Melasma the Mask of Pregnancy

Melasma the Mask of Pregnancy

Melasma is called a facial dyschromia, that is, a disorder of facial pigmentation that accompanies about seventy per cent of all pregnancies. It usually starts after the third month of pregnancy, and most commonly affects the centrofacial area which includes the chin, upper lip, and forehead. In about half of that many cases, it occurs on the cheeks, like a mask. In still fewer cases it appears on the jaw line. It is interesting that in geographical areas devoid of sun exposure, it only occurs in five per cent of pregnant women, suggesting a direct correlation betwee
UV light exposure and the development of melasma. In most cases melasma disappears after the baby is born, but in some cases it can remain and even get worse after sun exposure. Melasma is part of the entire increased pigmentary process of pregnancy. Other areas of pigmentation can include the nipples and areola, the skin around the belly button, the midline line that goes from the belly button to the symphysis pubis, and the anogenital areas. Like melasma, these other pigmented areas usually return to normal after delivery, but they may not. This is especially true in women with darker skin.

What causes melasma and the other dyschromias of pregnancy? Probably it’s the extra levels of the hormones estrogen and progesterone that circulate during pregnancy. The production of melanin pigment is increased by estrogen, and progesterone augments that process. The pituitary gland swells during pregnancy and releases a hormone which increases pigment productivity. It’s interesting that light-skinned and dark-skinned women have about the same number of melanocyte cells in the skin. It’s just that the latter is able to produce more of the pigment melanin.
So, what’s to be done? The first thing is to avoid the sun. The pregnant or recently pregnant woman should wear a sun hat, use broad spectrum sun screen, and try to avoid exposure to the sun. If she is after delivery, and after nursing, a triple combination of facial topical cream can be compounded of skin bleach, a topical steroid, and a peeling agent to try to remove the pigmentation. Never washes as Obagi or Dermes are often great correcting this pigment problem. There is a technique with a fractionated laser which can destroy the skin pigment in the hands of an experienced aesthetic physician.

Women are very sensitive about conditions which affect the appearance of their facial skin. Of course, a good quality make-up, skillfully applied, can help the situation. Skin products are available which gradually peel the skin down to its younger epidermal cells. The topical medicine and laser can help, but avoidance of sun exposure is probably the most important thing which can be done to prevent and treat persistent melasma.

John Drew Laurusonis M.D.
Doctors Medical Center