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S2:E5 What Happens to the Vulva? And Other Pressing Pregnancy Skin Issues with Dr. Kavita Mariwalla

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S2:E5 What Happens to the Vulva? And Other Pressing Pregnancy Skin Issues with Dr. Kavita Mariwalla

Season 2 Episode 5 Full Transcript: What happens to the vulva? And other pressing pregnancy skin issues with Dr. Kavita Mariwalla

[Amy Gordinier] Total Skin Nerds is brought to you by Skinfix. We're clean, clinically active, and on a mission to deliver healthy skin.

 Welcome to Total Skin Nerds. I'm Amy Gordinier, founder of Skinfix. Total Skin Nerds is where I get to nerd out with some of the world's foremost experts in skin. We deep dive into issues related to skin disease, skin care ingredients, diet and lifestyle modifications to support skin health, and even spiritual practices and their skin benefits. I'm truly excited for this episode of the Total Skin Nerds podcast. Today, in season two episode five, I'm speaking with board certified dermatologist and fellowship trained Mohs surgeon, Dr. Kavita Mariwalla. Dr. Mariwalla has been a great friend of ours at Skinfix for many years now. In fact, she currently serves on our scientific advisory board.

Dr. Mariwalla is one of North America's foremost experts when it comes to the skin, how the skin works, and why it reacts the way it does. That kind of knowledge is invaluable during pregnancy when so many things are in flux, and our skin can change drastically from day to day. We'll talk about what happens to the skin during and after pregnancy, the kinds of products to use, and the types of products to avoid. We'll touch on Melasma, the effects of sleep deprivation, and Dr. Mariwalla will even break some news about stretch marks. Stay tuned, skin nerds. It's all ahead.

[Amy Gordinier] So, Kavita Mariwalla, Dr. Kavita Mariwalla, on the Total Skin Nerds podcast, season two, we are so excited to have you. This woman is a machine, she's incredible. I don't know how you do it. You have three boys, you have an incredibly successful practice. You mentor other derms, you work with lots of different people. You're amazing. The ideas we get from you and the things that you help us with in terms of our product formulations, and how we market, and how we talk to derms. So, you're incredible. But we wanted to talk today a little bit about skincare and pregnancy, because we get lots of questions. And I always refer to your advice when we're asked. And I know you have a pretty strong opinion about, which I love, about what to use and what not to use and why. So, we wanted to talk a little bit about skin care and pregnancy, and let the listeners hear from the expert. First and foremost, what is happening to our skin when we're pregnant? What are some of the changes that you see that occur?

[Dr. Kavita Mariwalla] So, the way I explain it to people is when you are pregnant, your number one goal at all times is just to bake that baby. All the things are just making that baby come out fine. And that's no small feat, and it's no small feat because it requires a lot of metabolism from you. It requires a good amount of sleep that definitely decreases and is less comfortable with time. And it requires healthy eating habits. And it requires just general healthy habits of exercise, moving, so that your body's strong enough to carry this baby to term. So, what does that mean for your skin? Well, first of all, your blood flow increases overall, your overall blood volume actually increases in pregnancy because you've got your circulating blood volume and you have to have enough blood volume to circulate around the baby.

 So, that means you tend to get a little bit more red. Some people will say old wives tale, like, "Oh, we know you're having a girl or a boy if your face changes, or certain characteristics about you change, you get more cherry angiomas," those little red dots. People's moles darken, the same hormone that keeps your placenta intact and gives you that brown stripe on your belly actually makes your moles darker. So, you have to make sure you're seeing your dermatologist because turns out you can actually have abnormal moles while you're pregnant. Your moles can change. And then things grow. So, you grow skin tags, the good part is your hair grows, and your nails grow faster, but your skin can also ... If you were somebody who didn't break out, you can start breaking out because it's a change in hormones.

 If you are somebody who used to break out, it might all clear up. Same thing happens with eczema. You can have the most amazing nine months of your life, but then afterwards your eczema will come back, and psoriasis is the same way. So, think of pregnancy like an inflammatory state. It's a beautiful thing, because you're making a baby, but there's a lot that your body's trying to do 24/7 to keep this little human alive in you. And so, I tell people, "Don't add stuff." Now is not the time to be worrying about your wrinkles, and your volume loss. Just bake that baby. That being said, I don't think that means that when you're pregnant you can't enjoy things, and you can't partake in luxurious self-care. Especially as the months go by, sometimes all you need is a calming soothing bath to just get it all together.

[Amy Gordinier] Yeah. So, speaking of baths, how do you feel about essential oils and pregnancy?

[Dr. Kavita Mariwalla] So, it depends on the essential oil because as it turns out, some essential oils can actually induce labor. So, you want to be really careful with that, especially if you're using it in different parts of your body, but it's not unheard of for people to try to induce labor using certain essential oils in certain areas of the body. So, you've got to be careful with that. And remember that essential oils also, depending on where you put them on your body, can elicit an allergic reaction. So, if you're somebody who's never used an essential oil before, now's not the time to start. And they can also cause a little bit of a, what we call a phyto-photo reaction. So, let's say you're doing essential oils on your skin, and it smells so good, and it's great. And then you go outside, all of a sudden you might end up with a sunburn because some of them are sensitizing.

 So, I tend to tell people, instead of trying brand new ingredients, try to go for brands or products that are…have fewer things, but in almost better quality because I think you can still do luxurious stuff without having to delve into something that's highly fragranced, or really texturized, or massive amounts of exfoliation.

[Amy Gordinier] Now, if you're using essential oils before you get pregnant, and are not having any sensitivity, is it safe in most cases to continue to use those?

[Dr. Kavita Mariwalla] Yeah.

[Amy Gordinier] Okay.

[Dr. Kavita Mariwalla] Pregnancy doesn't typically make you more sensitized. You know what I mean? It's just one of those things where if you've never been using it before, now's not the time to dip into the lavender essential oil for all of your hair care needs, or the pumpkin seed oil for your hair care needs because if you've never done it before, you don't need to do it now.

[Amy Gordinier] Okay. Got it. So, now let's talk about the belly a bit, because you have talked about this in different articles that we've read, and talk a little bit about taking care of the skin on the belly, because it's obviously being stretched and can end up with stretch marks. And what would you recommend someone do to really keep that skin supple, and healthy, and try to avoid, if possible, stretch marks, which I know aren't always easy to avoid.

[Dr. Kavita Mariwalla] So, this is something near and dear to my heart because I do think stretch marks make people feel gross. They make them feel like, "Oh my God. Now my whole body is ruined? And what am I going to do?" And to some extent, they're inevitable. We have these wives tales in our heads that like, "Oh, if I just moisturize a lot, I'm going to avoid stretch marks." That's not true. So, the predilection towards a stretch mark is actually hereditary. Obviously if you gain an excessive amount of weight, you're going to stretch, your skin's literally going to stretch around you. And what happens in the stretch mark is the elasticity, or the elastic fiber, loses its integrity. And so, the skin literally stretches, and that elasticity, because it's not great, breaks down. And so, the result is that you get this stretched or thinned part of skin. And people will say like, "Oh, you can't undo it. You can't undo it."

 Well, you can make it look softer with topical agents after pregnancy. You can definitely do things to make the texture look better, but it won't ever be the same as normal skin again. And that's the finality of it. Sort of stinks. It feels, "Oh my God. Now what?" And it's a source of I think a good amount of sadness for people, especially if you're somebody who had a normal looking belly before, and then there's nothing you can do to really prevent it. And then you have it, and there's not a lot of great options for afterwards. So, I think because of that feeling of just hopelessness, people try a lot of stuff, and they're willing to believe a lot of things that will prevent them. And so, that's why you get this whole myth of, "Oh, if I use this cocoa butter, or this body butter, or this shea oil, or whatever, that my stretch marks won't happen."

 Some people just have good luck, and some people don't. And so, for me, I'm somebody ... I had terrible luck. I had the cutest belly. It was perfect. And then at eight months I was like, "Oh, I'm itchy." And it was as if overnight. And I was like, "Oh my God." And so, now will anybody ever see my belly in a bikini? Of course not. Is that the worst thing that ever happened in the world, would I trade my kids for it? Of course not, but does it still sometimes bum me out? Of course, it does. You feel you lose a part of you in order to have your children. And it's almost an always visible marker that that's happened. That being said, I think there's a lot of ways to smooth them, to make them not look as obvious. And I am all about the empowering movement of they're your tiger stripes.

They're the marks that you've created a human and you are here to tell the tale of it, because that's a pretty crazy, awesome thing. So, I think there are things that happen to moms with their bodies that in pregnancy are just tough to accept sometimes, but know that even though people don't always talk about it, every single woman who's had a child has had something that afterwards you're like, "Wait."

[Amy Gordinier] That's not the same, that didn't go back to where it was before. 100%. And I think the body positivity movement on Instagram has actually been really positive.

[Dr. Kavita Mariwalla] Yeah. For people to show people that this is what my belly looks like is good. I might not flaunt it in a midriff, but if you want to, that's amazing. As a dermatologist, I see bodies all day long. So, to me, it all is normal. That doesn't phase me. I don't think anything's weird about it. It's great. But for a lot of people, they don't see women's bellies all day long. So, they're thinking, "Oh my gosh, I'm the only one who has this." So, I'm a fan of people having ... talking about it, showing their bodies, showing people what it looks, and being able to do that. So, but again, I think moisturizing is really important. I think that making sure that everything is healthy and safe is a really good thing.

[Amy Gordinier] Now, you talked about itching. So, when you feel that itching, does that typically mean things are starting to stretch? Is that why we get itchy?

[Dr. Kavita Mariwalla] Yeah.

[Amy Gordinier] Okay.

[Dr. Kavita Mariwalla] So, I think that's also why people find that moisturizers help them because if you keep...there's one concept that if that elastic fiber gets weakened, or loses its elasticity and stretches, if you can keep it hydrated and your skin barrier, which we know a lot about, stays intact and you don't have as much inflammation, can you have a decreased length of that stretch mark, or width of that stretch mark? And I do think that that's true. So, what I would tell people is the presence of a stretch mark, or getting a stretch mark is a little bit genetic, so don't sweat it. But that the extent to which it happens and the depth and length of that line can sometimes be modulated by really good hydration and moisturizing.

[Amy Gordinier] Okay. And would you recommend using products for eczema if you're itchy? Things that have colloidal oatmeal, sweet almond oil that might help calm the itch?

[Dr. Kavita Mariwalla] So, I know that those products are marketed for eczema, but what I would actually encourage people to realize is those in ingredients are universal as skin soothers. So, I love colloidal oatmeal as a skin soother. If you have eczema, will it work particularly well for you? Absolutely. And the data suggests actually that using colloidal oatmeal regularly repairs the skin barrier. Because here's the thing, we talk about your skin being able to repair itself and that barrier improving, and people are often like, "Oh, skin barrier," and they just use that word. But it's literally the armor around you that prevents infections, that prevents you from dissipating into the universe. It keeps water in and bacteria out. And when it's in disrepair, you develop three cardinal symptoms, inflammation, itching, and some sensitivity. So, sensitivity, itch, inflammation, redness are all signs of a disrupted barrier.

 The extent to which that happens can be eczema. But if you back it up a little bit, you could just end up with sensitive skin, or just it that itches every once in a while. When you're not hydrated, not only does your barrier not recover or repair itself, but it does it in a slower way. So, hydration is almost putting the glue back in the cracks, repairing it with the mortar, but also speeds the kinetics of skin barrier recovery. So, now, stay with me on the journey for a second, you've got something that's hydrating, and it's got colloidal oatmeal, and it's got sweet almond oil. So, now you've got something that just alone is going to speed recovery, decrease itch, colloidal oatmeal's going to advance the skin barrier repair mechanism, and sweet almond oil is ...has enough of a humectant and oil in it to really help nourish and moisturize the skin.

 So, now it's not just any moisturizer, it's like plus-plus. And so, for me in pregnancy, those are the kinds of products you want to look for because it's still luxurious, and it doesn't have to have all these new ingredients. I've never heard of anyone being allergic to colloidal oatmeal actually. So, you don't have to venture out to all these crazy things. You can do something really good for your skin. So, it's fewer, better ingredients, and that's the kind of thing I like to steer patients towards in pregnancy because now you're ticking off all the boxes of ingredient story, why it works. And "Hey, I'm pregnant. I don't have to worry about it being toxic for me, or bad for the baby."

[Amy Gordinier] Awesome. And FDA approved to treat the itch irritation associated with eczema. So, perfect for an itchy, stretching-

[Dr. Kavita Mariwalla] An itchy belly.

[Amy Gordinier] ... pregnant belly. Itchy belly.

[Dr. Kavita Mariwalla] Itchy belly.

[Amy Gordinier] So, let's talk about dark spots, because melasma, and that dark line you get on your belly, clearly I had the mask of pregnancy when I had both my kids. I'm very prone to melasma. So, what do you do if you can't ...what can you use? Or is there anything you can use while you're pregnant to treat melasma? Or should you just ride it out and wait until you've had the baby, and you're done breastfeeding, and then do something about it?

[Dr. Kavita Mariwalla] Well, it turns out that the number one thing you can do to treat melasma is use sunscreen. So, that you can do any time of year, in any condition that you're in. But the actual things that we use to lighten pigment, I always tell people to just hold off because you don't ...while you have to disrupt that tyrosinase pathway for the melasma, some of it, even though it's hydroquinone free, there's something about it that I don't love my pregnant patients using. So, I tell them, "Definitely use sunscreen," but afterwards, and you can do it during breastfeeding can go ahead and start using agents to help lift that melasma out. If you want to wait until after breastfeeding, no problem. But I don't have a real big problem with ingredients that are going to help lift pigment during breastfeeding. But during pregnancy, then again this is just my being a super conservative person, following my mantra of just bake the baby, I tend to tell people to go easy on skincare for that. But sunscreen, sunscreen, sunscreen all the way.

[Amy Gordinier] Okay. And how do you feel about chemical versus physical sunscreen during pregnancy?

[Dr. Kavita Mariwalla] You know, I'm somebody who I like to meet patients where they are for their sunscreen use. And so, if you said to me, "Well, do you think that you can get absorption of chemical sunscreens?" I want to just point out that, that came from an FDA study that was a max use test. And what that means is they were trying to use as much sunscreen as possible in a maximal way to see if anything gets absorbed. That is the definition of a max use test. So, what they did is they had some volunteers, they put them in a room without any sun. So, already the actual mechanism of a chemical filter is being hindered because when UV hits it, that filter starts to degrade. But you have no UV in this room, and you slather it on them. You didn't put it on somebody else, put it on for you.

 So, they're using the exact amount that one uses every two hours. And I will tell you, there's not a person on the planet who uses sunscreen like that. It's for like three days. And then they're like, "Oh, can we measure any of it in your body?" So, there are a couple that showed up in tiny amounts in your bloodstream. Well, yeah, it's a max use test. That's what it was for. So, I think that to step back from that, if you say to everybody, "Oh, chemical sunscreens now can be found in your body and your bloodstream," but then you have a whole population, like my skin tone, that a lot of physical sunscreens just don't look good. I mean, there's a couple, maybe, that absorb okay. And they look fine, but it's not like it looks great. It's not like it looks really like my skin tone.

 It always leaves a little bit of a cast. So, you're already telling people, "Well, this chemical sunscreen is no good," which is not true. And you can only use a physical sunscreen, which will make you less likely to use it because it doesn't look good on you. Well, how are you doing anybody a service in that way? We know that the sun causes skin cancer. We know this. Does every use of a sunscreen get absorbed into your skin? It absolutely does not. I've never, and I've been doing this for a very long time, there's never been a reported case of a carcinoma caused by the use of sunscreen. That has not been reported. So, again, I think it's important to always keep these studies in mind, and what gets picked up in the media. And are we now starting to examine the sunscreen ingredients more?

 Absolutely. But why is that? Well, because they weren't tested to this extent 25 years ago, because the types of testing we did 25 years ago weren't what we have now. So, I think we have to keep things in balance a little bit. And when it comes to sunscreen, again, as somebody who does skin cancer surgeries all day, I am somebody who truly believes you've got to meet patients where they are. And if you're not going to use a physical sunscreen, then you know what? A chemical sunscreen's better than doing nothing, because the idea that you're somehow not going to go outside is not going to happen.

[Amy Gordinier] Or get a glare through your window, or-

[Dr. Kavita Mariwalla] Yeah.

[Amy Gordinier] ... yeah, absolutely. Well, I think that makes sense. I mean, as you say, you're on the front lines, you see people all the time and we certainly don't want to get skin cancer. So, let's talk about acne during pregnancy. And topicals and ingestibles. What is your protocol if one of your patients comes to you, and they're pregnant, and they're taking ingestibles for acne, or they're using topicals? How do you rework the protocol?

[Dr. Kavita Mariwalla] Yeah. So, most of the pills or orals that are used for acne are not really safe in pregnancy because a lot of them revolve around antibiotic use. So, I'm a hardcore don't do it person. And we actually, before all our acne patients get treated, we always ask are you planning on having or starting a family? Or what's that plan, just so that we can cater around it? And we tell them the things that we're giving to them, just make sure you don't get pregnant when you're using it, et cetera, et cetera. So, we do that on the medical side for sure. Now, what happens is you can't control what people use over the counter, and there are retinoids that are available over the counter. And so, for a long time we said, "Look, you shouldn't be using a retinoid in pregnancy."

 And the company that went and got FDA approval for it to be sold over the counter, was like, "Well, there's never been a case of a problem with a pregnant woman using a retinoid." And it's like, "But that's because doctors don't write that," because it's always been by prescription. So, they got approval. I'm very careful to tell patients not to use retinols or retinoids during pregnancy. Is it going to lead to horrible things? I don't think so, but I wouldn't do it. It's just not considered safe. The other thing is that we used to tell people don't use benzoyl peroxides. You can do a basic wash. Just don't leave it on your whole skin. Salicylic acids are out in pregnancy, but interestingly you can use a glycolic in pregnancy.

 You can use azelaic acid in pregnancy. I love azelaic acid, but you definitely want to stay away from the BHAs and that kind of thing. But azelaic acid is great. And you can use a benzoyl peroxide wash, and then I don't mind the LED lights during pregnancy either. I think those blue lights for acne are quite good. And then I always tell people, "Go see your derm," because there are certain things you can do that are out of the box for acne that you wouldn't necessarily think of as an over the counter option.

[Amy Gordinier] And are there any issues, as far as you can tell, from any of those acne topicals or ingestibles if you're trying to get pregnant? Should you give up using them even if you're thinking about trying to get pregnant?

[Dr. Kavita Mariwalla] Yeah. The tricky thing about trying is that you often don't know you are pregnant until you're about four to six weeks. So, you may think you're not pregnant today, and then tomorrow you're like, "Oh my God, what date is it?" And then you're pregnant. So, I always tell people, "If you're thinking of trying, if you're not-not trying, don't use this product."

[Amy Gordinier] Right, right. Now, what about if you are...you have psoriasis, and you're on medication for psoriasis. What is the protocol for pregnancy with psoriasis?

[Dr. Kavita Mariwalla] In my pregnant patients, there are some biologics or injectables that you can use, and have been shown to be safe in pregnancy. But I would only do it under the guidance of a dermatologist. We try not to use too many steroid creams. And I think one thing I would point out is that at each trimester there's different milestones that the baby hits after which the risk of bad things happening change. So, in that first trimester is when you want to be the most careful about everything because that's when organs are forming. And so, certain chemicals can have much more impact in those early weeks than they do later on. And then in that up to 20 week phase, you just try to be careful of not ingesting crazy things, and you can maybe relax a little bit.

 And then once all the organs are formed, which are about 20 weeks, then you can do a little bit more than you might otherwise in terms of medications. After 20 weeks, I will, if somebody really needs it, I'll give them a topical steroid for a short period of time. But before then I'm like, "No, no, no, no, no." And that's when we do use a lot of the topicals under occlusion, I'll do certain moisturizers I love with Saran Wrap. You do these cold to damp dressings. So, I tell them, "Wet pajama, dry pajama." So, they'll take a pajama top and bottom, make them damp. And then with warm water, rinse it out and then put that on the skin over an emollient that they've layered on. And then they put dry pajamas on top of that.

 So, then everything dries, and they leave that on for about 10 minutes, everything dries. And then their skin gets a lot better. So, that itching improves. Everything else improves, because it's a moisture level. It's almost it creates a little humidity barrier in there. And I love that for hands too, because pregnant women, they're always washing their hands and stuff like that. I mean, all of us are now, but for hand dermatitis I do wet sock, dry sock. So, I'll take someone's 911 for example, which I use a lot for many things. It's like my Windex, but so I would tell them to layer the 911 on, put that everywhere, then put a damp sock on, then a dry sock on, and just sit there, watch a movie.

 And when you take it off, your hands are brand new. And I do that for children. I do that for pregnant women. You're using the elements of skin barrier. So, you've got an emollient, you've got a humid layer that you've created. And then occlusion. So, you're driving water through a barrier to improve your barrier repair. And then it gets trapped by the emollient on the…it doesn't escape then.

[Amy Gordinier] Love that. Now, is that something that you do just as needed? Couple times a week if ... Just to keep the skin healthy and ...

[Dr. Kavita Mariwalla] And if you really need it, I actually tell people to do that three nights in a row. I've never had somebody who's needed it more than three nights in a row.

[Amy Gordinier] Okay. That's amazing. That's something easy to do. Now what about vulvar skin?

[Dr. Kavita Mariwalla] It changes a lot. A lot. So, there's a lot of swelling, and actually it's the one thing I will say that people are so hesitant to talk about. They're like, "What do you mean? What do you mean it's going to change down there?" And I'm like, "Oh, all the things all the things. All the things."

[Amy Gordinier] Just wait.

[Dr. Kavita Mariwalla] Just wait. And I feel the reason people don't talk about is because we'd be scared to death to actually have a child, and the world would not be populated. So, there's the things we talk about. They're like, "The baby's so cute. It won't be that bad." And other things nobody will tell you because you're like, "I'm not having a baby. Have you heard that's going to happen?" And then you're in it and you're like, "Oh my God. Now I have no choice. I have a baby in me. I have to get it out of me. Holy cow. Now what?" So, during pregnancy that skin can actually darken. It can change color, believe it or not. And it can swell the way that your legs swell, so can the vulvar skin. And then that can make you feel really itchy and sore. Almost like you can't sit properly because you're just uncomfortable.

 Then when that vulvar skin swells, the itching is pretty intense. And that's not exactly a place you can scratch when it feels itchy.

[Amy Gordinier] In public.

[Dr. Kavita Mariwalla] Yeah.

[Amy Gordinier] In public.

[Dr. Kavita Mariwalla] You can. It might feel like the pregnant lady's confused, but that happens to a lot of people actually. And then post delivery, oh my gosh. It's so swollen. So sore. And if you've had an episiotomy, it's like you have to do wound care. And then remember your bodily functions go through that zone front and back. And so, you're like, "Oh my God, how is this ever going to be okay?" So, those first six weeks postpartum in the vulvar area are brutal for most people, because they don't really know ... No one's ever taught them how to take care of that area when it doesn't feel fine, because most of your life it feels fine. What's there to do?

[Amy Gordinier] Exactly. Especially at the age of which you'd be having babies most likely. Wait until menopause, then everything changes again.

[Dr. Kavita Mariwalla] Everything changes again.

[Amy Gordinier] But what do you recommend people do to take care of the vulvar skin during pregnancy, but then in that really critical postpartum period when you, as you say, you're in wound care, and you're being exposed to all of the things at the same time? How do you keep it…

[Dr. Kavita Mariwalla] And you're wearing a diaper, and you're like, "I didn't ... This is not cute." I mean, they make those pads. They're like the size of your head. And you're like, "What am I doing with this?" And then all a sudden you're like, "I need three of these. Oh my God." You're like, "What?" And the underwear, and all the ... It's all the things. But so, that's why I'm glad we're talking about it because I don't think anyone ever tells you, this is not a conversation your girlfriends are having with you. I think it's really important to choose a cleanser wisely. It's not just a soap in your shower kind of thing. I think it's important to use a pH balanced cleanser. I think it's important to make sure that you're moisturizing in that area too.

 That skin is swollen. It's just gone through surgery. After the swelling goes down, it gets really dry and flaky, and that can be itchy. And without you realizing that you're scratching, and you can create a sore, or cut. So, I think you got to do something specific for that area too. And I think Sweet Spot Labs does a great job creating, curating a line of products that don't make you feel weird for using them. And that also are very gentle on skin so that you can use them without feeling you're using the Summer's Eve from the time of your grandma.

[Amy Gordinier] Right. And I think a lot of the ingredients in some of the products that were created a long, long time ago were quite irritating. When I had babies…

[Dr. Kavita Mariwalla] Oh yeah. They were like acetic acid, things you would not put on genital skin at all. I think people are like, "Oh, just use whatever you have at home. Just use your shampoo." And I'm like, "No, no, no, no. We do not use the shampoo in that area." Already your hormones are changing. So, the pH in that area is changing. And the worst thing that could be, is you end up with a vaginal yeast infection postpartum because you just didn't take care of anything the right way.

[Amy Gordinier] And then you're really unhappy.

[Dr. Kavita Mariwalla] Yeah. Then you're really unhappy.

[Amy Gordinier] So, talk about supplements. So, if you're not really able to take a lot of the products, or...sorry, if you're not able to take a lot of the prescriptions you would normally take, for acne, or perhaps psoriasis, or eczema, are there supplements that you would recommend to support skin health in pregnancy?

[Dr. Kavita Mariwalla] So, the thing that's a little weird about supplements in the United States, is that they're not approved by the FDA. They're not regulated the FDA. So, you don't really know what filler is in that tablet, or what other byproduct is in that tablet. So, I say use your prenatal vitamins, and then get your supplements, your vitamins and your nutrition from food that you consume and cook. So, don't have a ton of processed foods, because that's not good for you, and it's not good for the baby. And so, yeah, it's going to take more time, but take the time to chop the carrots, take the time to get the green beans, get the spinach, get the things that are all the different colors of the rainbow. My husband has a good saying for...he's a cardiologist. And oftentimes he has to meet people after they've had a heart attack, and then he has to talk to them about healthy eating and stuff like that.

 And he said, "The thing that happens with most people is once they have a heart attack, it's that shot across the bow, and they get terrified, and then they eat super healthy. And then they lose all this weight, and they're super fit, and they come back two years later and they cannot maintain it. So, I get a year, they look amazing. And two years later they're back to not doing the greatest." So, what happens? And he's like, "For the most part, it's because we've never ..." As a society, we don't really train ourselves or our kids how to eat proportionately correctly. In other words, he tells his patients, "Half of the plate is for me and half of the plate is for you. And my half of the plate has to always have vegetables and greens on it. Half the plate, that's my half. You can't change it. Your half, you can put whatever you want. You want to have a filet mignon? You want to have whatever? That's your half of the plate, but my half has to have three colors, and one of them has to be green."

 And it turns out that if you think about that same way in pregnancy, you will get all the nutrients and vitamins that your baby needs. I'm a big fan of folic acid. You need that. And I'm a big fan of prenatal vitamins. But aside from that, half the plate is yours, half the plate is mine. And that half that's mine has to have at least one green and two other colors.

[Amy Gordinier] I think that's a great philosophy. It makes sense. It's better to get it from food because, to your point, you don't always know what's in the supplements, and how much of it to take, and some of them you have to...I think that's a great suggestion. So, now skin care issues postpartum. When you're not getting sleep, and maybe you're not necessarily eating so well, because you're busy, and you've got a new baby, and you're just grabbing things on the fly. Do you see skin issues, and maybe because your hormones have started to fluctuate, do you see things flare after pregnancy?

[Dr. Kavita Mariwalla] Oh yeah. I mean, well number one, your hair falls out. So, there's that. So, about three to four months later, well, just when your vulvar skin's healed, then your hair falls out. That's good to end. And so, we're talking the truth here, talking the truth. It's telogen effluvium, your hair does grow back, but man, it makes you feel you're totally going to go bald for a while. And then sometimes you get a little bit of flare of that hormonal acne post-pregnancy. It's the time where you can start to treat your melasma. And then, for some people, if you're somebody who's very into the cosmetic upkeep of their skin, let's say you're somebody who's constantly doing Botox, or you do fillers, or you just do the stuff because that's your thing. Well, for nine months you can't.

 So, suddenly you look different. I have a lot of women who are like, "Oh my God, oh my God. I suddenly look so old," because they forget what they look like without all that stuff. And it's not that they look old. It's just that life's beating them up a little bit. And truth be told, and you and I both know this, when you don't have sleep, your inflammatory markers in your body just go up. And you end up accelerating cellular senescence, or the ways in which your cells die off, or the lifespan of the cells in your body. Chronic sleep deprivation shortens your lifespan. We know this. But does that mean that it's without repair mechanisms? No. So, you can do things like making sure you're eating a lot of antioxidants, and that doesn't have to be in a pill form.

 It's blueberries, it's raspberries, it's blackberries. You want to make sure that you're having a lot of your vitamins in terms of kale. Kale's an amazing source of iron and vitamins. And then also, you want to make sure that you're doing things like getting enough sleep, even though the baby's crying, but when the baby's sleeping, just sleep. It's okay. Nobody mopping the house isn't going to kill anybody. It's all right. And so, I think there are things that you have to really prioritize, and your health and the baby's health, and those critical first months is really part of it because also when you're sleep deprived, your mood, you're crankier, and everything feels a lot more overwhelming and stressed out than it might be if you just had a good night of sleep.

[Amy Gordinier] So, true. I'm a big sleeper. My kids laugh at me because I'm always at them to get more sleep, and I love to sleep. It's ...

[Dr. Kavita Mariwalla] It's so important. It's when your body does its repair mechanisms, it's when your brain allows itself to expunge the crazy things in the day and reset. But I don't think enough of us give it credit.

[Amy Gordinier] I love to hear it. I'm a big sleep fan. So, we had a couple of questions from our listeners. One asked, "What about the belly sheet masks that are available? Do you think they are effective?"

[Dr. Kavita Mariwalla] I mean, look. I think it's fun. You'll do things that make you feel good. But a sheet mask is only going to extend, not even past the epidermis, it does nothing. But there's something funny about putting a big thing on your belly, and just laying there, and okay, if you like it, do it. But it has zero impact on your skin or stretch marks.

[Amy Gordinier] Okay. And then next question from our listeners is, "How can I treat dermatitis flareups while pregnant?" And you commented on this, but specifically what would you ... No steroids, but what would you recommend for a dermatitis flare?

[Dr. Kavita Mariwalla] Think about all the steps in your skincare routine and how you can add hydration to all of them. So, you have to use some water, because have to take a shower. But can you do a hydrating skin oil? Can you do a hydrating foaming cleanser? Can you do an oil cleanser? Can you do an oil immediately after you step out of the shower? Or can you use a lipid-rich, ceramide-rich cream just put right over your damp skin the second you get out of the shower? All of those things are yes. Then at nighttime, when your skin is dry, what can you do to hydrate it? Do you use an ointment in certain areas of the body? Can you use an eczema balm? Remember, balms are anhydrous, so they're not super sticky. They absorb really well. And can you use that in areas of your skin, and your face, and your body? Absolutely.

 Just because something says it's for face doesn't mean you can't use it on your body. Same way. If something's for your body doesn't mean you can't use it on your face. I was actually interviewed in a magazine about hand cleansers, and I said, "My secret actually, after a day like today, is to use this Skinfix face cleanser, because it's so hydrating for your face, that why ... I'm going to use it on my hands, because it's the only thing that keeps my hands intact, and considering how many people I have to see all day long, that's really important. I don't want to have breaks in my skin barrier because I can get an infection."

[Amy Gordinier] Okay. So, lots of great suggestions for dermatitis when pregnant. I love also the pajama recommendation, lots of things you can do when you can't use your steroids to make sure you're keeping that skin barrier intact, and hydrated, and healthy. Well, this was amazing. I love the fact that you went there and that we talked about things that women don't often, as you said, hear about.

[Dr. Kavita Mariwalla] Yeah, I mean here's the thing. I think you and I are very open about explaining to people the reality of their skin and that's just it's all natural. It's all normal. But if nobody talks about it, you think you're the only person in the world who's having it. And then it's not like you're going to call your girlfriend and be like, "Did you know this happens to your vulva?" No one's saying that. But now you have two women on here that are like, "You know what? That looks crazy down there afterwards. Just don't look, and wash with this. Take this, thank me later."

[Amy Gordinier] Yes. Nurture the vulva. She's been through a lot.

[Dr. Kavita Mariwalla] You boys. I know a thing or two.

[Amy Gordinier] Yeah, yeah. No, this was really helpful. Great content. I mean, as I said, we get so many questions from women when they're pregnant about what they can use, what they can't use. I think there's such good information in here about what you would recommend, and what we need to avoid during those nine months to keep the baby baking in the belly, safe, and happy, and healthy. It was such a joy. I know you've had a crazy long day, surgery, patients, so really appreciate you doing this, Kavita.

[Dr. Kavita Mariwalla] Oh my gosh, I love being able to do this with you. Thank you so much for inviting me to this awesome podcast series. I think you do such a service to get real people talking about real things, but then also just with the skincare line, there's so many good products. And honestly, over and over again, to see the success of it, it warms my heart because I just ... I know that I use it so much myself. So, to see other people recognizing how good it is, it's a great thing.

[Amy Gordinier] Be sure to follow Dr. Mariwalla on Instagram at Mariwalla Dermatology, that's M-A-R-I-W-A-L-L-A Dermatology.

 What an amazing conversation with Dr. Mariwalla. So many insights into pregnancy, and how the body and skin change during and after pregnancy. I'm always so grateful to Dr. Mariwalla for sharing her deep knowledge of the skin with us. It's invaluable, and I always feel so much smarter after our conversations. Here are three things that really stood out for me in our conversation. First, I was intrigued by the idea that pregnancy is not the time to start using a new product or new ingredient, including and especially, an essential oil. Just because a product is marketed as a pregnancy product doesn't necessarily mean you should switch it up at this time, when the skin can be extra sensitive.

 Second, I'm a huge fan of sleep, and the incomparable benefits it has both on your skin health and overall body health. I didn't know that sleep deprivation, as is naturally common during and after pregnancy, increases your inflammatory markers and can act actually decrease the lifespan of your cells. Third, it was interesting to learn that the predilection towards developing stretch marks during pregnancy is actually hereditary. But that doesn't mean you shouldn't moisturize, moisturize, moisturize, and maybe even give Dr. Mariwalla's wet pajama, dry pajama routine a try.

 Thanks for listening to this fifth episode of the second season of Total Skin Nerds. We'd love to hear from you and would be so grateful if you could take the moment to leave a review. And please subscribe to the show on Apple Podcasts and Spotify, or wherever you listen to podcasts. Total Skin Nerds is produced by Rob Corso, Casey Kahn and Howie Kahn for Free Time Media. Our theme music is by John Palmer. Special thanks to Lauren Fonda, Amanda Knappman, Megan Collins, and Carmine Montalto. And I'm your host, Amy Gordinier. Till next time, skin nerds.

Speaker 2: Nerds.

Speaker 4: Total Skin Nerds is a podcast created to educate. It is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical advice. If you are looking for help with a skin concern, we would encourage you to seek the advice of a board certified dermatologist, functional medical practitioner, or other qualified healthcare provider. You can find a registry of board certified dermatologists in the US at find-a-derm.aad.org. And in Canada at dermatology.ca. For a registry of qualified functional medical practitioners, you can visit ifm.org. Thank you so much for joining us on this episode. We hope that you enjoy listening to Total Skin Nerds as much as we enjoy making it.

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