The Skinny on Melasma

Melasma, also known as chloasma or “mask of pregnancy” is a common skin disease that appears as pigmented areas of the forehead, cheeks, upper lip, and chin as well as forearms. At least 90% of people with melasma are women, and there is a higher incidence in Hispanics, Asian, and Africans. This skin disease has a high recurrence rate and can negatively impact quality of life. 

What causes Melasma during pregnancy?

The combination of sun, environmental factors, and hormones in pregnancy can cause melasma as well as other triggers listed below.  The placenta secretes melanocyte stimulating hormone (MSH) as well as estrogen and progesterone which cause our melanocytes or cells that make the pigment in our skin to work overtime.  This is why 50-70% of pregnant women develop melasma! These hormones can also make your nipples, skin folds, and genital area darker, in addition to creating a line on the tummy called linea nigra.

When does Melasma begin in pregnancy?

Melasma can start during the first trimester and can continue throughout the entire 9 months of pregnancy. After giving birth and/or breastfeeding, the pigment will start to fade. If melasma persists, talk to your board-certified dermatologist about appropriate and effective treatment options. 

How can I treat this disease?

First and foremost, SUNSCREEN, SUNSCREEN, SUNSCREEN!! Choose a physical or mineral based sunscreen with active ingredients of zinc oxide and/or titanium dioxide which will not absorb into the skin but instead acts as a physical barrier to protect your skin from the sun. Choose a sunscreen with at least an SPF of 30 which protects against 97% of suns’ rays for a 2-hour period. There are many fantastic sunscreens on the market at all different price points – just remember that ingredients matter! Staying cool and in the shade are helpful in controlling this disease state. Studies have also demonstrated that diets low in refined sugars (which cause inflammation) and high in folate and zinc may help improve your melasma. 

There are several key ingredients in skincare that help to treat and prevent melasma during pregnancy and breastfeeding. Vitamin C, niacinamide, azelaic acid, glycolic acid, lactic acid, mandelic acid, malic acid, and kojic acid are safe and effective to use during this time and may even help with the prevention of melasma. After pregnancy and breastfeeding, treatment with hydroquinone, tretinoin (retinoids), topical steroids (in combination with the aforementioned), and tranexamic acid as well as chemical peels and laser/light-based procedures can be effective with the guidance of your dermatologist.