Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2022;12(2):e2022062 1 Secret of The “White Belly Button” During Pregnancy Demystified Farah El Hadadi1, Line Mezni1, Laila Benzekri1, Mariame Meziane1, Karima Senouci1 1 Department of Dermatology-Venereology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco Key words: hypopigmentation, pregnancy, depigmentation, belly Citation: El Hadadi F, Mezni L, Benzekri L, Meziane M, Senouci K. Secret of the “white belly button” during pregnancy demystified. Dermatol Pract Concept. 2022;12(2):e2022062. DOI: https://doi.org/10.5826/dpc.1202a62 Accepted: September 2, 2021; Published: April 2022 Copyright: ©2022 Kenani et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication Corresponding author: Farah El Hadadi, Department of Dermatology-Venereology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco. E-mail: farahealhadadi1234@gmail.com Introduction During pregnancy, several physiological, hormonal, immu- nological, metabolic and vascular changes occur [1]. The skin is one of the first organs that maybe affected. We report a case of a sudden whitish macular eruption on the belly that occurred at 30 weeks of pregnancy. Case Presentation A 33-year-old female patient with no particular medical history at 36 weeks of pregnancy developed a white macule with irregular borders on the belly with a downward exten- sion which has occurred 6 weeks before (Figure 1) (Figure2). The patient didn’t complain about itch or pain, and no scle- rosis or scales were present on physical examination. Conclusions Pregnancy dermatoses are classified into: structural skin changes, specific dermatoses of pregnancy and preexisting Figure1. White macule of the belly with a downward extension and irregular borders in a 36 week pregnant women. 2 Research Letter | Dermatol Pract Concept. 2022;12(2):e2022062 Figure 2. Disappearance of the lesion after childbirth. dermatosis of pregnancy [2]. A rare condition characterized by the presence of a whitish macular eruption of the belly is often a cause of concern in pregnant women. The “white belly button” is a benign physiological phenomenon; it appears as a sudden demarcation of “white areas” or a “skin pallor” that affects the skin due to a vascular abnormality resulting from an excessive stretching of the skin. The abrupt onset of this macule has never been described or reported in any scientific journal and the physio-pathological mechanism remains un- known but can be explained by the presence of a tissue hy- poxia as a result of vasoconstriction of small dermal vessels. It is therefore important to differentiate this physiolog- ical pigmentation from other skin conditions such as post inflammatory hypopigmentation, vitiligo, nevus depigmen- tosus pityriasis versicolor and white spot disease to avoid un- necessary treatment and to reassure pregnant women about the benignity of this condition. References 1. Motosko CC, Bieber AK, Pomeranz MK, Stein JA, Martires KJ. Physiologic changes of pregnancy: A review of the literature. Int J Womens Dermatol. 2017;3(4):219–224. DOI: 10.1016/j .ijwd.2017.09.003. PMID: 29234716. PMCID: PMC5715231. 2. Sachdeva S. The dermatoses of pregnancy.  Indian J Dermatol. 2008;53(3):103–105. DOI: 10.4103/0019-5154.43203. PMID: 19882004. PMCID: PMC2763729.