Melasma in Pregnancy

pregnant women with melasma on face

Pregnancy is often a time full of excitement and anticipation for everyone involved, especially the person bearing the child. There is so much to think about and plan for when you’re pregnant, including preparing the baby’s room, taking prenatal classes and going to routine check-ups. So, when a common pregnancy-related skin condition like melasma is added to your list of things to think about, it can stretch your energy levels thin.

With this article, you can learn all about melasma and tips for preventing and treating it so you can focus on caring for your baby.

What Is Melasma in Pregnancy?

Melasma is a hyperpigmentation condition where flat brown or grey spots with asymmetrical borders appear on the sun-exposed areas of your body like your face, neck, arms and décolletage due to excess melanin production. It has a loose translation of “black spot,” derived from the Greek word “melas.” This condition commonly occurs in pregnancy. When it happens in pregnancy, it is often called chloasma or "mask of pregnancy".

Melasma may appear blotchy or confetti-like on your skin. The most prominent place where melasma shows up is on the face, particularly the cheeks, forehead, chin and upper lip. Where you get melasma determines the type of melasma you have. As such, here are the different types of melasma:

  • Brachial: This type of melasma occurs on your upper arms and shoulders.
  • Centrofacial: With centrofacial melasma, brown spots appear on your cheeks, forehead, nose and upper lip.
  • Lateral cheek pattern: Doctors diagnose you with lateral cheek pattern melasma if it appears on both cheeks.
  • Malar: Malar melasma is when the spots appear on your nose and cheeks.
  • Mandibular: The melasma occurs around your jawline with mandibular melasma.
  • Neck: This melasma type occurs on any side of the neck.

Melasma should not cause any pain, itchiness or soreness. If these symptoms occur, you are likely experiencing another condition that may need medical attention.

The brown spots that occur with melasma are melanin, produced from melanocytes. Melanin is the same pigment that gives your skin its natural color. Melanin’s other function is protecting your skin and eyes from sun damage. However, when your body produces too much melanin, it can cause aesthetic problems to your skin.

As a primarily cosmetic condition, melasma is benign, only affecting the outer layers of your skin. As such, melasma during pregnancy does not impact your baby’s health or indicate any other pregnancy complications. Still, you may find that this condition hurts your self-image, so it’s perfectly natural to want to learn how you can prevent or treat this condition. Moreover, since some skin cancers resemble melasma, it’s vital to receive an accurate diagnosis of melasma if you experience this condition, whether you’re pregnant or not.

We can help you find the best skin care products for your Baumann Skin Type.  Make sure you retake the quiz if you are newly pregnant because the results may change when you answer the pregnancy question.

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Is Melasma in Pregnancy Common?

Approximately 15%-50% of pregnant patients experience melasma, making it a highly common condition during pregnancy. This condition is so common during pregnancy that it is sometimes called the “mask of pregnancy.” It is called the mask of pregnancy because it most often shows up around your cheeks, forehead and mouth in a shape that may resemble a mask. Melasma during pregnancy is also more common in dark-skinned women but can affect any pregnant person.

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Does Melasma During Pregnancy Go Away?

Melasma often goes away after pregnancy. However, it is considered a chronic skin condition, meaning there is no definitive cure. At the very least, it shouldn’t get worse after you give birth, even though it may become more visible the further you are in your pregnancy. The length of time it takes to go away depends on various factors, including:

  • How dark the spots are.
  • Whether you’ve had melasma before.
  • Family history of melasma.

Melasma is more likely to go away without treatment if you’ve never had it before getting it during pregnancy. If you’ve had melasma before experiencing it during pregnancy, you may need treatment after delivering your child to get rid of the spots completely. Moreover, you are more likely to experience melasma in subsequent pregnancies with increased exacerbation after your initial experience.

In some cases, the spots never completely fade without treatment. In other cases, the melasma may fade once you stop breastfeeding. If you’re still experiencing melasma after weaning, ask your dermatologist or cosmetic provider about your treatment options.

What Causes Melasma in Pregnancy?

The leading cause of melasma in pregnancy is likely hormonal changes, but the underlying cause of melasma remains unclear. However, your skin naturally produces more pigment during pregnancy due to hormonal changes. Estrogen increases during pregnancy, is involved in melanin synthesis and stimulates melanocyte production. Excess melanocyte production directly leads to hyperpigmentation. Estrogen also impacts other aspects of your skin, such as:

  • The circulatory system.
  • Collagen production.
  • Hair follicles.
  • Sweat glands.

Some of these skin changes can be beneficial. For example, since collagen is essential to healthy skin and estrogen helps with its production, increased estrogen can lead to firmer skin.

Moreover, melanocyte-stimulating hormones (MSH) are also elevated during pregnancy. MSH hormones are a group of hormones involved with your skin’s pigmentation. Their increase can lead to hyperpigmentation of the face, areolas, perineum and down the center of your abdomen, also known as linea nigra. Besides melasma and hyperpigmentation, you may also notice that your freckles and moles appear darker.

Another cause of melasma during pregnancy is sun exposure, which can darken the melasma. The more time you spend in direct sunlight while pregnant, the greater your chance of experiencing melasma. For this reason, melasma often improves in the winter and worsens in the summer. You are also at higher risk of experiencing melasma during pregnancy if you have a history of melasma in your immediate family.

Contraceptives containing estrogen, other hormone therapies and some medications can also contribute to melasma. These therapies, products and medicines include:

  • Amiodarone, which treats heart arrhythmias.
  • Anticonvulsants, which treat epilepsy and various mood disorders.
  • Antimalarials.
  • Hormone replacement therapy (HRT).
  • Photosensitizers, which are often used as an antifungal medication.
  • Scented soaps.
  • Sulfonylureas, which treat type 2 diabetes.
  • Tanning beds.
  • Tetracyclines, which is a type of antibiotic.

When Does Melasma Start in Pregnancy?

Melasma can occur any time during pregnancy, as elevated estrogen production occurs in the first trimester. However, it most often occurs in the second and third trimesters. If you 

experience melasma in the first trimester, it may be due to too much sunlight exposure or other factors.

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How to Avoid Pigmentation During Pregnancy

While melasma is common in pregnancy, you can take steps to avoid hyperpigmentation issues during pregnancy. Read through these tips on how to prevent pigmentation during pregnancy. You can find more information about how to get rid of melasma here.

1. Seek the Shade

Feeling the sun on your skin can be refreshing and helps your body absorb vitamin D. The downside of sunlight exposure is that it also triggers increased pigment production, leading to melasma and other more severe skin issues. Bring an umbrella to the beach, sit under a tree at the park and wear a hat to keep the sun from triggering melasma and hyperpigmentation on your skin.

The sun’s ultraviolet A (UVA) and ultraviolet B (UVB) rays are harmful to your skin in cosmetic and medical ways. Here are some of the effects that the sun’s UV rays can have on your skin:

  • Aging spots.
  • Increased risk of skin cancer.
  • Loss of elasticity.
  • Melasma.
  • Premature aging.
  • Sunburns.
  • Wrinkles.

Since melanin is your body’s defense against UVA and UVB rays, your body produces more melanin in response to sunlight exposure. If your body is already prone to hyperpigmentation, as it is during pregnancy, too much sunlight exposure can lead to or worsen hyperpigmentation conditions like melasma. You should especially avoid sunlight exposure during the peak sunlight hours of 10 a.m. to 2 p.m. Avoiding sun exposure is the most effective way to prevent melasma during pregnancy.

2. Wear Protective Clothing

Wearing long-sleeved clothing with breathable fabric and a wide-brimmed hat is an excellent way to avoid sun exposure and prevent melasma. Ensure the clothing is loose-fitting to stay comfortable in the sun’s heat. While this strategy may not be a realistic solution to a day at the beach, consider it when you’re:

  • Going to the park.
  • Doing some gardening in your backyard or other yard work.
  • Going for an afternoon walk or hike.

If you decide to expose your skin to the sunshine, that’s all right — just ensure you wear enough sunscreen.

3. Wear Sunscreen

Given sunlight’s effects on your skin beyond melasma, make sunscreen a priority every day. A sunscreen with a sun protection factor (SPF) of 30 or higher is ideal, especially if it contains zinc or titanium oxide. Avoid sunscreens that rely on chemical blockers instead of mineral blockers. Mineral blockers are less irritating to the skin.

4. Use Gentle Skin Care Products

Ensure your skin care products are hypoallergenic, fragrance-free and dermatologist-approved. Products with these labels are gentler on your skin and can prevent melasma from worsening. Concealers are also safe to hide melasma if they’re hypoallergenic and dermatologist-approved.

5. Talk to Your Dermatologist or Medical Provider

If you’re concerned about melasma during pregnancy, whether you’re showing signs or want to prevent it, your dermatologist can help. When you bring your concerns to them, they can provide treatments and expert advice on avoiding pigmentation issues like melasma during pregnancy. It’s also best to speak with your dermatologist early on when you notice melasma, as it can get more challenging to treat the longer it lasts.

How to Treat Pregnancy Pigmentation

Treatment for melasma and hyperpigmentation during pregnancy varies with each individual. Speak with your doctor before trying any new melasma treatment when you’re pregnant to ensure you won’t experience any adverse effects. The best results for melasma treatment typically come from combination formulations uniquely suited to your skin type. A dermatologist can help you determine your specific skin type to find the right solution for melasma or hyperpigmentation during pregnancy.

Many people prefer a more natural approach to treating melasma when pregnant.  It is important to remember that whether you are treating melasma with chemicals, natural ingredients, supplements or vitamins, the baby can be exposed to these.  That is why it is always bests to discuss anything you put on or in your body with your doctor.

The safest treatment for melasma in pregnancy is a chemical free sunscreen and a Vitamin C serum.  However, Vitamin C serums are not very strong so your doctor may prescribe one of these skin lightening ingredients:

1. Hydroquinone

Hydroquinone is the gold standard of melasma treatment because it is the strongest and is only available by prescription.  However, most doctors recommend avoiding it in pregnancy although there are no reports questioning its safety in pregnancy.

 Hydroquinone is a tyrosinase inhibitor that lightens your skin by reducing melanin production in the treated area. 

2. Azelaic Acid

Azelaic acid is an organic substance derived from barley, rye and wheat. When used for melasma treatment, azelaic acid typically comes in cream form. Unlike hydroquinone, azelaic acid helps melasma by focusing on exfoliation, inflammation and  pigment reduction. As such, azelaic acid encourages cell turnover — the process of shedding dead skin cells so younger skin cells can grow in their place. The new skin cells will have a more balanced melanin concentration to improve the appearance of melasma.

3. Kojic Acid

Kojic acid occurs naturally in particular fungi species. Like hydroquinone and azelaic acid, kojic acid comes in a cream formulation. Kojic acid treats melasma by inhibiting tyrosinase production. Tyrosinase is an enzyme contained within melanocytes — the cells that produce melanin in your skin, hair and eyes. By inhibiting tyrosinase production, kojic acid effectively disrupts melanocyte proliferation, which keeps melasma from worsening.

4. Glycolic Acid

Glycolic acid occurs naturally in substances like beets, sugar cane and unripe grapes. Like azelaic acid, glycolic acid has an exfoliating effect on your skin, improving melasma by bringing about younger and healthier-looking skin. When combined with a tyrosinase inhibitor, glycolic acid is highly effective.

5. Vitamin, Mineral and Antioxidant Supplements

Various vitamin, mineral and antioxidant supplements can help with melasma by reducing inflammation. Inflammation is a known cause of pigmentation issues, including melasma. Some specific vitamins, minerals and antioxidants that can help with melasma include:

  • Green tea.
  • Melatonin.
  • Pine bark extract.
  • Polypodium leucotomos (PLE).
  • Vitamin A.
  • Vitamin B5.
  • Vitamin B12.
  • Vitamin C.
  • Vitamin E.

Besides supplements, ensure your diet is rich in fruits and vegetables to increase your antioxidant intake and low in inflammatory foods like processed foods or red meat. Other anti-inflammatory foods include:

  • Apple cider vinegar.
  • Fatty fish.
  • Nuts.
  • Olive oil.
  • Tomatoes.

With all the different melasma treatments, knowing which one is best for you can be challenging. At Skin Type Solutions, we can make that process easier by giving you specific recommendations for your skin type.  When you get pregnant- make sure you retake the skin type quiz because the recommendations for pregnancy skin care routines for melasma are different than for non pregnant people.

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