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Pregnancy and Melasma

Pregnant?

Pregnancy can be a very emotional mother or mother-to be according to the American Academy of Dermatology, up to 70 percent of pregnant women develop blotchy areas of darkened skin, commonly called the mask of pregnancy (but officially known as chloasma or melasma).

Women with darker complexions are more prone to this condition than women with lighter skin. The effects of chloasma may become more pronounced with each pregnancy.

The splotches can show up around your upper lip, nose, cheekbones, and forehead, sometimes in the shape of a mask (think Lone Ranger). They may also appear on your cheeks or along your jawline. You may develop dark patches on your forearms and other parts of your body that are exposed to the sun.

What's more, you may find that skin that is already more pigmented — such as your nipples, freckles, scars, and the skin around your genitals — becomes even darker during pregnancy. This also tends to happen in areas prone to friction, such as your underarms and inner thighs.

These changes are caused by hormonal changes during pregnancy, which stimulate a temporary increase in your body's production of melanin, the natural substance that gives color to hair, skin, and eyes. The areas of increased pigmentation will probably fade within a few months after delivery and your skin should return to its normal shade, although in some women the changes never completely disappear. 

Can I do anything to prevent skin discolorations during pregnancy?

Skin pigmentation changes usually disappear on their own after delivery, but you can do a few things to safely minimize them in the meantime:
•  Protect yourself from the sun: This is crucial because exposure to the sun's ultraviolet (UV) rays 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, whether it's sunny or not, and reapply often during the course of the day if you're outside.

In fact, even if you don't plan to leave the house or spend much time outside, make applying sun protection part of your morning routine. The American Academy of Dermatology cautions that your skin is exposed to a significant amount of UV light when you do things like walk down the street, ride in a car, or even sit inside near a window.

When you're outside, cover up and wear a hat with a brim, as well as a shirt with long sleeves 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.
•  Use gentle cleansers and facial creams. Preparations that irritate your skin may make the problem worse.
•  Apply a concealing makeup. (Don't use skin-bleaching products now. Wait to see if the pigmentation changes go away after you give birth.)

What about after my pregnancy?

After you have your baby, continue to protect your skin from the sun! Use sunscreen, cover up, and stay out of the sun at midday. In most cases, the discolorations will slowly fade without any treatment.

For a small number of women, however, contraceptives that contain estrogen (such as the Pill, the patch, and the vaginal ring) can contribute to chloasma. If the skin changes are bothersome, consider another birth control option.

If your skin is still blotchy after a few months and it's bothering you, talk to your practitioner or a dermatologist about treatment options. She may suggest using a bleaching cream that contains hydroquinone (some of which also contain sunscreen), a topical medication that contains tretinoin (Retin-A), or a chemical peel such as glycolic acid. Of course, if you're breastfeeding or plan on becoming pregnant again soon, be sure to let your practitioners know and also check in before using any over-the-counter treatments.

Don't expect instant results — it may take many months to see improvement. In rare cases, dermatologists can use laser treatments to remove the darkened skin, but that's not the first option. Whatever approach you take, it's crucial to continue protecting yourself from the sun during treatment and afterward.

Are these skin changes ever a sign of illness?

Certain types of skin discoloration can be a symptom of skin cancer or other medical problems, so let your practitioner know if changes in skin pigmentation are accompanied by 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 who can determine the cause of the changes and the appropriate treatment, if any.

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