Melasma, also called ‘chloasma’ and ‘pregnancy mask’, is a common skin condition of adults in which brown or greyish patches of pigmentation (colour) develop, usually on the face. The name comes from melas, the Greek word for black, or cholas, from the word green-ish. It is more common in women, particularly during pregnancy (when up to 50% of women may be affected). Sometimes men may also be affected.

Melasma is more common in people of colour and those who tan very quickly but can occur to anyone. Melasma usually becomes more noticeable in the summer and improves during the winter months. It is not an infection; therefore, it is not contagious, and it is not due to an allergy. It is not cancerous and will not develop into skin cancer.

What is the cause of pregnancy melasma?

The exact cause of pregnancy melasma is not known, but it is thought to be because of pigment-producing cells in the skin (melanocytes) producing too much pigment (melanin).

Several factors can contribute to developing melasma, including pregnancy and using hormonal drugs such as birth control pills and hormone replacement. Exposure to ultraviolet (UV) light from the sun and the use of sun-beds or phototherapy can trigger melasma or make it worse. Melasma appears darker than the surrounding skin- affecting the cheeks, forehead, upper lip, nose and chin. It looks like a tan mask that is why it is sometimes referred to as the mask of pregnancy.

When does melasma start and how long does it last during pregnancy?

Melasma can start in the first trimester and continue throughout pregnancy. For most women, the darkness fades after birth or after breastfeeding. If it persists, there are treatment options available.

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How to prevent melasma from getting worse

One of the most important things you can do to prevent melasma worsening is protecting yourself from UV radiation. This means avoiding the sun, wearing a wide-brimmed hat when you are outside and wearing broad-spectrum sun cream (SPF 30 or above, with a high UVA rating). The higher the SPF the more effective it will be. Avoid using sun-tanning beds. Protecting your skin from the sun will also help the below treatments be more effective.

The main melasma treatments aim at blocking the hyperactivity of the melanocytes, bleaching the extra pigmentation and peeling it away, and using sun protection.

How to treat pregnancy melasma AFTER pregnancy and breastfeeding

Skin lightening creams

Skin lightening creams Hydroquinone is a medicine that prevents pigment cells in the skin from producing melanin and is commonly used to treat melasma. It is combined with tretinoin creams and alpha hydroxy acid creams in the treatment of melasma. Retinoid creams, usually used to treat acne, and some types of acid cream (such as azelaic acid, ascorbic acid and kojic acid) can help improve the appearance of melasma but can also cause skin irritation. Some skin-lightening creams contain a combination of two or three ingredients to make them more effective. Skin lightening creams must only be used when prescribed, and under medical supervision to reduce the risk of side effects.

Chemical peels

Chemical peels can improve melasma by removing the outermost cells of the skin that contain the pigment. Chemical peels should be undertaken by an experienced practitioner as they could make the pigmentation worse, lighten the skin too much or cause scarring. (See info on dermamelan peel).

Recently, scientists have found that tranexamic acid (a drug usually used to stop bleeding) is effective in improving the appearance of melasma in some patients. It is prescribed as pills or combined with creams .

If melasma improves, this effect can be maintained by protecting your skin from the sun and using the advised creams by your dermatologist for maintenance .

Article by Dr. Hiba Injibar, Consultant Dermatologist, Dermasurge Clinic
121 Harley Street, 3rd floor, London, W1G 6 AX

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