As a dermatologist, I often see pregnant patients concerned about dark spots on their faces that began during pregnancy. This hyperpigmentation condition is so common in pregnancy that it is called  the "mask of pregnancy." This condition is known as melasma and typically appears on the cheeks, forehead, and upper lip. It's driven by hormonal changes during pregnancy, making the skin more sensitive to sun exposure and increasing melanin production.

Melasma is distressing, but it's important to understand that it's a common and manageable condition. The key to treating and preventing melasma while you are pregnant involves a combination of sun protection, safe skin care, and avoidance of heat and light. In this article I will share the advice that  I give my pregnant patients with melasma.

The best way to find a pregnancy safe skin care routine for melasma is to use your skin type to build a custom skin care routine to treat melasma with pregnancy safe products. Step 1 is to take the quiz. If you have any questions, ask our skin care concierge that is an AI bot.  It  might even offer you a discount on products to treat melasma during pregnancy.

Treating melasma during pregnancy is difficult because of increased estrogen levels and the fact that you cannot use some of the most effective treatments like hydroquinone due to systemic absorption and possible risks to the baby. These are the suggestions I give my patients but everyone's medical condition is different so please discuss  with your doctor who is familiar with your medical history.  

There are a few safe ways to treat melasma in pregnancy:

• Sun, light, and heat avoidance
• Topical skin care
• Procedures

I do not suggest taking any oral medications or supplements to treat your melasma while pregnant. This blog will discuss these other methods to treat the hyperpigmentation of melasma.

A safe and popular treatment for melasma in pregnancy is a chemical free tinted sunscreen and a Vitamin C serum. However, Vitamin C serums are not very strong so your skin care routine may include one of these pregnancy safe skin lightening ingredients:

Acids exfoliate and can be used to help remove pigmented skin cells. However, any exfoliant can slightly increase sun sensitivity so do not use any acids in your skin care routine if you have significant sun exposure.

These are safe acids to use in pregnancy:

• Azelaic Acid
• Glycolic Acid
• Kojic Acid
• Lactic Acid
• Mandelic acid

Note that salicylic acid is not on this list. You should not use SA over 2% on your face and you should not use any concentration of SA all over your body when you are pregnant because of the risk for systemic absorption. (It is in the aspirin family.)

Azelaic acid is a pregnancy category B which means that there are no adequate and well-controlled studies to demonstrate safety in pregnant women. If you use azelaic acid, limit use on small areas of the face to minimize systemic absorption.

Ascorbic acid, commonly known as vitamin C, is a vital nutrient for numerous bodily functions, including collagen synthesis, immune function, and the absorption of iron. During pregnancy, ascorbic acid plays a crucial role in fetal development and maternal health. Topically, it is widely used in skincare products for its antioxidant properties, helping to reduce hyperpigmentation and improve skin tone. It is considered safe for use during pregnancy, with no known adverse effects on the fetus. In fact, adequate levels of vitamin C are essential for preventing complications such as preeclampsia and ensuring proper fetal development. Ascorbic acid deficiencies during pregnancy can lead to impaired neonatal neurological development, emphasizing the importance of maintaining appropriate levels through diet and safe topical applications.

Niacinamide, also called Vitamin B3, is a skincare ingredient that helps improve melasma. It works by stopping pigment from moving into skin cells, which reduces dark spots and uneven color. It also calms inflammation. Niacinamide is safe to use during pregnancy because it is a water-soluble vitamin and does not harm the baby or get absorbed much into the body when used on the skin.

Hydroquinone is the strongest tyrosinase inhibitor but it cannot be used in pregnancy. Here is a list on ingredients that also block tyrosinase and prevent melanin synthesis that can be used when you are pregnant.

• Alpha-arbutin
• Ellagic Acid
• Ferulic Acid
• Mulberry Extract
• N-Acetyl Glucosamine

Hydroquinone is a potent skin-lightening agent commonly used to treat hyperpigmentation disorders like melasma. It works by blocking tyrosinase and injuring melanocytes. However, hydroquinone should be avoided during pregnancy due to its high systemic absorption rate, which ranges from 35% to 45%. This significant absorption raises concerns about potential systemic effects on both the mother and the fetus. While there is limited data on its teratogenic effects in humans, animal studies have suggested possible mutagenic properties. Additionally, the lack of extensive human studies means that the long-term safety profile of hydroquinone during pregnancy remains uncertain. Consequently, alternative treatments with better-established safety profiles are recommended for managing melasma in pregnant women.

Licorice Extract is derived from the root of the licorice plant (Glycyrrhiza glabra) and is widely used in skincare for its anti-inflammatory, antioxidant, and skin-lightening properties. One of its active components, Glabridin , is particularly noted for its ability to inhibit tyrosinase, but glabridin cannot be used in pregnancy. Glabridin has shown potential teratogenic effects in some studies, meaning it could cause developmental abnormalities in a fetus. 

Cysteamine is classified as an FDA Pregnancy Category C drug, meaning that animal studies have shown adverse effects on the fetus, including teratogenic effects like cleft palate, heart defects, and growth deficits. There are no adequate and well-controlled studies in pregnant women, so the potential risks to human fetuses are not fully known. Due to these potential risks, cysteamine should only be used during pregnancy if the potential benefits justify the potential harm to the fetus. Therefore, it is generally recommended to avoid cysteamine during pregnancy.

There are 3 main reasons you should not use resorcinol when you are pregnant:

First, resorcinol can be absorbed through the skin, potentially leading to systemic toxicity, which could be harmful during pregnancy. Second, some studies suggest that resorcinol may have endocrine-disrupting properties, potentially affecting thyroid function, which is crucial for fetal development. Finally, there is a lack of comprehensive studies on the safety of resorcinol during pregnancy, making it difficult to fully assess its potential risks.

Topical retinoids, including adapalene, tretinoin, and tazarotene, are often used to treat melasma due to their tyrosinase inhibiting effects and exfoliant benefits. However, retinoids are contraindicated during pregnancy due to their potential teratogenic effects (ability to cause birth defects). Retinoids are derivatives of vitamin A and can significantly affect cellular differentiation and proliferation. Studies have shown that their use during pregnancy can lead to congenital malformations, including craniofacial, cardiac, and central nervous system abnormalities. Tazarotene, in particular, has demonstrated mutagenic properties in preclinical models. Given these risks, it is crucial for pregnant women to avoid using topical retinoids and opt for safer alternatives under the guidance of a healthcare professional.

Melasma in pregnancy looks a bit like a racoon mask when severe. It starts as flat brown, black, or grey spots with asymmetrical borders. These spots are darker than your normal skin tone due to excess melanin production. They appear on the sun-exposed areas of your face and body. Common sites are the face, neck, arms and décolletage. The most prominent place where melasma shows up is on the face, particularly the cheeks, forehead, chin and upper lip.
These hyperpigmented spots, also known as dyschromia, may appear blotchy or confetti-like.

Melasma should not cause any pain, itchiness or soreness. If these symptoms occur, you are likely experiencing another condition that may need medical attention. If you get fever, blisters or severe itching in pregnancy, these can be signs of a serious condition so alert your OB/GYN doctor immediately. Melasma does not cause blisters or fever. It is associated only with color changes of the skin in sun exposed areas.

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 an uneven skin tone and dark spots on the skin called hyperpigmentation.

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. The only danger of melasma is pregnancy are:

1. Stress- stress is not good for the baby so comfort yourself knowing it usually goes away after pregnancy with sun avoidance and the right skin care routine.
2. Using topical ingredients that are not safe during pregnancy.
3. Making melasma worse by getting light treatments and lasers o sun exposure while pregnant

Melasma in itself is not dangerous to your health at all.  It is an annoying cosmetic condition, but you can take comfort in knowing htat it will be easier to clear after the pregnancy.

Melasma is very common i pregnancy. Approximately 15%-50% of pregnant patients experience melasma, making it a highly common condition during pregnancy. Melasma during pregnancy is also more common in dark-skinned women but can affect any pregnant person. It is worse in pregnancy because of increased levels of hormones like estrogen.

Melasma in pregnancy is usually temporary. 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.

The leading cause of melasma in pregnancy is hormones; mainly estrogen and melanocyte stimulating hormone (MSH).

 Estrogen and MSH increase during pregnancy and stimulates melanin pigment production.This is why you see darkening of the areolas, perineum and a dark line down the center of your abdomen ( known as linea nigra). Besides melasma and hyperpigmentation, you may also notice that your freckles and moles appear darker.

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.

While melasma is common in pregnancy, you can take steps to avoid hyperpigmentation issues during pregnancy. You can find more lifestyle information about how to get rid of melasma here.

Tips on how to prevent melasma during pregnancy:

Avoiding the sun is your best option.  When you must go in the sun, wear sunscreen and a wide brimmed hat. Wearing long-sleeved clothing with breathable fabric will help prevent melasma on the arms and chest. But remember- heat can cause melasma so try and limit your time in the heat.

Sunscreen is a must when you have melasma. You need to wear it everyday whether you are indoors or outdoors. Any kind of light, including blue light from your phone, can worsen melasma. Here are sunscreen tips for when you are pregnant and have hyperpigmentation:

• Choose a pregnancy safe sunscreen
• Wear SPF indoors to protect skin from light from your phone, computer and UA that gets through your windows.
• Choose a tinted SPF with iron oxides for extra protection

Make sure you are using the right skin care products for your Baumann Skin Type.  When you take our skin type quiz to get product recommendations, make sure you answer "yes" on the pregnancy question.

Heat plays a huge role in causing melasma.  Avoid these sources of heat on your face at all times:

• Hot shower
• Face steamer
• Heat from oven
• Hot hair dryer

There are many times that our face is exposed to heat that we may not think about t. Do you best to avoid it.  Wash face with warm water - not hot. Never steam your face.  If you get a facial, tell them not to steam your face. When you open the oven, stand back so the first burst of hit does not hit your face.

Going outside is problematic but it is not feasible to hide  inside all the time for most people  If you plan to be out in the heat - do everything you can to keep your face cool.

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