Definition

Melasma is a prevalent skin disorder characterized by dark patches, most commonly on the face. It is more frequently found in women, particularly during pregnancy.

Melasma is characterized by an excess production of skin pigment by the melanocytes, the cells responsible for skin coloration.  In pregnancy, it’s often referred to as chloasma or the “mask of pregnancy”. This condition does not affect the baby or cause other pregnancy complications. 

People with more pigment in their skin—for example, those of African, Middle Eastern, Latin or Hispanic, Asian, Indian, or Mediterranean descent—are more likely to develop chloasma, as they naturally have more active melanin production. Overall, between 50% and 70% of women will develop some form of melasma during pregnancy.

Causes

Hyperpigmentation, or darkening skin color during pregnancy, is very common. You may notice your nipples/areolas, armpits, or genitals become darker. You may see a line (linea nigra) extending from the pubic area over the belly or darker areas of the skin all over the body.

The underlying cause of pregnancy melasma is unknown beyond an overproduction of melanin pigment. This can occur when you’re pregnant due to an increase in hormones, specifically estrogen and progesterone.

Risk factor

Melasma can appear anytime during pregnancy, although it most commonly begins in the second or third trimester. Various factors contribute to the formation of melasma during pregnancy.

Additionally, sun exposure, using particular skin care products or treatments, and even genetic or hereditary factors can aggravate dark spots on the face. Hormonal imbalances that may develop as a result of taking birth control pills or using hormone replacement therapy can also make chloasma worse.

Skin color and type affect the appearance of melasma, making it more prominent or less noticeable. The more a person is exposed to sunlight or the presence of hereditary factors, the more it affects the appearance of melasma.

Symptoms

The primary symptom of melasma is the darkening of the skin on the face in the form of patches. The patches can be dark brown to faded gray and may appear on the forehead, cheeks, chin, or around the mouth. These areas may get darker the more you are exposed to the sun or the further you are in your pregnancy.

Pain or itchiness are not symptoms of melasma. If you experience these signs or develop severe irritation, you may be dealing with another skin condition. Consult your doctor for any additional symptoms you feel.

Diagnosis

It is important to avoid self-diagnosing your skin condition. Only a dermatologist can accurately confirm whether you have melasma during pregnancy. The diagnosis of melasma is based on the timing of symptoms and the location of patches on the skin. Typically, dark patches on the skin appear during pregnancy, after taking birth control pills, or in the summer. Chloasma is a skin condition that rarely affects only one side of the face.

A dermatologist can accurately diagnose your condition using a special light called a Wood's lamp, which helps show whether a skin condition is bacterial, fungal, or otherwise concerning. When a definitive diagnosis cannot be made, the doctor may perform a biopsy by taking a skin tissue sample to ensure the discoloration is not indicative of another skin condition, such as melanoma or skin cancer.

Management

The good news is that this hyperpigmentation likely won’t get worse after you deliver your child. It may take months for it to fade completely without any targeted treatment.

• Pregnancy-safe treatments

Speak with your doctor about ways to treat your melasma during pregnancy. Your doctor may refer you to a dermatologist for further treatment if needed. 

Some experts do not recommend treating melasma during pregnancy. One reason is that it may resolve on its own, and some treatment methods may not be safe or effective. The best course of treatment may be prevention, with the help of a few lifestyle changes.

• Seek shade

When outdoors, seek shade since the sun may trigger the development of more pigment. It's best to stay out of its rays, especially for long periods of time. Limit sunbathing and try relaxing under a tree or umbrella instead. If you’re exercising, try avoiding peak sun hours. Head out early in the morning or later in the evening when the sun is low.

• Wear sunscreen

Having melasma doesn't mean you must stay indoors when the sun is out, though Wearing a good pregnancy-safe sunscreen with SPF 30+ if you have to do outdoor activities.

Look for products that contain zinc oxide, titanium dioxide, or other physical blockers (mineral sunscreens) versus those that rely on chemical blockers. Physical blocking sunscreens offer broader protection and may be less irritating to the skin.

• Use gentle skin care products

Face washes, lotions, and serums irritating your skin may worsen melasma. Choose products that are labeled "non-comedogenic," "sensitive," "fragrance-free," or "dermatologist-approved" if you get overwhelmed in the beauty aisle.

The same goes for makeup you may use to conceal the dark areas. Look for non-comedogenic or hypoallergenic foundations, concealers, powders, and other products. Use makeup in yellow or white tones to cover dark patches if they interfere with your appearance.

• Eat well and rest

Since melasma may also result from hormonal imbalances, you can improve matters by maintaining a healthy lifestyle. Make sure you’re staying hydrated, eating a diet with plenty of fresh fruits and vegetables, and getting enough sleep each night.

Ensure you’re rounding out your diet by consuming supplemental omega-3 fatty acids. Ask your doctor about any potential vitamin deficiencies. Some studies link melasma to a deficiency in iron and possibly vitamin B12.

If your melasma does not fade on its own after pregnancy, you may ask your dermatologist about other treatments. Treatments include topical medications like hydroquinone, tretinoin, or corticosteroids, according to the doctor's rules.

Your doctor may also recommend certain acids that lighten the skin. Some procedures, including chemical peels, microdermabrasion, laser treatments, and other light therapies, may also work according to the doctor's advice.

Complications

There are no known medical complications associated with melasma, and it does not increase the risk of skin cancer. What may occur are psychosocial complications due to the changed and uneven skin color.

Patients may feel embarrassed and stressed due to the change in skin color or the lengthy treatment process. In addition, melasma tends to recur if proper preventive measures are not taken. Fortunately, melasma generally fades within a few months after childbirth. 

Always consult your doctor regarding the benefits and risks of each safe treatment option for your pregnancy.

Prevention

Some ways to prevent melasma are:

• Limiting sun exposure
• Wear sunscreen with UVA and UVB protection and a minimum SPF of 30 or more. Sunscreens containing zinc or titanium oxide are good choices. Apply sunscreen 20 minutes before you go in the sun and reapply every 2 hours, more if swimming or sweating
• Wear a wide-brimmed hat and sunglasses to protect from the sun
• Limit sun time between 10 am and 2 pm
• Use gentle face cleansers and creams to avoid irritating your skin, which can make chloasma worse

When to see a doctor? 

Call doctor if:

• If you notice a new black spot or mole, or one that is changing rapidly
• You have pain, tenderness, redness, or bleeding with skin color changes

Looking for more information about skin and other hair disease?  read  here!