Melasma during pregnancy: Causes, symptoms & how to treat

What is melasma during pregnancy?

Melasma is a very common, harmless skin condition that can affect anyone – but it’s particularly common during pregnancy, affecting 50-70% of women during pregnancy [1]. Also known as ‘chloasama’ or ‘pregnancy mask’, it’s a type of hyperpigmentation (which is when there are patches of skin that are darker than the surrounding skin). All melsama is hyperpigmentation, but not all hyperpigmentation is melasma. Melsama specifically, then, is characterized by dark, patchy skin on the face – usually on the cheeks, forehead, nose and upper lip. These patches are usually brown or greyish. 

It can affect anyone but it’s more common in people with darker skin-types. It’s typically more noticeable in the summer months and less noticeable in winter [2].

This hyperpigmentation during pregnancy is entirely safe. It’s not an infection, so it can’t be passed on to other people – and it’s also important to know that it isn’t cancerous, and it won’t turn into skin cancer [3].

Will melasma affect my baby?

No, don’t worry – melasma won’t affect your baby. It’s a skin condition that affects the mother’s skin pigmentation due to hormonal changes during pregnancy. It has no impact on the baby's health or development.

However, some treatments for melasma may not be safe to use during pregnancy, so it’s always best to speak to your doctor or dermatologist about how to manage your melasma while pregnant.

Symptoms of melasma in pregnancy

If you have melasma, the only symptom is the change in your skin – you may notice different colored patches on your skin, which can be tan, brown, greyish or blue grey. You may also experience freckle-like spots on your skin.

It’s most common to get melasma on your face (usually your cheeks, forehead, chin, and above the upper lip), but it can also develop on your arms, neck, or other parts of your body. The affected skin shouldn’t be itchy or painful. If you do have these symptoms, you should speak to your healthcare provider, as they may be symptoms of another condition rather than melasma.

Many people with melasma report feeling distressed, due to the visible nature of the condition, and the fact it mainly affects the face. Studies have shown that patients with melasma have reported feelings of low self-esteem, shame, an inability to feel pleasure (anhedonia), and an unwillingness to go outside [4].

If you’re affected in this way by melasma or feel as though it’s affecting your quality of life, you should consult your healthcare provider. They can help you with treatment options for melasma, and suggest some ways to deal with your low mood and self-esteem.

Causes of melasma in pregnancy

Although melasma is very common, it’s not fully understood why some people develop it and others don’t. It’s mostly commonly linked to hormonal changes during pregnancy, specifically increased levels of the hormones estrogen and progesterone. As well as pregnant women, women who are taking oral contraceptives and those who take hormone replacement therapy (HRT) during menopause may also experience melasma [5].

Another key hormone that increases during pregnancy is the melanocyte-stimulating hormone (MSH). It plays a key role in stimulating melanocytes, the cells responsible for producing melanin, the pigment that gives color to the skin, hair, and eyes. As MSH levels are increased during pregnancy, it’s thought that this is another cause of hyperpigmentation of the skin, or melasma during pregnancy – although studies are inconclusive on this, as women who have never given birth (and so don’t have heightened levels of MSH) can also get melasma [6, 7].

Other causes of melasma

It’s more common for people who have a blood relative with melasma to also get melasama [8]. In one survey of 324 women, it was found that 48% of the individuals have a family history of melasma [9].

Additionally, melasma is often triggered by sun exposure. Spending time in ultraviolet (UV) light can either trigger melasma, or make it worse – and that UV light can either come from spending time outside in the sun, or from using sunbeds [3].

When melasma may start in pregnancy

Melasma typically starts during the second or third trimester of pregnancy, when hormonal changes are at their peak. However, it can develop earlier in pregnancy, depending on individual sensitivity to hormonal fluctuations and factors like sun exposure.

When does pregnancy melasma in pregnancy go away?

If you’ve developed melasma during pregnancy, it often goes away on its own a few months after giving birth – although it may come back if you’re exposed to the sun again. It may also make another appearance if you have another pregnancy [10].

Melasma really varies from person to person. If you still have a visible mark a few months after giving birth, consult a dermatologist, who’ll be able to advise you on the best course of action.

How to prevent melasma during pregnancy

The best way to prevent melasma during pregnancy is by minimizing sun exposure, as this can make the condition worse. Always wear a broad-spectrum sunscreen with SPF 30 or higher and a 4 or 5 UVA rating, even on cloudy days. Wear wide-brimmed hats and try to avoid the sun when it's at its peak (usually between 10am and 4pm) [3].

You may also want to cover up with long-sleeved tops and if you’re swimming you may prefer to opt for a long sleeved swimming top (sometimes called a rash guard) rather than a swimsuit. Additionally, you should avoid using sunbeds if you’re pregnant.

How to treat melasma

Unfortunately, there’s no sure way to prevent melasma, and there’s no cure that’s guaranteed to work [8]. As melasma isn’t harmful, there’s no need to treat it at all if it doesn’t bother you. But if you dislike it or it’s causing you distress, there are several melasma options available that can help to reduce the uneven skin tone. Remember that not all of these are safe to use during pregnancy, so it’s really important to consult your doctor before starting any treatments. 

Here are some of the options, both medical and natural, that you can use to treat and/or prevent melasma:

1. Protect your skin

As we already mentioned, the most important thing is to protect your skin from the sun, as sun exposure stimulates melanin production, which can worsen pigmentation and make melasma patches darker [11]. Protecting your skin is good practice for your health at all times, not just during pregnancy. You can choose a facial moisturizer that already contains SPF to add more sun protection to your daily routine. 

2. Take medication

Typically, people with melasma will be prescribed medications that are applied topically to the skin, such as hydroquinone, azelaic acid, kojic acid, niacinamide, cysteamine, rucinol, and tranexamic acid. 

However, most of these aren’t suitable for use during pregnancy, except for azelaic acid, which unclogs your pores and refines the skin’s surface, and is safe to use when pregnant [12].

3. Use gentle skin care products

Use fragrance-free and non-comedogenic products to avoid irritation that may upset your skin and make melasma worse. Look out for gentle, dermatologist-approved products that don’t contain any harsh chemicals.

4. Apply skin camouflage

While melasma is completely normal and very common, some people are very self-conscious about it. If it’s affecting you, your doctor may suggest skin camouflage, specially formulated makeup products that are designed to conceal skin conditions like melasma, scars, vitiligo, or birthmarks. 

These products provide long-lasting coverage, are often water-resistant, and come in a range of shades to match various skin tones, helping to restore confidence and create a more even complexion [13, 14].

5. Try chemical peels

Chemical peels can be an effective treatment for melasma by removing the outer layers of skin to promote the growth of new, more even-toned skin. It's important to consult with a dermatologist before undergoing a chemical peel, especially during pregnancy, as some treatments may not be safe [2]. Additionally, it’s vital that you use sunscreen consistently after a peel to prevent the melasma from worsening.

6. Practice self-care

It’s not a common theory, and the evidence isn’t great, but some small studies have shown that stress can exacerbate melasma [4]. You might want to try self-care methods like meditation, yoga, and getting plenty of sleep to see if that helps your melasma – and if not, there are no downsides to some extra self-care during pregnancy.

When to see a doctor

You can see a healthcare professional at any time if you notice any unusual skin changes on your face or any other part of your body. A doctor or dermatologist will be able to tell you whether you have melasma or another skin condition, and they can advise on what treatments are most beneficial for you – as well as which ones are safe, particularly during pregnancy and postpartum. And while most people’s melasma goes away a few months after giving birth, you may want to see a doctor if this isn’t the case for you.

Additionally, if your melasma is causing you distress or you feel self-conscious about it, you should speak to your doctor. They can offer guidance on effective treatments or coping strategies, and may refer you to a dermatologist or other specialist for further support.

Postpartum support from Natural Cycles

There’s a lot going on during pregnancy – and beyond. If you need a helping hand to navigate the postpartum period, we’re here to help with NC° Postpartum. Our latest app experience is packed full of helpful guides and content so you can learn what’s happening in your body at every stage of your recovery journey. Learn more about how we can support you, or get started today.