Melasma is a skin condition that causes hyperpigmentation, meaning darkened patches of skin. These patches most commonly occur on the face but can occur elsewhere. Women are more susceptible to this skin condition than men, especially since hormonal changes, such as pregnancy, can cause it. For this reason, melasma is often called “the pregnancy mask.”

What Causes Melasma?

Although melasma can occur anytime, pregnancy is a common instigator for its appearance. The exact causes of melasma are relatively unknown, but hormonal changes such as birth control medications, hormone replacement therapy, and pregnancy are common factors.

Melasma appears as patches or freckled brown, blue, or grey skin. It is most commonly found on the nose, forehead, upper lip, chin, or any area where your skin is regularly exposed to the sun, such as your neck and forearms. This skin condition is rare in men and is most common in Latin and Asian women due to their higher amount of pigment-producing cells, although it can affect fair-skinned women. In Indians, melasma is the most common skin condition. Melasma can occur at any time of life but most often first shows up during your 20s and 30s.

Melasma does not have any other symptoms besides skin patches, but it can cause emotional distress. Approximately six million women in the United States experience this skin condition, with an estimated 15-50% of women getting it during pregnancy.

Prevention and Treatment

The single best way to prevent melasma is to avoid direct sunlight. When pigment-producing cells become hyperactive, they produce too much pigment in certain skin areas, resulting in melasma.

Sun exposure activates pigment-producing cells and is the biggest trigger for melasma. Even if you are prone to developing melasma, it may not appear unless exposed to the sun. For this reason, wearing a wide-brimmed hat and always wearing sunscreen could help you avoid it. However, sunscreen may not be enough. Wearing sunscreen is vital for protecting against skin cancer, but melasma may result from the heat and visible light, regardless of sunscreen use.

Wearing a wide-brimmed hat, especially during the summer months, can help you avoid melasma. When choosing a sunscreen, opt for the kind that acts as a physical barrier rather than a chemical one—sunscreens containing ingredients such as zinc oxide act to block the light waves from your skin physically.

Medications for Melasma

There are medications for melasma that you can ask your doctor about. Topical treatments such as retinol and retinoids can help boost cell turnover and fade the skin’s darkened patches. However, the melasma will likely return. A popular treatment is prescription hydroquinone (HQ), which blocks melanin production. HQ should be used with care as these creams can cause lightened patches of skin to appear. If choosing to use hydroquinone, keep the following in mind:

• Typical concentrations range from 2 to 5% and are applied once daily.
• Most people have good results, but they are reversible.
• Effects can take 5-7 weeks to show.
• Continue treatment for a minimum of three months and up to a year for the best results.
• Your dermatologist may prescribe a combination of HQ, topical steroids, sunscreen, glycolic acids, and retinoids for better results.

Various side effects of hydroquinone can occur, such as stinging, irritation, contact dermatitis, nail discoloration, and depigmentation. Be sure to consult with your doctor if you experience these effects.

Use caution when seeking out skin-lightening treatments as they are often ineffective and can even be dangerous. Be especially careful of injectable treatments such as glutathione. These can cause kidney and thyroid problems and are not approved by the FDA. Additionally, many topical treatments for melasma are not approved for use during pregnancy and breastfeeding. There isn’t enough research to be sure of its safety, and so it is best avoided.

Skin Treatments for The Pregnancy Mask

There are some skin treatments for melasma that help to fade the patches, including:

• Chemical peels
• Dermabrasion
• Microdermabrasion
• Laser treatment and intense pulse light therapy (IPL)

With any of these skin treatments designed to help fade melasma, they are often only temporary if the underlying hormonal issue is not resolved and if you continue to be exposed to sunlight.

It May Clear Up on Its Own

Melasma may fade and clear up on its own without treatment, especially during less sunny seasons. Although emotionally difficult, melasma has no health risks and can be covered with makeup. Avoiding direct sun exposure is the least invasive treatment and is a smart practice for avoiding other issues such as sunspots, wrinkles, and skin cancers. If melasma is an issue for you, speak to your healthcare provider about what the best treatment for you may be.