to clean, to perfume and to
protect, keeping their physiological and microbiological
characteristics and/or altering its appearance [1].
In addition to the issues associated with premature aging
and overweight, the main concerns during pregnancy leads
women to search for safe available treatments, especially for
skin and hair care, to maintain their appearance and well-being
[2].
During pregnancy, cutaneous alterations are caused by
hormonal increase, such as estrogen, progesterone, prolactin,
β-HCG, as well as due to changes in the metabolism of
proteins, lipids and carbohydrates, and change in immune
response. Consequently, to these physiological alterations,
skin abnormalities may occur, as pigmentation disorders
(lentigines and melasma) vascular disorders (varicose veins
and edema) and metabolic disorders (acne) [2].
Weight gain on an average of 22 pounds can be considered
a habitual change, resulting from the increase of fat and bodily
fluids, hormonal changes and other obvious causes, such as
the presence of the fetus and embryonic attachments. In
response to the weight gain, some changes occur in maternal
metabolism. It requires more energy to supply the
D. F. Maluf is with the Federal University of Parana, Curitiba, PR, 80210-
170 Brazil (phone: (55) 41-3360-4077; e-mail: daniela.maluf@ufpr.br).
F. Roters, was with Federal University of Parana, Curitiba, PR, Curitiba,
PR, 80210-170 Brazil.
L. S. Camacho is with with the Federal University of Parana, Curitiba, PR,
Curitiba, PR, 80210-170 Brazil.
physiological needs of the growing fetus like faster liver
metabolism, intermediate fast pumping of blood by the heart,
digestion and accelerated assimilation of food, in addition to
increased respiratory rate [3]. Besides these alterations,
gestational hormones are responsible for an increase of one
liter of blood. Some of the blood is needed to fill the breasts
and placenta and the remainder generates an increase in
cardiac output by approximately 30%. In this condition,
swelling in the legs raises a common complaint among
pregnant women, as well as some common dermatological
changes during this period [3].
II. LITERATURE REVIEW
There are three groups of dermatological problems
considered usual in pregnancy. The first one is the
exacerbation of skin diseases such as atopic dermatitis, lupus
erythematosus, leprosy, pemphigus and psoriasis. In the
second group are the specific dermatoses that appear during
the gestational period, known as gestational pemphigoid,
pruritus of pregnancy, pruritic folliculitis of pregnancy and
polymorphic eruption of pregnancy. These diseases can
generate risks to the mother and the fetus according to their
length, depth of injury, risk of infection and treatment. In the
third group, are those considered physiological skin changes
as the appearance of stretch marks (alterations in connective
tissue), skin pigmentation, vascular, hair and nails
modifications, besides acne appearance [4].
According to an exploratory descriptive study of Urasaki,
91.1% of pregnant women related abnormalities in the skin
during gestational period and 67.2% related that skin changes
affect their self-esteem and wellness. Pigment spots are the
major occurrences, followed by vascular changes, stretch
marks and acne [4].
There is a concern about safety of cosmetic treatments
when they are focused on pregnant women. Considering this,
the US FDA (Food and Drug Administration) established five
letter risk categories - A, B, C, D or X - to indicate the
potential of a drug to cause birth defects if used during
pregnancy. The A, B, C, D and X risk categories, in use since
1979, was replaced in 2015 with narrative sections and
subsections to include: Pregnancy (Pregnancy Exposure
Registry, Risk Summary, Clinical Considerations, Data)
Lactation (Risk Summary, Clinical Considerations, Data) and
Females and Males of Reproductive Potential (Pregnancy
Testing, Contraception, Infertility). Despite this update, the
old classification still remains usual in the literature [1].
Examples of non-recommended ingredients during gestational
period are mentioned above: essential oils, dichloroethane and
dichloroethylenes, xanthines, retinoic acid and its salts
(category C), hydroquinone (category C), benzoyl peroxide
Current Cosmetic Treatments in Pregnancy
Daniela F. Maluf, Fernanda Roters, Luma C. F. Silva
C
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(category C), Aluminum chloride hexahydrate (category C),
and large amounts of dyes and some fragrances [1].
TABLE I
FDA PREGNANCY CATEGORIES OF RISK
Category Description
A Adequate and well-controlled studies have failed to demonstrate
a risk to the fetus in the first trimester of pregnancy (and there is
no evidence of risk in later trimesters).
B Animal reproduction studies have failed to demonstrate a risk to
the fetus and there are no adequate and well-controlled studies
in pregnant women.
C Animal reproduction studies have shown an adverse effect on
the fetus and there are no adequate and well-controlled studies
in humans, but potential benefits may warrant use of the drug in
pregnant women despite potential risks.
D There is positive evidence of human fetal risk based on adverse
reaction data from investigational or marketing experience or
studies in humans, but potential benefits may warrant use of the
drug in pregnant women despite potential risks.
X Studies in animals or humans have demonstrated fetal
abnormalities and/or there is positive evidence of human fetal
risk based on adverse reaction data from investigational or
marketing experience, and the risks involved in use of the drug
in pregnant women clearly outweigh potential benefits.
N FDA has not yet classified the drug into a specified pregnancy
category.
A. Cosmetic Treatments for Stretch Marks
Stretch marks (striae gravidarum) are caused by the rupture
of collagen and elastin fibers in the dermis occurring mainly in
the hips, breasts, buttocks and abdomen regions during
pregnancy. They affect approximately 70% of pregnant
women between the sixth and seventh month of pregnancy.
Available treatments for stretch marks include aesthetic
procedures like laser protocols and carboxytherapy, besides
cosmetic use like ultra moisturizing and nutritive creams
containing actives which promotes collagen synthesis and
epithelial restoration.
Moisturizers like emollients and humectants are used in
order to treat or minimize the injuries caused by tearing of the
dermis. Alpha-hydroxy acids, ammonium lactate, siliceous
organic, lipids, phospholipids, cholesterol, fatty acid,
propylene glycol, glycerin and sorbitol can be cited as
ingredients for safe use during pregnancy [5].
Vitamin E plays an important role as antioxidant and
emollient agent due to its ability to prevent not only biological
molecules oxidation but also the transepidermal water loss.
For this reason, it is used in the treatment of rupture of
collagen and elastin fibers caused by dehydration or excess of
stretching [6].
Cosmeceutical ingredients may be included in the auxiliary
treatment of stretch marks, such as hyaluronic acid, panthenol,
allantoin, elastin and collagen. The hyaluronic acid is
considered safe for use during pregnancy, due its abundant
presence in fetus tissue. It is a polysaccharide of
glycosaminoglycans located in connective tissues of mammals
and intracellular spaces. Its main function is to keep water
binding in the epithelial and cartilage tissues, which maintain
flexibility and elasticity. Its use is freely recommended during
pregnancy period, but for assure permeation into dermis it
may be considered a low molecular weight state of hyaluronic
acid, obtained by fragments of the polymer and/or
nanotechnology process [7]. Likewise, panthenol
(pantothenol) is considered a safe option as constituent of the
skin [2].
At the end of pregnancy, it is usual that stretch marks be
more reduced, its appearance improves and the color becomes
pinkish white. After birth, some authors indicate the topical
tretinoin 0.1%, nighttime use, for the treatment of the
remaining scars, because it stimulates mitosis and cell renewal
of the epidermis and may be related to dermal collagen
synthesis. However, FDA agency classifies tretinoin as a risk
C substance, which means to be contraindicated for use in
pregnant and/or lactating women because of the risk to cause
problems for the fetus and the newborn child during
breastfeeding [2], [8], [9].
B. Cosmetic Treatments for Pigmentation Disorders
Pigmentary skin disorders are very usual during pregnancy,
affecting almost 90% of women in this condition, being even
more frequent in those who have darker skin [10].
The most frequent manifestation is melasma, and can be
prevented by using sunscreens and avoiding excess of sun
exposure [11].
One of the most suitable sunscreens is the physical filter
type, also known as inorganic, because they are not absorbed
through the skin and they have low skin-irritation potential.
They have been used in sensitive skin, children and pregnant
women. Their mechanism of action occurs through the
formation of a layer that reflects and scatters ultraviolet
radiation, not allowing it to be absorbed. The most common
molecules account for this blocking action of physical filters
are titanium dioxide and zinc oxide; they are semiconductor
materials that protect the skin according to the size of its
particles suspended in formulation, being the ideal size
proportional to the order of radiation [12].
The other category of sunscreens that can also be used, but
with greater caution because of the risk of dermal absorption,
is the organic UV filters. They are made up of ortho/para-
substituted aromatic molecules that absorb high energy
ultraviolet radiation and turn it into a lower-energy radiation,
harmless to human skin, allowing the excess energy be
released into the form of heat [13].
The minimum sun protection factor (SPF) recommended for
pregnant women is 15, values higher than 30 represent
unnecessary exposure to increase amounts of organic filters.
The effectiveness of sunscreens is related to the application
time before sun exposure. Ideally, it should be used half an
hour before sun exposure and reapplied each two hours or
whenever necessary [11], [14].
When hyperpigmented areas are observed on the skin of
pregnant women, even though proper care is taken, it is
recommended to wait until childbirth to treat these pigmentary
stains. During pregnancy, corrective makeup cosmetics seem
to be an appropriate procedure to camouflage stains in order to
offer a safe and convenient protocol for the psychological
welfare of women in this condition [15].
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For the treatment of hyperpigmentation, lightening agents
are topically used, and these cosmetics may act by different
inhibitory mechanisms: inhibition of melanocyte-stimulating
hormone (α-MSH), of tyrosinase activity and of melanin
transference by melanocytes. It is usual to prescribe
hydroquinone as skin bleaching, because it reduces the
melanin synthesis, but professionals must be cautious to
recommend it to pregnant women. The FDA classifies
hydroquinone as Group C of risk, and it is advised to lower
doses or equal to 300 mg/kg [8].
Another substance used for skin lightening purposes is kojic
acid, which is produced by Aspergillus fungi. Kojic acid
suppresses melanogenesis by copper ion chelation. This ion
plays a cofactor role in the tyrosinase activity. It is generally
used in emulsion (1-3%) associated with glycolic acid [16].
Azelaic acid can also be used to reduce hyperpigmentation
spots, and it does not act in regular melanocytes, which
prevents the occurrence of leukoderma (white spots) and
ochronosis (blue-black hyperpigmentation). According to
FDA, azelaic acid belongs to the Group B of risk, and can be
used by pregnant women, and also during lactation [8].
There is also another class of substances used for the
cosmetic bleaching treatment, represented by retinoids. Its
mechanism of action involves the dispensing of beads of
pigmentation of keratinocytes and increased cell turnover, thus
decreasing the hyperpigmentation of the skin. Oral retinoid
use is not recommended during pregnancy because of
teratogenicity. Although some studies have shown no
teratogenic action of topical retinoids, they are still not
recommended during pregnancy (category C by FDA) [10].
There are also alpha-hydroxy acids (AHA) to improve the
treatment of skin pigmentation. At low concentrations they
reduce the cohesion of the corneal extract corneocytes, and
stimulate the proliferation of cells in the epidermis. It is safe
for use by pregnant women at a concentration of 10%, in the
form of lotions, creams, gels, and solutions [17].
Natural products have been associated with different action
mechanisms. A common association is between chamomile,
phytic acid and arbutin. Chamomile acts by inhibiting the
endothelins, while phytic acid and arbutin by tyrosinase
inhibition. In addition, the phytic acid also has chelating action
of copper, which further increases their whitening efficiency
[18], [19]. These compounds demonstrate better stability when
compared to hydroquinone, lower toxicity, have no unpleasant
odor and are safe to use during pregnancy [20].
C. Cosmetic Treatments for Pregnancy Acne
Increase in progesterone levels during pregnancy stimulates
sebum secretion that, associated to hyperkeratosis and cellular
debris accumulation, promotes microbial proliferation and an
inflammatory process culminating in the appearance of acne
vulgaris lesions [21].
Oral medication treatments for acne are not indicated during
pregnancy. Antimicrobial soaps and scrubs are used quite
often, but these are not very beneficial and exfoliating can
reduce adherence to treatment through their abrasive power
and ability to cause skin irritation [21].
Cosmetic formulations based on azelaic acid exhibit activity
against Propionibacterium acnes, and they are indicated for
the treatment of initial stages of acne [8].
Nicotinamide is the active form of nicotinic acid (vitamin
B3) and its topical use may be an alternative treatment of mild
to moderate acne in pregnant women. It has anti-inflammatory
potential and it has comparable efficacy to topical antibiotics
[21].
Alpha hydroxy acids (AHA) are suitable for non-
inflammatory lesions, acting to reduce follicular plugging. It is
recommended applying a thin layer in the affected area, but
exacerbation of lesions can occur during the treatment
depending on the sensitivity of the skin and frequency of use
[22].
It is important to note that patients who undergo treatment
with AHA may suffer photosensitivity, requiring the
application of sunscreens. They also may experience
erythema, flaking and sensitivity, which are common adverse
reactions of this class of substance [21].
More severe cases of acne during pregnancy implicate in
efficacy-safety evaluation. If necessary, erythromycin can be
considered because of its relative safety. It exceeds the
placental barrier in low concentrations, and it is the first-line
antibiotic therapy in this situation. Other advantages of
erythromycin systemic treatment are the possibility of
concomitant intake of food, decreased occurrence of vaginal
candidiasis, and the absence of photosensitivity during the
course of treatment [21].
Alternatively, penicillins and cephalosporins are classified
in category B of risk, due to lack of documented abnormalities
caused by these drugs. Other classes of antibiotic, like
aminoglycosides, tetracycline, antimycotics and vancomycins,
should not be used during pregnancy because they are not
considered safe by regulatory agencies [8].
D. Cosmetic Treatments for Hair and Nail Changes
During pregnancy changes occur in the woman's body and
many of them are related to hypervolemia. It causes a non-
injurious dilution in maternal blood, but it can lead to anemia
mainly during the second trimester. This anemia is responsible
for the weakening of nails and hair of pregnant woman [23].
Additionally, there are a significant number of women of
reproductive age, which present low iron stocks and low
hemoglobin count, contributing to the onset of anemia [24].
Transformations that occur during pregnancy require a great
amount of vitamins, proteins, and minerals for maintenance of
the mother’s body and the fetus. In most cases, nail and/or hair
changes are caused due to some lack of these compounds,
requiring medical follow-up [25].
Hair growth involves three main phases and it is not
characterized by continuity. The first phase is marked by
growth (anangen phase) and may last from three to seven
years. It suffers interindividual variations according to gender,
age, genetics, diet and other factors. The second phase follows
the first one, in which the follicles come into involution and
cessation (catagen phase) lasting about four weeks. The cycle
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ends when the follicles enter a phase of rest (telogen phase),
marked by hair loss and returning to the anagen phase [26].
In pregnancy, when there is no anemia, an increase of
follicles in the anagen phase occurs due to the influence of
hormonal changes. For this reason, healthy pregnant women
feel they have stronger more voluminous hair than before.
After delivery, abrupt changes occurs in hormone levels which
promotes the evolution of the anagen phase to the telogen
phase, causing what is known as telogen effluvium, a diffuse
hair shedding. Under regular conditions, hair density returns in
three months [26].
Hair growth stimulating shampoos and lotions are
treatments widely employed. Spironolactone mechanism for
alopecia treatment is not well elucidated, but it is known that it
has antiandrogenic action inhibiting testosterone production
and competing with dihydrotestosterone in androgenic
receptors. For this reason, it is more indicated for alopecia
caused by the androgen hormone. Its use for pregnant women
is not recommended, because it can induce feminization of the
male fetus [27].
Minoxidil topical solution is used in concentrations of 1%
and 5%. It has been verified that this concentration range is
well tolerated by patients and it has minimal systemic
absorption, not bringing severe risks to health. The mechanism
of action takes place through its vasodilation property, which
increases the blood flow in hair follicles, favoring the growth
of hair. However, minoxidil topical should not be
administered during pregnancy because reduced conception
rates and an increased incidence of fetal absorption have been
observed in rabbits [28].
Among other therapeutic options is the use of progesterone
in topical solutions. It has similar structure to testosterone and
is a competitive inhibitor for the 5 alpha-reduction of
testosterone (an anti-androgen applied in alopecia). Its use can
be considered since with medical follow-up, avoiding its
application in weeks closer to childbirth [25].
In addition to the changes that can occur, some women feel
the need to continue the cosmetic treatments such as hair
coloring during this period. The Organization of Teratology
Information Services (OTIS) affirms that there are no reports
of hair dye causing damage in human pregnancies, and that
very small amount of the chemicals in hair dye is actually
absorbed into the body. OTIS recommends waiting to use hair
dyes until the second trimester [29].
Nails grow at a fast rate during pregnancy, and may become
brittle, soft, and dystrophy, with the appearance of transverse
grooves. The causes are not yet well known, but it is
recognized that these changes are reversible. The most widely
used nail cosmetics for all women, including pregnant women,
are nail polishes. The ideal at this stage is to replace acetone
for hypoallergenic removers [30].
E. Anti-Aging Therapy during Pregnancy
Skin aging is associated with the loss of fibrous tissue,
decreasing cell renewal and reduction of the vascular and
glandular network. These factors are responsible for intrinsic
aging, while the extrinsic aging is the result of the photoaging
caused by the incidence of UV radiation [31].
The most wanted aesthetic facial treatment is the anti-aging
treatment. The aging process has genetic causes, hormonal,
and environmental factors (UV radiation, smoking habits and
alcohol intake).
Many anti-aging cosmetics are produced with antioxidants
such as vitamin C, vitamin E, lipoic acid and ubiquinone, in
order to reduce the oxidative stress of cells, neutralizing
oxygen reactive species, and restoring the balance [32].
Vitamin C (ascorbic acid) is an antioxidant molecule that
acts for both peroxide and hydroxyl free radicals, besides
acting in the control of oxidative stress as an inhibitor of
metalloproteinase-1. Additionally, vitamin C promotes
collagen synthesis and has a lightening power due to
prevention of oxidation during the melanin synthesis process
[33], [34].
Another antioxidant option is vitamin E, also known as
tocopherol. An advantage of its use is for the prevention of the
appearance of age marks, and is safe for use during the
gestational period. This substance has four isomers, of which,
the major activity is the isomer ϒ; however, it is unstable and
does not allow application in cosmetic formulations. Thus, the
molecule used in formulations is the alpha-tocopherol with the
inconvenience of being photosensitive. Its action takes place
via the phospholipid link chain with the cell membrane,
leaving one side in contact with the water and the other with
the lipids; that way, the alpha-tocopherol capture free radicals
and rust, forming the alpha-tocopheroxyl, acting directly on
the inhibition of lipid peroxidation [34].
When formed, the radical alfa-tocopheroxyl can return to
the active form after reacting with ubiquinol. The result of this
reaction is vitamin E with the return of its antioxidant power
and the formation of ubiquinone. Ubiquinone has endogenous
synthesis, present in lipid in cell membranes, and it has an
antioxidant action and low molecular weight. When in the
presence of free radicals, ubiquinone stops the chain reaction
of free radicals. As it has endogenous origin, it does not bring
health risks to the fetus and to the pregnant woman if applied
in cosmetics [34], [35].
A third very common anti-aging active is lipoic acid. It is an
antioxidant that can be considered a superficial chemical
renewal. Its major activity occurs when in association with
ascorbic acid, protecting the biological membranes against
oxidation. It is believed that it has a great performance in
fibroblasts, reducing skin aging and also the damage on actin
[36].
The topical use of lipoic acid is effective when it is at
concentrations between 0.5% and 5%. It is safe for pregnant
women, since its use has presented no toxic events to the
human body [37].
In addition to the traditional antioxidants, are ferulic acid
and resveratrol. Ferulic acid is a derived plant compound
found in flaxseed and other sources, such as corn and rice
bran. It has high antioxidant effect, working as a cell
membrane and hindering the action of free radicals, with the
benefit of preventing the formation of erythema caused by
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UVB radiation. When associated with vitamin C, protective
potential increases becoming a barrier also to UV radiation.
Resveratrol, as well as ferulic acid, is a phenolic compound
found in many plant species including grapes. It has an
antioxidant activity related to cytoprotection of plant and
animal cells [38]. Resveratrol naturally occurs in Z and E
isoforms, the second one is the most active and easily
converted to form Z through photodegradation. Because it is a
phenolic compound, its action occurs through the hydrogen
molecule, which acts on free radicals. Resveratrol is
considered safe for pregnant women in cosmetic formulations,
but its use by oral administration can cause problems for the
fetus [39].
F. Cosmetic Treatments for Vascular Changes
Edema is the accumulation of fluid in the intercellular
spaces that hinders the capillary permeability affecting mainly
the lower limbs. Some of the causal factors are hormonal
changes, increased capillary permeability, increased capillary
pressure, hypoproteinemia, and compression of the venous
valves. In this phase, the heavy uterus presses pelvic and
abdominal veins, causing a swelling that can be redistributed
when the woman is in the reclining position [37].
In addition to edema, there are often other problems related
to movement accompanying pregnant women, such as the
emergence or worsening of preexisting varicose veins. There
are some risk factors for the development of varicose veins in
pregnancy such as age, family background, number of
pregnancies, weight gain, peripheral vasodilation induced by
hormones and compression of the uterus. This is a problem of
high prevalence among pregnant women, coming to be present
in around 70% of pregnant women, most in the second
trimester of gestation [40].
There are preventive measures that reduce the appearance
or worsening of this swelling, as the use of compressive elastic
stockings, proper diet and rest with elevation of the legs by a
proper period. When there is no reduction of the edema in
treatment, manual lymphatic drainage is indicated because it
improves symptoms like pain and tingling, and reduces the
swelling without major risks for the patient. However, the use
of diuretics during this period or lymphatic drainage
performed with equipment is not recommended [41].
Cosmetics used for edema relief are relaxing gels and
creams that contain arnica, hamamelis and horse chestnut. All
these substances have natural origins, but some of them may
offer serious risks to pregnant woman. Oral administration of
arnica, for example, may result in abortion due to uterine
contraction stimulation. When applied in the skin, arnica has
anti-inflammatory, healing and analgesic properties, in
addition to activating the circulation. Topical formulations
offer lower risk compared to the oral route of administration,
nevertheless pregnant women may avoid its application [42],
[43].
Witch-hazel is a shrub that blooms in the autumn and has
many therapeutic properties. Among them, we can highlight
their hemostatic function, anti-inflammatory and
vasoconstriction properties [44].
Another ingredient used in topical preparations for edema is
horse chestnut. It contains aescin, which is a mixture of
triterpenoid saponins, responsible for its anti-inflammatory
activity in reducing edema. Its use is quite safe for all
population groups, including pregnant women, and the
application of horse chestnut for edema is justified [45], [46].
Cosmetic products with camphor and menthol above 3%,
often found in moisturizers for pain relief, are not recommend
for pregnant women because they cross the placental barrier,
and have embryotoxic and abortifacient effects [44]-[46].
Another aesthetic problem experienced by women, not just
those during the gestational period, is cellulite. Cellulite is by
definition an edematous connective tissue infiltration, with
polymerization of amorphous ground substance, which
produces a fibrotic reaction manifested through nodules of
different sizes. It is caused by lipid accumulation on
adipocytes, which ends up retaining the greatest amount of
lipids and fluids, resulting in a worsening of local circulation
associated with the breakdown of collagen and elastin fibers
[47].
Topical cosmetics associated with lymphatic drainage
massages have broad action with performance in local skin
restructuring and lipodystrophy aid in drainage. Among the
major formulations it is possible to highlight those containing
plant extracts and methylxanthines [26].
The plant extracts containing xanthines derivatives have a
decongestant action contributing to drainage by improving the
microcirculation. Regarding their use during the gestational
period, there is no data to prove their safety to the fetus and to
the mother, mainly considering that these actives are often
vectorized by liposomes, which enhance their absorption
through deeper layers of the skin [48].
The methylxanthines group includes caffeine, theobromine,
theophylline, and aminophylline. By a combined mechanism
of AmpC increasing and phosphodiesterase (PDE) inhibition,
methylxanthines have a lipolytic action on the adipocytes,
resulting in a transformation of excess lipids in free fatty acids
removed through the lymphatic system of the body [49].
Caffeine is relatively safe since it does not exceed a
concentration of 5% in cosmetic products. Other xanthines
cannot exceed 4% of the formulation. Even so, its use is not
recommended in pregnant women [49].
G. The Use of Insect Repellents during Gestational Period
Cosmetic repellents act by slow release outward from the
skin of a chemical with repulsive odor to insects [50]. The use
of insect repellents by pregnant women has become a public
healthcare measure in tropical countries like Brazil, where the
incidence of potentially fatal diseases by the Aedes aegypti
mosquito (Zika, Dengue and Cikungunya virus) is alarming.
The main concern is the Zika virus infection in pregnant
women that causes microcephaly in newborns. In Brazil
(2016), 802,429 cases of Dengue were reported followed by
91,387 cases of Zika and 39,017 cases of Chikungunya [51],
[52].
For this reason, the use of repellents in cosmetic products
has been strongly recommended by pregnant women in
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tropical countries, mainly in the second and third trimesters of
pregnancy. The use of repellents containing, n-diethyl-meta-
Toluamide (DEET) 10% - 30% for pregnant women is
considered safe (AI). However, it is not recommended for use
in children under two years of age [52].
Other chemicals used as repellents include hydroxyethyl
isobutyl piperidine carboxylate (Icaridin or Picaridin) 10% -
20% (AII), ethyl butylacetylaminopropionate (EBAAP or
IR3535) and essential oils such as citronella, but there is no
safety study of its use in pregnant women [50].
III. CONCLUSION
Cosmetic treatments can represent a better choice when
compared to restricted drug options for the main complaints of
pregnant women. However, some ingredients can represent a
risk to the fetus and safety studies are being constantly
updated. Some divergences of safety information arise from
regulatory agencies from the USA, Europe and South
America. This aspect reveals the need of further cosmetic
harmonization.
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