A nurse in a prenatal clinic is completing a skin assessment of a client who is in the second trimester. Which of the following findings should the nurse expect? (Select all that apply)

Choice A rationale Chloasma, often referred to as the "mask of pregnancy," is a common dermatological condition resulting from increased estrogen and progesterone levels stimulating melanocyte-stimulating hormone (MSH) production. This leads to hyperpigmentation, particularly on the face (forehead, cheeks, nose, and chin). The mechanism is an overproduction and deposition of melanin in the epidermal and dermal layers, typically worsening with sun exposure. Choice B rationale Psoriasis is a chronic autoimmune skin disease characterized by accelerated keratinocyte proliferation, resulting in thick, scaly, erythematous plaques. While the hormonal changes of pregnancy can sometimes influence the severity (either improving or worsening) of pre-existing psoriasis due to immunological shifts (pregnancy being a relatively immunosuppressive state), it is not a finding expected as a typical, pregnancy-induced dermatosis like chloasma or striae. Choice C rationale Eczema (atopic dermatitis) is a chronic inflammatory skin condition characterized by dry, pruritic, and inflamed skin. Like psoriasis, it is an immune-mediated disorder. While some women may experience a flare or new onset of eczema during pregnancy due to hormonal and immunological changes, it is not considered an expected, physiological change of the integumentary system universally associated with the gravid state like linea nigra. Choice D rationale Striae gravidarum, or "stretch marks," are extremely common, especially over areas of maximal distension (abdomen, breasts, thighs) and are due to the combined effect of mechanical stretching of the skin and underlying connective tissue along with the action of relaxin and high circulating adrenal steroids (glucocorticoids). These factors contribute to the degradation and reorganization of collagen and elastin fibers in the dermis, manifesting as reddish-purple lesions initially. Choice E rationale Linea nigra is a manifestation of hyperpigmentation along the linea alba, a fibrous structure running vertically down the midline of the abdomen. This change is expected and caused by the same hormonal influences as chloasma—elevated levels of estrogen, progesterone, and MSH. The darkening occurs because the melanocytes in this area are particularly responsive to these stimulatory hormones, leading to an increased melanin deposition.