Melasma & Pregnancy: Everything You Need to Know


Melasma: Local hyperpigmentation of the skin during pregnancy

1) Presented as:
• Areas of the face with hyperpigmentation (darker skin).
It is common during pregnancy for pregnant women with a hereditary predisposition to develop dark spots on the skin of the face them. The condition is commonly called "the mask of pregnancy," but is scientifically known as chloasma or melasma of pregnancy.
Women with dark skin are more prone to this condition. Also, there may be a family predisposition. The appearance of melasma may become even more pronounced in subsequent pregnancies that occur.
Melasma occurs in three topographic patterns. It can appear in the central part of the face (around the lips, on the nose, on the forehead) or on the lateral parts of the face, i.e. on the cheeks-cheekbones, or finally, along the lower jaw (jawline). In some cases, it can develop as pigmented spots on the forearms as well as other photoexposed (sun) areas of the body.
Also the nipples, facial freckles, scars, as well as the genital skin become even darker during pregnancy. This tends to happen in areas prone to friction, such as the elbows and inner thighs.
These changes are caused by hormonal changes during pregnancy, which stimulate a temporary increase in the endogenous production of melanin. Melanin is the natural pigment that gives color to hair, skin and eyes. Sun exposure also plays an important role in the appearance and severity of melasma.
Areas of hyperpigmentation will probably fade within a few months after delivery. The skin will return to its normal complexion (hue) although in some cases the changes never completely reverse.
• Dark line along the abdomen below the navel – linea nigra
Before pregnancy, there was a line called the linea alba (meaning white line) that ran from the navel to the pubic bone. It has the same color as the rest of the skin, so it is not noticeable.
The increased production of melanin that causes the spots on the face is also responsible for the increased color in the line on the belly which darkens it as well. It will most likely fade to pre-pregnancy color tone several months after delivery.

Appearance of melasma on the face

2) Prevention of melasma during pregnancy
A few things can be done during pregnancy to minimize the appearance of melasma:
Sun protection is vital because exposure to the sun's ultraviolet (UV) rays intensifies changes in skin pigment (melanin). It is recommended to use a broad-spectrum sunscreen (protecting against UVA and UVB rays) with a protection factor of SPF 30 or higher, daily, regardless of whether the day is sunny or not, and to replace it frequently during the day, especially for long stays outdoors. Sunscreens should be applied to all areas of exposed skin 20-30 minutes before sun exposure. The American Academy of Dermatology warns that the skin is also exposed when we do daily activities such as walking down the street, driving a car, or even when sitting indoors but next to a window.
When we are outside, the best precaution is to cover up. Brimmed hats are recommended, as well as long-sleeved shirts. Also limiting the time we spend in the sun, and especially between 12 am. and 4 p.m. and definitely avoid artificial tanning.
The use of mild facial cleansers and creams is recommended. Preparations that irritate the skin can make the problem worse.
Beware of scented soaps, perfumes and cosmetics that can potentially cause a melasma problem.
It is recommended to apply a cover-up make-up for concealment (which also provides sun protection) rather than the use of whitening products which should be postponed after delivery.

3) Melasma treatments after pregnancy
After giving birth, sun protection should also be continued! Sunscreens, cover as much as possible of the exposed areas of the body, avoiding the sun at noon. In most cases, the discolorations will fade slowly, without any therapeutic intervention.
For a small number of women, however, estrogen-containing contraceptives may contribute to melasma. These women should prefer another method of contraception
If melasma remains on the skin as spots after a few months of home remedies followed by medical advice, a bleaching cream containing hydroquinone or tretinoin is recommended, or in more severe cases, a combination cream (with hydroquinone, tretinoin and corticosteroids). Possible side effects of these treatments include temporary skin irritation. Possible minor side effects of hydroquinone include itching (pruritus), redness (erythema), scaling (dry skin), and a temporary burning sensation that tends to improve after 14-30 days of use
In the dermatology clinic the options are expanded with chemical peels (chemical exfoliation), microdermabrasion (mechanical exfoliation with diamond or microcrystals) and laser therapy. Chemical peels such as azelaic acid, kojic acid, mandelic acid, pyruvic acid and AHAs (alpha hydroxy acids) such as glycolic acid are also an option, especially when topical whitening creams have given poor results. Of course, if the woman is breastfeeding or there is an intention to become pregnant again, the dermatologist should be informed before treatment is given. In rare cases, we end up with depigmentation laser treatments, but this is not the first choice as an aggressive treatment can even worsen some forms of melasma. Multiple low-intensity laser treatments may be necessary to achieve results.
Treatments are applied to all types of melasma, but the epidermal type responds best to treatment because the pigment is closer to the surface of the skin
Just as melasma develops slowly, recovery and clearance also tends to be slow. Patients should not expect immediate results – it may take many months to see improvement. Whatever the treatment approach it is vital to continue sun protection during treatment and afterwards as melasma has a tendency to recur.