The mask of pregnancy (melasma)

What is melasma?

During pregnancy, brown or grayish brown patches may appear and slowly darken on your face. This is a condition known as melasma. Although it appears most commonly on the cheeks, it can also be found on the forehead, nose, upper lip, and chin. 

Images: drpimplepopper

Melasma, sometimes referred to as the mask of pregnancy, commonly occur during pregnancy, from the rapid rise in hormones. But it is not limited to only pregnant women, it can occur in men or women at all stages of life. 

Does melasma pose other health risks?

Although melasma does not pose any health risks, it can be quite frustrating to have and also to treat. It may slowly resolve after baby is delivered, or it may last for months to years. 

What causes melasma?

The causes of melasma is still being investigated. Genetics and hormones play a key role. But one of the most modifiable risk factors is sun exposure. 

What are some melasma treatments?

Strict sun protection is one of the most important treatments for melasma. The best sunscreen are physical blockers containing zinc oxide and titanium dioxide. Reapplying sunscreen every 2 hours when outside and wearing a wide brim hat are key factors to prevent worsening melasma. Recently, blue light has also been shown to worsen melasma. Finding sunscreens that also contain iron oxide and using a screen protector on your phone and computer screens may decrease blue light exposure. 

Image: Antonio Gabola

When to seek a dermatologist…

If melasma is not getting better on its own, a trip to the dermatologist may be necessary to make the correct diagnosis and determine the cause. For example, if a 25-year-old woman comes in with dark patches on her cheeks and she was recently started oral contraceptives, then this may be the cause of her melasma. Switching her to a different type of birth control may be the cure for her melasma. 

A dermatologist may also recommend specific over the counter and prescription topical or oral treatments to treat melasma. Topical products may include Vitamin C, E, and A (i.e. adapalene gel/cream, tretinoin gel/cream), lightening agents such as hydroquinone, kojic acid, azelaic acid, tranexamic acid, and cysteamine. Recently, oral tranexamic acid has been shown to be very effective for melasma but require lab monitoring by a physician due to risk of blood clots.

Sometimes, topical or oral treatments are not enough and patients may require in-office treatments such as chemical peels, laser treatments, and/or microneedling.

Image: Getty Images

Finally, it’s important to be aware that there is no one-size fit all model for melasma. Some treatments work for some, but  may make melasma worse in others. Thus, being in close communication with a dermatologist will help you find the best treatment for your melasma.

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