You hear a lot about the glow that pregnant women exude, the radiance that overcomes them, how carrying another human makes a person beautiful and youthful and fresh. What you don’t hear about are other realities such as melasma, a hormone-related skin condition that appears as dark, blotchy patches, most often on the face, and most often in pregnant women. The condition has earned the nickname “pregnancy mask”; the National Institutes of Health once estimated that up to 70% of expecting women will develop it.
What basically happens in people with melasma is the melanocytes — the cells that make melanin, the pigment that determines the color of your skin — are in overdrive. They’re activated and they don’t stop being activated, so they continue to produce pigment without slowing down.
The condition develops most frequently as a result of hormonal changes and can occur in people who aren’t pregnant, too. Oral contraceptives containing estrogen and progesterone are often a contributing factor. Melasma can also be a reaction to certain medications or cosmetics, or to an underactive thyroid that doesn’t produce enough thyroid hormone.
According to a 2009 article published in The Journal of the European Academy of Dermatology and Venereology, nearly half of people with melasma have reported that the condition runs in their family. Currently it affects more than five million people in the United States. People with darker skin are more susceptible to developing melasma because they possess more melanocytes.
The condition isn’t harmful, but it’s tough to treat. Options include hydroquinone, which is sold as a lotion, cream, or gel; corticosteroids and tretinoin, which are also sold as lotions, creams, and gels; and medical procedures such as chemical peels, microdermabrasion, light therapies, and laser treatments. However, there are risks associated with all of these and many should be avoided during pregnancy.
Hydroquinone lotions can cause dermatitis, a painful redness. Topical creams can be expensive. Microdermabrasion can result in inflammation. A 2014 article in Dermatology and Therapy is clear that laser treatment should be “a last resort”.
The safest and earliest solution is to avoid birth control pills and hormone therapy, limit sun exposure, and wear broad-spectrum sunscreen. Medical professionals call this prophylactic management, and agree that discontinuing the use of oral contraceptives is the most effective way to avoid developing melasma, either before or during pregnancy, and that avoiding sun exposure and using sunscreen helps too. An article in the Journal of Community Hospital Internal Medicine Perspectives notes that of all treatment options, birth control pill “discontinuation is perhaps most important, as this has been found to be linked with melasma in patients even without genetic predisposition”. And while the sun doesn’t cause melasma, it can make the patches on your face that melasma produces look darker, so it’s best to always use the right sunscreen and to avoid UV radiation when possible — generally these are good ideas, even your goal is not to avoid melasma but just to achieve radiant, youthful-looking, elastic skin.