Every summer, it creeps back slowly, a subtle darkening of the skin on my forehead and temples that eventually comes into view like a map of some uncharted continent. It’s been a decade since I was last pregnant, but my shifting skin offers an annual reminder that no part of my body was untouched by the experience. I carry the memory on my face.
Sometimes called the “mask of pregnancy,” because it so often occurs when a person is expecting, melasma is a “hyperpigmentation or dark skin discolouration that can occur anywhere on the face, but often involving patches on the forehead, cheeks, and above the upper lip,” Dr. Susan Massick, a dermatologist at Wexner Medical Center, Ohio State University, told HuffPost.
It’s worth seeing a dermatologist, Dr. Christine Greves, an OB-GYN at Orlando Health Winnie Palmer Hospital for Women and Babies, told HuffPost. “Sometimes it can be confused with other skin conditions,” Greves explained, adding that diagnosis can be made by a dermatologist “looking closely at the skin, usually with a specialised device.”
The good news is that, other than the discolouration, melasma isn’t dangerous and doesn’t cause other symptoms. You won’t have pain, discomfort, itching or inflammation, Massick said. However, she added that you may feel “self-conscious about it.”
“Diagnosis is made by the clinical appearance and the history behind it — what it looks like on your skin as well as how/when it started,” Massick explained.
Among the world’s population, the incidence of melasma is about 1.5%-33%, but that rises to 15-50% among people who are pregnant.
What causes melasma?
Darker patches of skin are caused by an increase of melanin, “which is responsible for providing pigment to your skin,” Greves said.
There are “a variety of different factors which cause the skin to darken, such as hormonal changes (pregnancy, birth control pills with oestrogen), sun exposure, genetics/family history, medications, or other systemic diseases like thyroid problems,” Massick said.
Because it is so common in pregnancy, and occurs more in women than men, hormones often seem to be the trigger. Hormone levels rise during pregnancy, causing “higher blood flow and oil production,” Greves said. “There are specific oestrogen and progesterone receptors on humans’ skin,” she continued.
Greves added that “women who have medium to dark skin tones are at a higher risk.”
In my case, the melasma developed during my pregnancy, and was helped along by my olive-hued skin and a generous dose of summer sun (in spite of dutiful daily sunscreen application).
When should I see a doctor?
Even if you’re pretty sure that your skin changes are a harmless melasma, “make sure you mention it to your doctor for help with not only treatments but also to ensure that it actually is melasma and not something else that needs to be addressed,” Greves said.
There can be a correlation between thyroid disease, which impacts hormone levels, and melasma, “so it’s important to treat any underlying thyroid issues appropriately,” Massick said.
While there is not a correlation between melasma and skin cancer, “it is
important for a board-certified dermatologist to help manage any new or changing pigmented lesions on your face,” Massick explained. “There is a type of melanoma called lentigo maligna melanoma that can appear as an irregular hyperpigmented patch on the face,” she said, so it’s best to have any skin changes checked out by a professional.
What treatments are available?
Because UV rays are such a common trigger for melasma, sun protection is usually among the first things doctors recommend.
“Strict sun protection to the area, such as daily sunscreen use, is a critical key to treatment,” Massick said.
If your melasma is related to birth control or another medication, switching prescriptions may be a treatment option for you.
Over-the-counter topical treatments that can help, Massick said, include vitamin C, retinol and azelaic acid. You can also see a dermatologist who can prescribe other topical treatments such as lightening creams that contain hydroquinone, sometimes along with kojic acid, and retinoids, Massick said. Tranexamic
acid may also be an option. It can be prescribed orally or topically.
You can also try chemical peels or laser treatments. Massick cautioned that laser treatments “should only be done with a board-certified dermatologist or plastic surgeon skilled in laser technology since you can have a paradoxical worsening of the hyperpigmentation if the wrong laser or settings are used.”
If you are pregnant, you should “focus solely on sun protection and sun avoidance,” Massick said. “You can do more aggressive options after delivery and weaning if breastfeeding.”
Does melasma ever go away?
You may see your melasma dissipate after you deliver your baby, switch to a different birth control pill, or decrease your sun exposure. But it’s also not uncommon for melasma to return — as in my annual, seasonal occurence.
Melasma “is considered a chronic disease, meaning it can come back,” Greves said. Another shift in medication, a pregnancy or simply enjoying a bit of summer sun (even with sunscreen) can lead to a recurrence.
“There is no cure for melasma — it can easily recur and worsen if left untreated or if exposed to the sun/ultraviolet light (including tanning beds),” Massick said. “If it recurs, it will be in the exact place it was before,” she added.
While it doesn’t threaten your health, melasma can “affect people’s self-image and self-esteem,” Massick said. She added that “there are also cultural implications for some ethnicities where any type of discolouration, particularly on the face, is viewed negatively.”
Massick said she focuses on helping patients understand that there isn’t a cure, and treatment may take some time. “You have to have realistic expectations,” she said. She also explained that melasma can be “more challenging to treat and more persistent in skin of colour, particularly in Asian, Hispanic, and African
Americans.”
In addition to seeing a dermatologist, avoiding sun exposure, using sunscreen and having patience with treatment, Massick advised avoiding lightening creams that promise incredible results. “If it overpromises, it will likely
underdeliver, particularly with OTCs,” she said.
When it comes to topical medications such as these creams, “more is not better,” she said. “Overdoing it with products can actually exacerbate the condition — irritation will lead to more hyperpigmentation.”
“Prolonged use or excessive use of hydroquinone,” she said, can also sometimes lead to a “paradoxical darkening” of the skin.