What Is Pregnancy Melasma? Exactly How to Treat the Skin Discoloration

Woman's upper lip close-up

Getty Images / Jonathan Storey

Pregnancy melasma, also known as a “pregnancy mask,” is an extremely common condition that causes skin hyperpigmentation (i.e. darkening), especially among people who are pregnant. It largely affects people who were assigned female at birth—a whopping 90% of them—during their reproductive years, when they’re 20 to 40 years old.

As you’ve likely already inferred from its alternate moniker, becoming pregnant puts you at a higher risk of developing pregnancy melasma. Between 50% to 70% of all melasma cases are among those who are pregnant.

Although it’s a benign condition that doesn’t cause any pain or discomfort, its appearance can negatively impact your confidence and self-esteem. But, keep in mind that it can fade on its own after you’re no longer pregnant, and there are other ways to help it along the way.

Ahead, we’re discussing everything you need to know about pregnancy melasma, including what it is, what causes it, and how you can both treat and help prevent it. We even asked a couple of board-certified dermatologists to weigh in.

What Is Pregnancy Melasma?

As mentioned, pregnancy melasma is a skin condition that’s pervasive among pregnant people. Originally coined in Latin, it loosely translates into “black spot.” While melasma doesn’t actually cause black spots to appear on the skin, it does create brown or blue-gray discolorations that are grouped together to form larger patches. 

“Melasma is a super common skin condition characterized by hyperpigmentation on certain areas of the face,” explains Dan Belkin, MD, a board-certified dermatologist at the New York Dermatology Group in NYC. “It is typically hormonally-triggered, much more common in women, and often arising or worsening in pregnancy or with birth control pills.” The surge in hormones you experience when you’re pregnant makes your skin more susceptible to sunlight and other pregnancy melasma triggers.

For many people, pregnancy melasma can improve after you’re no longer pregnant—once your hormonal levels return to their normal, pre-pregnant levels. But, keep in mind, once you experience this patchwork discoloration, you’re more susceptible to it recurring if you become pregnant again.

Thankfully, the only thing it interferes with is your skin’s appearance, and it’s not the kind of skin condition that causes cancer or can turn into cancer. That said, there are skin cancers that look similar to melasma, so it’s important to see your dermatologist to get a definitive diagnosis.

Dr. Rachel Nazarian, MD

It often presents as a darkening in skin color around the mid or upper forehead, lateral cheeks, and upper lip.

— Dr. Rachel Nazarian, MD

What Does Pregnancy Melasma Look Like?

Pregnancy melasma is a pretty straightforward skin condition. If you didn’t see it in pictures or a mirror, you wouldn’t even know you had it—it doesn’t itch, hurt, or cause any other sensation. It’s only symptom is the gradual development of mottled dark spots on your skin, typically on the forehead, cheeks, nose, and upper lip, though it can also appear on the forearms.

“It often presents as a darkening in skin color around the mid or upper forehead, lateral cheeks, and upper lip,” describes Rachel Nazarian, MD, a board-certified dermatologist at the Schweiger Dermatology Group in NYC. “It mimics discoloration of other skin conditions, and should be diagnosed by a board-certified dermatologist MD/DO to prevent misdiagnosis and incorrect treatments.”

These discolorations are flat, clustered, asymmetrical splotches. They’re also commonly mistaken for freckles or age spots, however, those tend to be smaller. The intensity of pregnancy melasma can fluctuate throughout the year, darkening in the summer and lightening up in the winter. We’re explaining why this occurs, below.

What Causes Pregnancy Melasma?

The underlying cause of pregnancy melasma is unknown, beyond an overproduction of melanin, the pigment that gives your skin its color. This can occur when you’re pregnant due to an increase in hormones, specifically estrogen and progesterone. (Other hormonal alterations, such as birth control medication and hormonal replacement therapy can also trigger melasma in nonpregnant people.) 

If you’re susceptible to pregnancy melasma, unprotected sun exposure can worsen it. “It is supremely sensitive to the sun, worsening with relatively minimal exposure,” cautions Dr. Belkin. This is because radiation from ultraviolet rays acts as a catalyst for melanin production. You’re also at a higher risk for it if you a have darker skin tone. 

What is known is that there is a genetic component in the development of melasma. Around 33% to 50% of people with the condition have a family member with it—even a majority of identical twins share melasma.

Aside from pregnancy hormones, the sun’s UV rays, and genetics, there are other potential sparks that light the fire of melasma. They include medications, makeup, and cosmetics that irritate your skin or make it more sensitive to sunlight, the blue light emitted from your devices, and underlying thyroid disease.

How Many Types of Pregnancy Melasma Are There?

Pregnancy melasma, and melasma in general, fall into three categories based on how deep into the skin the dark spots are: epidermal, dermal, and mixed.

Epidermal melasma resides in the surface of the skin. It’s dark brown in color, has well-defined borders, glows under blacklight, and can respond well to treatment. Dermal melasma is light brown or bluish, with blurred borders. It is not visible under blacklight and is much more challenging to treat.

The most common type, mixed melasma, is exactly what it sounds like—it’s both brown and bluish in appearance, has a mixed pattern under black light, and is somewhat responsive to treatment.

How Is Pregnancy Melasma Diagnosed?

First and foremost, try to resist the urge to self-diagnose. (We know, we’ve felt that knee-jerk instinct at times, too.) Only a dermatologist will be able to tell you for sure if you have pregnancy melasma. Dr. Belkin says his pregnancy melasma diagnoses center around the timing of its appearance and its placement. 

“If hyperpigmentation started in pregnancy or after birth control pills, or worsens in summer, that would suggest melasma,” he says. “I look for symmetry, since it would be unusual to have melasma only or much worse on one side of the face.”

He goes on to explain that the shape of the discolorations matters as well, since melasma coalesces in patches, as opposed to being distinct spots—which would likely be other kinds of hyperpigmentation, such as sunspots. 

Other ways to diagnose melasma involve a special blacklight lamp, called a Wood’s lamp, which would quite literally shine a light on the different types of melasma we discussed. In rare circumstances, specifically, when it’s harder to make a clear diagnosis, a small biopsy may be performed to be sure the discoloration isn’t indicative of another skin condition, like melanoma, the scientific word for skin cancer.

What Helps With Melasma During Pregnancy? 

The most effective way to treat pregnancy melasma is to see your dermatologist as soon as you start to see its hallmark patchwork appear. After all, as it progresses, it gets more difficult to treat.

With that being said, most people with melasma don’t require treatment—it’s a personal choice. And, if you’re pregnant, its appearance may improve on its own around three months after your baby arrives and your surge in pregnancy hormones stabilizes. (This can occur whether or not you choose to breastfeed, because estrogen and progesterone are not the hormones involved in lactation—those would be prolactin and oxytocin.)

If you do opt for treatment for your pregnancy melasma, your healthcare provider will likely prescribe a topical skin-lightening cream, with pregnancy-safe ingredients, like hydroquinone. For more brightening oomph, they may recommend exfoliating treatments, such as microdermabrasion or chemical peels, which slough away dead skin cells to promote skin rejuvenation.

Dr. Nazarian shares that she prefers a multipronged approach to treating pregnancy melasma. “I use a variety of modalities to treat this condition—specific topicals and chemical peels,” she shares. “Those with a combination of ingredients that help using different pathways to diminish pigment.”

Her go-to ingredients include vitamin C, kojic acid, and licorice root extract, as well as hydroquinone and glycolic acid. She’ll also sometimes prescribe oral medication to slow down the rate of re-pigmentation and rebounding. 

Another exfoliation option would be to have a laser skin resurfacing treatment. In addition to topical treatments and oral medication, Dr. Belkin recommends going that route, with a couple of caveats.

“Laser is a great option,” he shares. “But, it has to be gentle enough and done by an experienced board-certified dermatologist.” This is because lasers can also exacerbate melasma, he explains. When your skin heals from the treatment, it may cause even more discoloration.

Can Melasma Be Prevented During Pregnancy?

Since it’s unknown what causes melasma, aside from the things that trigger it, it can be difficult to prevent it. Plus, you can’t change your genetics. However, you can take certain precautions to lower your risk of developing it while pregnant or otherwise.

The most important one is something you should be doing every day, year-round, anyway—wearing a broad-spectrum sunscreen, and reapplying it every two hours or after swimming or sweating.

Dr. Dan Belkin, MD

Melasma can be managed, but often not entirely cured, in the sense that in someone who is predisposed, it can always come back. Careful sun protection is key.

— Dr. Dan Belkin, MD

“Melasma can be managed, but often not entirely cured, in the sense that in someone who is predisposed, it can always come back,” Dr. Belkin cautions. “Careful sun protection is key.” You can help make your sun protection efforts even more effective if you wear protective clothing, such as long-sleeved shirts, pants, a hat, and sunglasses, and limit your time in the sun, especially between its peak hours between 10 a.m. and 2 p.m.

In fact, taking these precautions has been shown to lower your chance of getting melasma at any time in your life by 50%, and slashing your risk of pregnancy melasma by a whopping 90%.

There are also other tactics you can try. “Even after melasma is treated and improved, I recommend use of a daily topical cream and oral antioxidants to maintain results long-term,” advises Dr. Nazarian. Y

ou can also be sure to eat a healthy, skin-friendly diet that contains plenty of nutrients and vitamin D. Foods that fit the bill include eggs (only if they’re fully cooked), yogurt, meat (fully cooked), fish high in fatty acids (also fully cooked), and mushrooms. Milk, almond milk, and orange juice can help too.

What Are Some Ways To Help Cope With Pregnancy Melasma?

Despite the fact that pregnancy melasma isn’t a dangerous condition, it can do a number on your self-esteem and confidence. If it bothers you, Dr. Belkin recommends using a tinted sunscreen to help, well, mask your “pregnancy mask.”

You can also try other camouflaging makeup and skincare products, like concealers, full-coverage foundation, and skin-brightening products. Most importantly, try and remind yourself that you likely notice and dwell on your pregnancy melasma more than anyone else, and that you’re far from alone in experiencing it. 

A Word From Verywell

Melasma is a highly common skin condition—and the majority of cases are among pregnant people. Although it’s a physically harmless skin condition, we know that it can be bothersome, even to the point of making you feel self-conscious in social settings. If you feel that it’s negatively impacting your life, or you have any other concerns, try not to suffer in silence. It’s always best to speak with your healthcare provider.

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