Melasma: Skin darkening during pregnancy

  1. It appears as:

  • Patches of hyperpigmentation (darker skin) on the face.

It’s common for pregnant women to develop blotchy areas of darkened skin, commonly called “ the mask of pregnancy” but scientifically known as chloasma or melasma gravidarum.

Women with darker skin are more prone to this condition. Also it can run in the family, in the majority of cases there is a genetic predisposition. The effects of melasma may become more pronounced with each pregnancy.

The darker patches are characterized by three locational patterns. They can appear in the central face (around the upper lip, nose,forehead) on the cheekbones, and along the jawline. In some cases patches may develop on the forearms and other sunexposed parts of the body.

Also the nipples, freckles, scars, and the genital skin become even darker during pregnancy. This also tends to happen in areas prone to friction, such as elbows and inner thighs.

These changes may be triggered by hormonal changes during pregnancy, which stimulate a temporary increase in the body’s production of melanin, the natural substance that gives color to hair, skin, and eyes. Sun exposure plays a role, too.

The areas of increased pigmentation will probably fade within a few months after delivery and theskin should return to its normal hue although in some women the changes never completely disappear.

  • Dark line running down the abdomen (belly)- linea nigra

Before pregnancy, there was a line called the linea alba (meaning white line) running from the umbilicus (belly button) to the pubic bone. It may not be noticed, as it was the same color as the rest of your skin.
The same increased production of melanin that causes facial blotches is responsible for darkening this line on the belly. It will probably fade back to its pre-pregnant color several months after the delivery of the baby

  1. Melasma hyperpigmentation prevention during pregnancy

Few things can be done during pregnancy to safely minimize melasma:

Sun protection is crucial because exposure to the sun’s ultraviolet (UV) rays intensifies pigment changes. Use a broad-spectrum sunblock (a formula that protects against both UVA and UVB rays) with SPF 30 or higher every day, whether it’s sunny or not, and reapply often during the course of the day if you’re outside. Sunscreen should be applied in all the regions of the skin for 20-30 minutes before sun exposure. The American Academy of Dermatology cautions that your skin is exposed to a significant amount of UV light when you do things like walk down the street, ride in a car, or even sit inside near a window.

When you’re outside, cover up and wear a hat with a brim, as well as a shirt with long sleeves if you have pigmentation changes on your arms. Limit the time you spend in the sun, especially between 10 a.m. and 2 p.m. And definitely avoid tanning salons.

Use gentle cleansers and facial creams. Preparations that irritate the skin may worsen the problem.

Attention to truly aromatic soaps and cosmetics that may potentially cause problems.

Apply a concealing makeup. If the pigmentation changes bother you, cover them up for now – don’t use skin-bleaching products during pregnancy. The changes may go away on their own after delivery.

  1. Melasma treatments after the pregnancy

After delivery, sun protection should also be continued! Sunscreen, cover up, sun avoidance at midday. In most cases, the discolorations will slowly fade without any treatment.

For a small number of women, however, contraceptives that contain estrogen can contribute to melasma. These women should prefer another birth control option
If the skin remains blotchy after a few months a bleaching cream that contains hydroquinone or tretinoin, or in more severe cases a combined cream (hydroquinone and tretinoin plus corticosteroids) should be considered as an option. Possible side effects of melasma treatments include temporary skin irritation. Possible minor side effects of hydroquinone include
 itching (pruritus), redness (erythema), scaling (dry patches), and a temporary burning sensation that tends to improve after 14-30 days of use

At the dermatological clinic chemical peels (chemical exfoliation), microdermabrasion (mechanical exfoliation) and laser therapy can be applied. Chemical peels such as azelaic acid , kojic acid, mandelic acid, pyrouvic acid and AHAs (alpha hydroxyacids) like glycolic acid are also an option, especially when topical bleaching creams gave poor results. Of course, if the woman is breastfeeding or trying to become pregnant again soon, to dermatologist should be informed before using any over-the-counter treatments . In rare cases, dermatologists can use laser treatments to lighten the darkened skin, but that’s not the first option. Microdermabrasion utilizes vacuum suction and an abrasive material like fine diamond chips or aluminum oxide crystals to exfoliate the top layers of the skin. The vacuum pressure is adjusted depending on the sensitivity and tolerance of the skin. Lasers may actually worsen some types of melasma and should be used with caution. Multiple laser treatments may be necessary to see results, as treatments are most effective when they are repeated.

The final response to the treatment can not be predicted.  In some cases if treatments are too harsh or abrasive, melasma can be induced or worsen. Treatments are applied to all types of melasma, but the epidermal type responds better to treatment than the others because the pigment is closer to the skin surface

Just as melasma develops slowly, clearance also tends to be slow. Patients should not expect instant results – it may take many months to see improvement. Whatever the approach may be it’s crucial to continue sun protection during treatment and afterward as melasma has a tendency for relapse.