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Is it normal to have melasma during pregnancy?
Yes, it's common to develop blotchy spots of darker skin when you're pregnant, a condition called melasma or chloasma. Melasma is also sometimes referred to as the mask of pregnancy because the splotches typically show up around your upper lip, nose, cheekbones, and forehead in the shape of a mask.
You may also develop dark patches on your cheeks, along your jawline, or on your forearms and other parts of your body that are exposed to the sun. What's more, skin that's already more pigmented – such as your nipples, freckles, scars, and the skin of your genitals – may become even darker during pregnancy. This also tends to happen in areas where friction is common, such as your underarms and inner thighs.
What causes melasma?
Melasma may be triggered by hormonal changes during pregnancy, which stimulate a temporary increase in the amount of melanin your body produces. Melanin is the natural substance that gives color to hair, skin, and eyes.
Sun exposure plays a role too. Women with darker complexions are more likely to have melasma than women with lighter skin.
You're also more likely to develop melasma if it runs in your family.
Is my linea nigra related to melasma?
The same increased production of melanin that causes the facial splotches of melasma also causes the linea nigra, or dark line that you may notice running down your belly.
Before pregnancy, the linea alba (white line) ran from your belly button to your pubic bone, though you probably didn't notice it because it was the same color as the rest of your skin.
During pregnancy, pigmentation from increased melanin production turns the linea alba into the linea nigra (black line). The linea nigra will probably fade back to its pre-pregnancy color several months after you deliver your baby.
How can I prevent melasma from getting worse during pregnancy?
All changes in skin pigmentation due to melasma usually disappear on their own after delivery, but you can do a few things to safely minimize darkened spots on your skin during pregnancy:
- Use sun protection. This is crucial because exposure to the sun's ultraviolet (UV) rays triggers melasma and intensifies pigment changes. Use a broad-spectrum sunblock (a formula that protects against both UVA and UVB rays) with SPF 30 or higher every day, even when it's not sunny, and reapply often during the day if you're outside.
Even if you don't plan to leave the house or spend much time outside, it's a good idea to apply sun protection as part of your morning routine. The American Academy of Dermatology cautions that your skin is exposed to a significant amount of UV light whenever you walk down the street, ride in a car, or even sit inside near a window.
When you're outside, wear a wide-brimmed hat as well as a long-sleeved shirt if you have pigmentation changes on your arms. Limit the time you spend in the sun, especially between 10 a.m. and 2 p.m. And definitely avoid tanning salons.
- Don't wax. Using wax to remove hair can cause skin inflammation that worsens melasma, especially in areas of your body that are affected by pigmentation changes.
- Use hypoallergenic skin care products. Cleansers and face creams that irritate your skin may make melasma worse.
- Apply concealer. If the darkened spots bother you, cover them up by using makeup with white and yellow undertones for now. Don't use skin-bleaching products while you're pregnant.
Will I still have melasma after my pregnancy?
Melasma usually fades without treatment after you have your baby. The darkened spots probably will fade within a year after delivery, and your skin should return to its normal shade, although sometimes the changes never completely disappear.
For some women, contraceptives containing estrogen (such as the Pill, the patch, and the vaginal ring) can also contribute to melasma. If the skin changes are bothersome, consider another birth control option.
If your skin is still blotchy a few months after giving birth and it's bothering you, talk to your healthcare provider or a dermatologist about treatment options for melasma. She may suggest using a bleaching cream that contains hydroquinone (and possibly sunscreen), a topical medication that contains tretinoin (Retin-A), or a chemical peel such as glycolic acid.
If you're breastfeeding or plan to get pregnant again soon, let your provider know and check with her before using any over-the-counter treatments.
Don't expect instant results – it may take many months to see improvement. If other treatments haven't helped, a dermatologist can lighten dark spots with laser treatments, but that's not the first option.
In any case, continue to protect your skin from the sun by using sunscreen every day, wearing protective clothing, and staying out of the sun during peak hours.
Are darkened spots on skin during pregnancy ever a sign of illness?
Certain types of skin discoloration can be a symptom of skin cancer or other medical problems.
Call your provider if you have changes in skin pigmentation as well as pain, tenderness, redness, or bleeding, or if you notice any changes in the color, shape, or size of a mole.
You may be referred to a dermatologist for a diagnosis and appropriate treatment.