What Causes Melasma During Pregnancy?

Reviewed on 12/30/2020

What is melasma?

Melasma is a condition that causes blotchy patches of skin discoloration usually on the face. It is common during pregnancy and while the exact cause is unknown, some possible triggers are an increase in active skin cells, increased hormones, medications, skin care products, sun exposure, and certain thyroid conditions.
Melasma is a condition that causes blotchy patches of skin discoloration usually on the face. It is common during pregnancy and while the exact cause is unknown, some possible triggers are an increase in active skin cells, increased hormones, medications, skin care products, sun exposure, and certain thyroid conditions.

Melasma is a skin condition that most often appears on a woman’s face during pregnancy, though women who are not pregnant can also experience it. It is sometimes called chloasma or pregnancy mask. 

Melasma causes a skin discoloration called hyperpigmentation and affects an estimated six million American women.

Signs of melasma during pregnancy

Melasma occurs most often on the face as brown or grayish-brown patches that sometimes look blotchy. In pregnant women, it most often appears on the:

Other skin changes often occur with melasma during pregnancy, including:

  • Darkened nipples, armpits, and genitals
  • A darkened line on the belly called linea nigra

People who have melasma don’t feel anything as melasma appears. It’s not itchy or painful, but it can cause significant changes to the skin. These changes may cause emotional symptoms. Sometimes women become distressed about their appearance, which can lead to anxiety, shame, and low self-esteem.

Causes of melasma during pregnancy

Melasma is the result of increased melanin production in the skin. Melanin is the pigment that gives color to skin, eyes, and hair. The exact cause of melasma is unknown. However, people who have melasma and melasma during pregnancy may have more active skin cells, called melanocytes. 

Some other factors may trigger melasma, including:

Increased hormones

During pregnancy, the body produces more hormones to sustain life and grow a baby. This increase is a factor in developing melasma. 

Certain medications

Birth control pills, which contain synthetic hormones, and hormone replacement therapy are also a risk factor. People who take these hormone medications and pregnant women who have taken them may develop melasma. 

Steroid medications and photosensitizing drugs may also cause melasma. 

Skin care products

Some ingredients in skin care products may cause photosensitivity, and this may lead to melasma. These ingredients include:

  • Alpha-hydroxy acids (AHAs)
  • Beta-hydroxy acids (BHAs or salicylic acid)
  • Retinoids

Products that irritate the skin may also worsen melasma. Retinoids should not be used during pregnancy.

Sun exposure

Sunlight affects the way skin cells produce melanin. Exposure to the sun and not wearing sunscreen may cause melasma. 

Thyroid disease and adrenal disease

Some other hormone diseases like hypothyroidism, hyperthyroidism, Hashimoto’s disease, Graves’ disease, and Addison’s disease may also cause melasma. 

Family history

If you have a close family member who has melasma, you may have an increased chance of developing it. However, the condition is not hereditary. 

Melasma during pregnancy is usually caused by an increase in hormones, but it is possible to have some of the above conditions that also contribute to melasma while pregnant.

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Tests for melasma during pregnancy

Your prenatal doctor or your dermatologist will examine your skin and record your medical history. Extensive tests usually are not required because your doctor can often diagnose melasma by its appearance.

However, your doctor may want to take a small biopsy of your skin under local anesthesia to examine or rule out any other concern.

Treatments for melasma during pregnancy

There isn’t a cure for melasma, but it can be treated. Some treatments for melasma during pregnancy include:

Skin care procedures

For nonpregnancy melasma, your doctor may use laser treatments, chemical peels, and microdermabrasion. During pregnancy, laser treatments are usually safe, but make sure to receive this treatment from a board-certified dermatologist. 

Medications

Non Pregnancy melasma is often treated with medications like tretinoin and hydroquinone. These medications lighten the skin but may be unsafe to use during pregnancy. 

Skin care products

Some skin care ingredients may help slow melanin production and can be used to treat melasma during pregnancy, including:

Sun protection

Good sun protection is recommended to keep skin healthy and for melasma because exposure to the sun can worsen the condition. This involves wearing sunscreen, staying in the shade, and wearing a wide-brimmed hat. 

Treating other diseases

Treating underlying conditions like thyroid disease and Addison’s disease may help reduce melasma. Your doctor will monitor your disease for appropriate treatment. 

In most cases, melasma during pregnancy will disappear on its own after the pregnancy. It may reappear with other pregnancies or if you take birth control pills afterward.

Make sure to speak to your prenatal doctor and dermatologist if you have melasma during pregnancy. If melasma causes emotional distress, speak to your doctor for medical advice.

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References
American Academy of Dermatology Association: "Melasma: Diagnosis and Treatment."

American Academy of Dermatology Association: "Melasma: Signs and Symptoms."

American Family Physician: "Skin Conditions in Pregnancy."

Anais Brasileiros de Dermatologia: "Melasma: a clinical and epidemiological review."

British Skin Foundation: "Melasma."

Harvard Health Publishing: "Unmasking the causes and treatments of melasma."

Skin Cancer Foundation: "When Beauty Products Cause Sun Sensitivity."

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