Hyperpigmentation affects approximately 90% of pregnant women. It is characterised by darker patches or spots of darker skin covering any part of the body but is most common on the breasts and inner thighs.
Hyperpigmentation on the face is known as melasma gravidarum, chloasma or the ‘mask of pregnancy’. It can appear as dark patches on the forehead, upper lip, cheeks and chin.
It is theorised that the hormones progesterone and estrogen stimulate melanocytes to produce more melanin – this is the substance that creates colour to the skin and hair. Melasma affects approximately 70% of women in pregnancy but women with dark skin i.e. asian, indian, afro-caribbean/african american, may have higher rates.
The good news is that melasma often goes after women have their babies with fewer than 10% of women having persistent cases.
Prevention and Treatment
There are a number of options available to help deal with Melasma. Firstly, avoid direct sunlight especially between the hours of 10am and 2pm and use a high factor sunscreen – Factor 30 and higher. This will prevent any further darkening of your skin. Secondly, avoid any harsh cleansers or scrubs as this may irritate your skin and make the situation worse. Thirdly, apply concealing makeup and wait to see if your skin changes after delivery.
There are a number of topical creams on the market that contain active ingredients known to help treat hyperpigmentation; hydroquinone and tretonin.
Tretonin
Although Tretonin or Retin A has a low skin absorption rate it has been liked to retinoid embryopathy in four published cases. Other studies examined use during the first trimester of pregnancy with 96 and 106 women. These studies did not find an increased risk of birth defects or evidence of retinoid embryopathy. That said, experts in this field would advise not to use retinoids while pregnant as there needs to be further investigation in this area.
Hydroquinone
Hydroquinone is used as a skin lightener in the treatment of melasma (in non pregnancy cases) however it is estimated that a high 35-40% is systemically absorbed through the skin. A single study has been published involving the use of hydroquinone during pregnancy and it does not appear to be associated with any risk to the growing baby, however due to the lack of further research and because of the high level of absorption it is probably better to avoid it.
Sun Protection
Sun creams are used to protect the skin from the sun’s harmful rays. Very little of the active ingredients are absorbed into the skin or into the body. Pregnant women have used sun screens for decades to help prevent melasma with no adverse effects.
Conclusion
Melasma can be a problem for women in terms of their self esteem and in particularly severe cases it has an effect on their psychological or mental health. My advice would be that if melasma is really affecting your quality of life and enjoyment of your pregnancy then see your doctor, obstetritian or midwife for further advice.
