It’s common for pregnant women to notice changes in their skin during pregnancy. One of the most common changes is melasma, also known as the “mask of pregnancy.” This refers to darker pigmented patches that can appear on the face, often on the forehead, cheeks, upper lip, and chin.
What causes skin darkening during pregnancy?
Melasma is caused by the overproduction of melanin, the natural pigment that gives color to the skin. Several factors related to pregnancy can trigger melasma:
- Hormonal changes – Increased levels of estrogen and progesterone can stimulate melanocytes, the cells that produce melanin.
- Sun exposure – Pregnancy can make skin more sensitive to UV rays, which activates melanin production.
- Genetics – Women with naturally darker complexions are more prone to developing melasma during pregnancy.
- Thyroid dysfunction – Having an underactive or overactive thyroid can contribute to melasma.
When does pregnancy-related skin darkening appear?
Melasma often begins around the second or third trimester of pregnancy when hormone levels peak. However, it can occur earlier or later for some women. The pigmentation tends to progressively darken as the pregnancy continues. Women carrying twins or multiples may be more likely to develop more pronounced skin darkening earlier on.
Where does skin darkening during pregnancy appear?
The face is the most common location for melasma to develop during pregnancy. The forehead, upper lip, nose, chin, and cheeks are typical facial areas affected. However, melasma can occasionally occur on other parts of the body as well, such as the forearms, neck, or upper chest.
Does pregnancy skin darkening go away after delivery?
After giving birth, the extra melanin production often slows down and pregnancy-related skin darkening fades. However, it does not always go away completely on its own. Here’s an overview of what to expect:
- Within a few weeks postpartum, melasma often starts lightening up or disappearing.
- For many women, the dark patches are much faded around 3 months postpartum.
- Up to 50-70% of women find their melasma has significantly resolved by 6-12 months after childbirth.
- For 30-50% of women, stubborn traces of melasma remain for longer than 12 months after delivery.
- A small percentage of women continue to have persistent melasma for years after pregnancy.
As you can see, pregnancy melasma does not always resolve on its own. The timing for natural fading varies widely among different women.
Factors that influence fading of melasma
Certain factors contribute to whether skin discoloration is more likely to fade or persist postpartum:
| Factor | Influence on Melasma |
|---|---|
| Skin type | Darker skin types see less spontaneous improvement |
| Severity | More pronounced darkening fades more slowly |
| Location | Facial melasma is harder to get rid of than body spots |
| Genetics | Family history predicts slower fading |
| Sun exposure | More sun exposure delays clearing |
| Future pregnancies | Repeated pregnancies make melasma more persistent |
Treatments to help fade postpartum melasma
While patience is needed to allow pregnancy skin changes to resolve, there are treatments that can speed up the fading process if melasma remains bothersome:
Sunscreen
Sun exposure makes melasma much harder to get rid of. A broad-spectrum sunscreen of SPF 30 or higher should be applied daily to prevent worsening of pigmentation.
Hydroquinone
Skin lightening creams containing hydroquinone effectively lighten melasma. Prescription strength 2-4% hydroquinone works best. However, this ingredient is controversial and can only be used for limited periods.
Retinoids
Topical retinoids like tretinoin help exfoliate the skin to fade pigmentation faster. They may be prescribed alone or in combination with hydroquinone.
Azelaic acid
Azelaic acid has mild lightening effects and can help address post-inflammatory hyperpigmentation. It is considered safe for use while breastfeeding.
Chemical peels
Superficial chemical peels performed by a dermatologist can help remove pigmented skin and promote skin cell turnover. Several repeat treatments are usually needed.
Laser treatments
A series of laser resurfacing treatments is sometimes used for stubborn melasma that doesn’t respond sufficiently to topical creams alone.
Other options
Other medical treatments that may be considered for melasma include microdermabrasion, intense pulsed light therapy, and trichloroacetic acid peels. Always see a board-certified dermatologist for these cosmetic procedures.
Can melasma return after fading?
It’s possible for melasma to recur after it fades – either during a future pregnancy or from sun exposure. To keep it from returning, be diligent about sunscreen use and wear wide-brimmed hats outdoors. Trying a maintenance regimen of azelaic acid or hydroquinone can also help.
When to see a dermatologist
Make an appointment with a dermatologist if:
- Melasma does not begin to improve 3-6 months after delivery.
- You are bothered by the appearance of persistent melasma.
- Over-the-counter products do not sufficiently lighten the pigmented areas.
- You experience any new pigmentation or suspicious spots.
A dermatologist can determine if any skin biopsy or testing is recommended. They may also prescribe clinical treatments not available over-the-counter.
Caring for skin during pregnancy
While melasma can’t always be prevented, the following tips can help minimize your risk:
- Wear sunscreen daily and reapply every 2 hours when outdoors.
- Stay in the shade whenever possible and wear wide-brimmed hats and sunglasses.
- Use a broad spectrum UVA/UVB sunscreen on all sun-exposed skin.
- Avoid prolonged heat exposure from activities like sunbathing.
- Consider using a facial self-tanning lotion to camouflage uneven pigmentation.
- Use a moisturizer formulated for hyperpigmentation if your skin is very dry.
- Look for skin care products containing niacinamide, vitmain C, soy, licorice extract or kojic acid.
- Talk to your doctor before using any skin lightening products while pregnant or nursing.
When to see your doctor
Consult your physician if you have any concerns about new pigmentation during pregnancy such as:
- Dark spots spreading across your body or face.
- Discoloration accompanied by rashes, itching, dryness or other changes.
- Pigmentation appearing early in the first trimester.
- Melasma not fading within 12 months after birth.
Sudden onset of melasma or itching and inflammation around dark areas could indicate a different condition, like chloasma. Thyroid issues and other hormonal disorders that can cause pigmentation should also be ruled out.
Conclusion
Skin darkening is common during pregnancy but often fades in the months after giving birth. With diligent sun protection and medical treatments if necessary, most women can improve the appearance of melasma over time. Speak to your doctor if pregnancy-related skin changes remain pronounced so any underlying condition can be diagnosed.
