Mask of pregnancy - what Melasma treatment options are available?
Are you alarmed by the appearance of dark patches on your face, forehead, nose and maybe even upper lip? Fret not! The likely culprit is ‘Melasma’, a skin condition that affects up to 75% of all pregnant women in Singapore. Dermatology expert Dr. Tham Siew Nee tells you everything you need to know about Melasma.
Melasma (brown skin) is a skin condition that causes increased, usually blotchy and irregular pigmentation to occur.
During pregnancy, the steep escalation of oestrogen (primary female sex hormone) causes an increase in pigmentation on the face – thus why the condition is commonly referred to as the mask of pregnancy.
There are three types of Melasma:
- Epidermal melasma. The most superficial and thus the easiest to treat. Occurs on the outermost layers of cells on the skin. It is usually dark brown in colour and has a well-defined border. This form of Melasma is more visible under black light.
- Dermal melasma. Occurs in the deeper mid-layer of the skin. It has an ill-defined border and is light brown or bluish in colour. Dermal Melasma responds poorly to treatment and is more persistent.
- Mixed melasma. This is the most common type of Melasma and as the name suggests, has properties of both Epidermal and Dermal Melasma. It is characterised by a combination of bluish, light and dark brown patches. With treatment, this variant of the condition improves partially.
Senior Dermatologist and previous Deputy Medical Director at the National Skin Centre, Dr. Tham, Tham Siew Nee Skin Clinic (Gleneagles Hospital), explains how the rise in oestregon during pregnancy triggers excess melanin (responsible for skin and hair colour) production.
This explains the darkening of the skin. Apart from the face, Melasma also affects other areas of the skin such as the nipples, areola and vulva. Your existing moles and freckles may darken and there is likely to be a dark line down the centre of your abdomen (linea nigra).
The good news about the Mask of Pregnancy
Melasma that occurs in pregnancy is a very common condition and there is nothing about it that is serious enough to cause you to be a bundle of nerves or make your blood run cold.
The hyperpigmentation usually disappears after delivery or at times, when you stop breastfeeding. It is an aesthetic problem more than anything else.
The bad news about the Mask of Pregnancy
As Melasma is not exclusive to pregnancy, there are chances that it may reappear later in life. It is generally caused by hormonal changes and as such, throughout your reproductive age, you remain susceptible to the condition.
Signs and Symptoms
Dr. Tham describes Melasma to be an asymptomatic (a disease or infection with no symptoms) condition. It is mainly a cosmetic problem appearing as irregular pigmentation mostly on the cheeks, nose and forehead.
Patches of discoloration, darker than your normal skin colour tend to appear on your face in a symmetrical manner.
Melasma causes coloured patches to appear on your cheeks, chin, forehead, the bridge of your nose and at times even your upper lip. Other areas of your skin such as your neck and forearms, which are in more contact with sunlight may also face discolouration.
Melasma typically presents itself as freckle-like spots or larger, flat and brown patches. It appears symmetrically on both sides of your face with an irregular border. At times you may also encounter reddened or inflamed forms of melasma.
Causes of Melasma
As in the case of many medical conditions, it is difficult to pinpoint the exact cause of Melasma. There are however a number of factors that increase the likeliness of it occurring.
- Hormonal changes. Oestrogen and progesterone sensitivity are commonly associated with Melasma. As such, pregnancy, the consumption of birth control pills and hormone therapy (hormone replacement, intrauterine device and implants) are responsible for about a quarter of Melasma cases.
- Genetic Predisposition. In her 30 over years of practice, Dr. Tham has observed that many patients with Melasma report a family history. If your mother had Melasma during her pregnancy, there are high chances that you too might. Melasma is linked to the presence of over-active melanocytes (cells that produce melanin which gives our skin its colour).
- Exposure to Ultraviolet Rays. Ultraviolet A (long-wave) and Ultraviolet B (short-wave) rays are known to stimulate the production of melanin. Constant and frequent exposure to the sun in itself, or in conjunction with other triggers can cause Melasma to occur.
- Cosmetics. Scented cosmetics and skin products, deodorants, soaps and toiletries may cause a phototoxic reaction (chemically induced skin irritation) which in turn triggers Melasma. Melasma that occurs as a result of this may persis in the long run.
- Hypothyroidism. Low levels of thyroid hormone in the body, along with stress has also been linked with the occurrence of Melasma.
Dr. Tham states that Melasma can just about affect anyone, but the following groups of people face higher risks:
- Women in their reproductive age. Though not restricted to, women between the age of 20 to 40 are more likely to develop Melasma. This is due to the link between Melasma and hormonal changes.
- People with tanned skin. Melasma occurs more commonly among people like Asians and Hispanics, who tan well or have naturally brown skin. People with very fair or black skin are less likely to get Melasma.
- People who live in tropical climates. As Melasma is closely linked with sun exposure, people living in tropical climates and who are always under the sun are highly susceptible to Melasma. Which of course means that Singaporean women are 'likely candidates'!
In her practice, Dr. Tham notes that Melasma is a common condition in Singapore and that all the racial groups seem to have equal chances of developing it. She emphasised that Melasma is definitely more common among those who are constantly outdoors.
So mums-to-be, it might be a good idea to give the tanning a break and head indoors instead!
Melasma is not a very complicated condition and its appearance is highly characteristic. A simple visual examination is usually sufficient for diagnosis.
At times, your doctor might advise you to undergo other tests to rule out certain conditions or specific causes. In rare situations, a skin biopsy (sample skin tissue taken for close examination) may be ordered to confirm the diagnosis of Melasma and rule out serious skin conditions.
One of the testing methods that may be used is known as the Wood's Lamp Examination. This involves holding a special kind of light up to your skin. This examination aids in determining if there is any infection present and the type of Melasma (how many layers of skin are affected) that has affected you.
Dr. Tham wishes for you to know that although Melasma is generally harmless, it is necessary to get the diagnosis confirmed by an experienced doctor as some conditions like drug induced pigmentation or contact dermatitis may appear similar.
While Melasma treatment options are aplenty, many treatments are not safe during pregnancy or while breastfeeding. Azelaic acid, a topical cream and a glycolic acid chemical peel are considered safe but it is a must to consult your doctor before using any of these.
The following are Melasma treatment options available out there, but most of them can only be done after you have delivered and / or stopped breastfeeding:
- Hydroquinone. This medication works by blocking the activity of melanocytes (melanin-forming cells that contribute to pigmentation). It is a prescription cream that you need to get from your doctor. Dr. Tham cautions that high concentrations of hydroquinone should be avoided as it can cause increased pigmentation.
- Combination creams. Tretinoin, cortisone and hydroquinone combination creams have been found to be effective in lightening the appearance of Melasma, but may also cause skin irritation. But do remember this tip for this Melasma treatment: the cream should be used only under close supervision by your doctor.
- Cosmeceuticals. Some cosmeceuticals like Kojic Acid, Azelaic Acid and Arbutin are also reported to be effective but the effects appear to be milder than hydroquinone.
- Vitamin creams. These are anti-oxidants and may be used to complement the above treatments. Vitamin C creams are generally quite safe for use during pregnancy but as always, it is best to check with your doctor prior to using any product during pregnancy.
- Folic acid intake. Studies have proven that folic acid deficiency is linked to hyperpigmentation. In addition to your pre-natal supplements, you can consume food like green leafy vegetables, oranges, whole-wheat bread, and whole-grain cereal. All of these contain folic acid.
- Chemical peeling. Chemical peeling in combination with lightening agents may be useful Melasma treatment for some people.
- Laser treatment. Laser treatment with NdYAG laser have been used to treat deep pigmentation but this has to be done with care and only by experienced doctors.
It is unpleasant to have blotchy skin and it is only natural to want to do something about it at soonest, but it is very important not to do anything that is unsafe for you or your baby during this crucial period. Peels, bleach and other lightening treatments should not be used during pregnancy for they may penetrate your skin.
Don't even think about laser treatments as an Melasma treatment option!
Administrative Manager Mdm. Fauziah developed Melasma during her first pregnancy. She shares her experience. "I have always been very conscious about the way I look and so pregnancy and the changes it brought put me on an emotional roller-coaster.
First it was the weight gain, then the puffiness, then the skin patches (Melasma), the line down my belly and what not.
Initially I became self-conscious and even depressed whenever I saw a change and when my face started having these pigmentation problems, it was like the icing on the cake.
I was so upset and wanted to do whatever I could to get rid of it. Then when I consulted my doctor and read up about how some treatments might be unsafe, I snapped out of it.
Suddenly I felt quite ashamed of myself. I realised that all these things that were changing in my body were a small price to pay for a bigger blessing. My husband also comforted me by reminding me that these changes are not permanent".
So remember ladies, if you feel self-conscious or that your confidence is shaken, you are definitely not alone. Hang in there and you can seek treatment options when the time is right!
Lifestyle and Home Remedies
While there is not much that you can do to treat Melasma during pregnancy or breastfeeding, there are definitely some home remedies that you can try. These remedies are safe, do not cost much and have worked wonders for some mums.
- Conceal. When all else fails, just hide the truth. Choose a good concealer and ensure that it is hypoallergenic and made specially to cover hyperpigmentation. The colour tone should be one shade lighter than your usual colour. Apply it on the patchy spots and use foundation for the rest of your face. If your skin does not take too well to concealer, consider using pressed powder to lighten the dark spots.
- Lemon Juice. Lemon juice is a holy grail when it comes to skin brightening in general. Highly acidic in nature, it helps to peel off the outer layer of skin and hence reduce the appearance of Melasma. It also contains high levels of Vitamin C that is useful in reducing the effects of any kind of pigmentation problem.
- Apple Cider Vinegar. This is another popular kitchen ingredient that does wonders for your skin due to the good bacteria and raw enzymes that it contains. It is a natural colour corrector and all you need to do is to mix one part of apple cider vinegar with one part of water and apply it on affected areas. Along with correcting Melasma, it makes your face bright and radiant.
- Tumeric. Tumeric has a world of benefits and some of it include anti-inflammatory and anti-oxidant properties. It is famous for its ability to correct hyperpigmentation and the tan caused by sun exposure. Tumeric also cures acne so if you can get past the trademark yellow stain of it, you are in for a whole lot of benefits.
TCM generally uses Manual Acupuncture (thin needles inserted into the body) and a range of herbs to treat Melasma. Some mums are most comfortable with TCM and swear by it while others are skeptical due to the lack of medical evidence backing up TCM.
Whatever your choice is, similar to the other treatment options, most of these are not safe during pregnancy and breastfeeding. Wait until you have weaned your baby to explore these treatments.
Prevention is better than cure and in the case of Melasma, it certainly is the case. None of the Melasma treatment options guarantee permanent results, so do what you can to minimise the odds of it occurring in the first place.
Here are some simple things that you can do to prevent Melasma from developing.
- Use sunscreen. Sunscreen is not only a remedy as regular use of sunscreen may prevent Melasma from developing. In fact, whether or not Melasma is a concern, you should always be using sunscreen to ensure that your skin is protected from sun damage. So remember ladies, never leave your home without sunscreen. And that includes cloudy or rainy days because even if you don't feel it as much, the sun's rays are still present.
- Avoid the sun. In addition to sunscreen, put on a wide-brimmed hat, your favorite designer sunglasses and protective clothing. Who says you can't look glamorous while pregnant? Protecting yourself from the sun just adds reason to up your glam factor! Also, it is best to void the sun during its hottest hours, between 10am to 4pm.
- Avoid harsh skin products. Harsh skin products may cause skin irritation which exacerbates Melasma. You should avoid products that leave your skin stinging or burning. And be very careful with scented products for the nicer they smell, the more chemicals they contain and that increases the likeliness of skin irritation. Especially during pregnancy, you should avoid exposure to chemicals, parabens, sulphates and the like.
Just so you know ladies, there is no completely foolproof method of preventing the occurrence of Melasma. Although in most cases prevention is quite successful, pregnancy hormones are a greater power than we can contradict and they thwart even the best of preventive measures!
The journey to meeting your little one is definitely interesting and those mischievous pregnancy hormones will never fail to surprise you. On some days you may strut around in full confidence and on other days you might not want to step out of your house.
But remember mummies, you are on one of the most beautiful journeys in your life and despite all these physical changes, you are beautiful. Don't ever let anything make you feel otherwise!
Is there anything you wish to know or share about Melasma? We'd be glad to hear so leave us a comment mums!