Chloasma during pregnancy

Changes to your skin during pregnancy

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As your pregnancy develops, you may find that you experience changes to your skin and hair. Some women can develop dark patches on their face and hormonal changes can make your skin a little darker.

You may also develop stretch marks on your body, particularly around your stomach where your skin is stretching to accommodate your growing baby.

Chloasma - dark patches on the face

Some pregnant women develop dark irregular patches on their face most commonly on the upper cheek, nose, lips, and forehead. This is called 'chloasma'. It is also sometimes known as 'melasma' or the 'mask of pregnancy'.

Chloasma is thought to be due to stimulation of pigment-producing cells by female sex hormones so that they produce more melanin pigments (dark coloured pigments) when the skin is exposed to sun. Some women develop these patches when they take oral contraceptives (the pill).

Women with a light brown skin type who are living in regions with intense sun exposure are more likely to develop these patches. The patches usually fade over a period of several months after giving birth, though they may last for several years for some women.

Careful protection of the skin using broad spectrum sunscreens every day during pregnancy and while taking the pill may make it less likely that chloasma will develop. It is necessary to continue to use sunscreen after pregnancy as sun exposure may cause the patches to reappear. Some creams that need to be prescribed by doctors may help to fade the patches.

Skin and hair changes

Hormonal changes taking place in pregnancy will make your nipples and the area around them go darker. Your skin colour may also darken a little, either in patches or all over. Birthmarks, moles and freckles may also darken. Some women develop a dark line down the middle of their stomach, called 'linea nigra'. These changes will gradually fade after the baby is born, although your nipples may remain a little darker.

If you sunbathe while you are pregnant, you may burn more easily. Protect your skin with a good high-factor sunscreen and don't stay in the sun for a long time.

Hair growth can also increase in pregnancy, and your hair may be greasier. After the baby is born, it may seem as if you are losing a lot of hair but you are simply losing the extra hair.

Stretch marks

Many women develop stretch marks during their pregnancy, usually in the last 3 months.

They usually appear on your stomach or sometimes on your upper thighs or breasts. Stretch marks are not harmful and over time, your skin will shrink and the stretch marks will fade into white-coloured scars.

Find out more on stretch marks.

Sources:

Royal Women's Hospital Victoria (Common concerns in early pregnancy - itching and skin), The Australasian College of Dermatologists (Striae), The Australasian College of Dermatologists (Melasma)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: January 2020

Common discomforts during pregnancy
Stretch marks

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Chloasma--the mask of pregnancy - PubMed

Review

. 2008 Oct;32 Suppl 2:139-41.

Ivan Bolanca¹, Zeljana Bolanca, Krunoslav Kuna, Ante Vuković, Neven Tuckar, Radoslav Herman, Goran Grubisić

Affiliations

Affiliation

¹ University Department of Obstetrics and Gynecology, University Hospital Sestre milosrdnice, Zagreb, Croatia. [email protected]

PMID: 19140277

Review

Ivan Bolanca et al. Coll Antropol. 2008 Oct.

. 2008 Oct;32 Suppl 2:139-41.

Authors

Ivan Bolanca¹, Zeljana Bolanca, Krunoslav Kuna, Ante Vuković, Neven Tuckar, Radoslav Herman, Goran Grubisić

Affiliation

¹ University Department of Obstetrics and Gynecology, University Hospital Sestre milosrdnice, Zagreb, Croatia. [email protected]

PMID: 19140277

Abstract

Chloasma is a required hypermelanosis of sun-exposed areas occurred during pregnancy and it can affect 50-70% of pregnant women. It presents as symmetric hyperpigmented macules, which can confluent or punctuate. The most common locations are the cheeks, the upper lip, the chin and the forehead. The exact mechanism by which pregnancy affects the process of melanogenesis is unknown. Estrogen, progesterone, and melanocyte-stimulating hormone (MSH) levels are normally increased during the third trimester of pregnancy. However, nulliparous patients with chloasma have no increased levels of estrogen or MSH. In addition, the occurrence of melasma with estrogen- and progesterone-containing oral contraceptive pills has been reported. The observation that postmenopausal woman who are given progesterone develop melasma, while those who are given only estrogen do not, implicates progesterone as playing a critical role in the development of melasma. UV-B, UV-A, and visible light are all capable of stimulating melanogenesis. The condition is self-limited; however spontaneous resolution is time-consuming and may take months to resolve normal pigmentation. Therefore, it is worthwhile to prevent the onset of chloasma, by strict photoprotection. Prudent measures to avoid sun exposure include hats and other forms of shade combined with the application of a broad-spectrum sunscreen at least daily. Sunscreens containing physical blockers, such as titanium dioxide and zinc oxide, are preferred over chemical blockers because of their broader protection. Chloasma can be difficult to treat. Quick fixes with destructive modalities (eg, cryotherapy, medium-depth chemical peels, lasers) yield unpredictable results and are associated with a number of potential adverse effects. The mainstay of treatment remains topical depigmenting agents. Hydroquinone (HQ) is most commonly used.

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Chloasma: causes, symptoms, diagnosis and treatment.

Definition

Chloasma is an acquired limited hypermelanosis, or hyperpigmentation of the skin (violation of the formation of melanin pigment in the direction of strengthening). Melanin grains accumulate in the cells of the basal and prickly layers of the epidermis, and the number of melanosomes in the superficial layers of the dermis increases. Spots of dark yellow or dark brown color appear more often in women aged 20 to 50 years, have an irregular shape and are usually localized on the skin of the face - in the cheeks, upper lip, around the eyes, on the temples and bridge of the nose. nine0013

Chloasma occurs in pregnant women, patients with chronic liver disease, women diagnosed with inflammatory processes in the gynecological area, or using oral contraceptive drugs.

Causes of chloasma

The exact cause of chloasma is unknown. There are observations that speak of a genetic predisposition to excessive formation of melanin - there are known cases of the disease in several family members at once. Exposure to sunlight plays a significant role in the development of chloasma - exacerbations occur after prolonged exposure to the sun and fade away when there is no insolation. nine0013

Often chloasma appears during pregnancy, so its other name is “pregnancy mask”. This type of dyschromia partially or completely disappears in the postpartum period after the resumption of menstruation. However, residual effects can persist for quite a long period.

Chloasma can manifest itself while taking hormonal contraceptives, in patients with ovarian tumors, since there is an association between increased melanin production and changes in the level of sex hormones estrogen and progesterone. nine0013

The risk factors provoking the formation of chloasma include:

pregnancy, menopause;
viral hepatitis, liver cirrhosis, tuberculosis;
inflammatory diseases of the genital organs in women;
taking oral contraceptives;
excessive sun exposure, including artificial tanning.

Classification of the disease

Depending on the localization of lesions on the face, the following clinical forms of the disease are distinguished:

centrofacial chloasma - located in the center of the forehead, on the nose, in the region of the upper lip, chin;
molar chloasma - located on the cheeks and wings of the nose;
mandibular (mandibular) chloasma - located on the skin of the lower jaw.

According to the clinical course allocate:

passing forms - the spots disappear on their own, without treatment;
persistent forms - the spots decrease during treatment, the progress of the disease slows down, but the hyperpigmentation does not completely disappear. nine0004

Depending on the level of deposition of melanin pigment , there are:

epidermal type;
dermal type;
mixed type.

Symptoms of chloasma

Chloasma is characterized by various sizes of light brown, dark brown or heterogeneously colored spots of irregular shape, single or multiple. As a rule, they are located symmetrically on open areas of the skin of the face, less often - on the neck, in the décolleté area. The spots have clear uneven boundaries, are not raised above the surface of the skin, and can merge with each other. Chloasma does not cause physical discomfort, because it is not accompanied by peeling, itching and soreness. nine0013

In pregnant women, chloasma spots can be localized on the midline of the abdomen, in the nipples and vulva.

Chloasma diagnostics

The diagnosis of "chloasma" is established by the doctor on the basis of examination and history taking - to exclude the congenital or post-inflammatory nature of hyperpigmentation.

A more detailed study of age spots is carried out by a specialist using the dermatoscopy method. A dermatoscope is a device designed to examine the superficial and deep layers of the skin under 10x (sometimes more) magnification. Dermatoscopy is widely used in modern dermatology and cosmetology and makes it possible to detect malignant changes in the early stages, as well as to observe age spots in dynamics to assess the effectiveness of treatment. nine0013

The use of a Wood's lamp (ultraviolet lamp) helps to distinguish between epidermal and dermal types of chloasma.

Laboratory diagnostics includes determining the level of sex hormones in the blood: estradiol, progesterone, luteinizing hormone, testosterone.

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Since in some cases hyperpigmentation may be one of the manifestations of an ovarian tumor, an ultrasound examination (ultrasound) of the pelvic organs is performed.

US examination of pelvic organs (uterus, adnexa)

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Which doctors to contact

Dermatologists are involved in the examination and treatment of patients with hyperpigmentation. Since the development of the disease may be associated with hormonal imbalances, it is often involved in the process of examination and treatment.

gynecologist

Treatment of chloasma

Benign hyperpigmentation does not affect health in general, does not degenerate into malignant neoplasms, but their appearance on the face often brings psychological discomfort. nine0013

For effective treatment of chloasma, first of all, it is necessary to eliminate the cause that provoked the development of this disease. For example, if chloasma arose as a result of a liver disease, then the function of this organ is restored first of all. In cases where chloasma is the result of hormonal disorders, drugs are prescribed that correct this condition, change or completely cancel oral contraceptives, etc.

Before proceeding with the cosmetic removal of chloasma spots, it is necessary to make sure that the composition of skin care products used on a regular basis does not include photosensitizing ingredients - retinoids, alpha and beta hydroxy acids, etc. nine0013

In the arsenal of modern cosmetology there are many methods aimed at correcting age spots. Their appointment is the competence of a dermatologist. In cases where chloasma is localized in the epidermis, it is often possible to limit oneself to depigmenting cosmetic preparations, which include arbutin, kojic, ascorbic and azelaic acids, hydroquinone, rucinol and other active substances with whitening properties. In addition, mesotherapeutic procedures are performed, as well as chemical peels (phytic, retinoic, pyruvic, azelaic, glycolic, etc.). In case of treatment failure, hardware procedures are used - microdermabrasion, laser resurfacing or laser peeling. nine0013

Treatments with fractional or neodymium lasers are recommended for dermal chloasma.

Complications

Chloasma has no complications that could affect a person's life, but it brings considerable psychological discomfort.

Chloasma prophylaxis

The main preventive measure is the restriction of exposure to the open sun, the exclusion of visits to solariums and the use of sunscreen even in cloudy weather. nine0013

When using hormonal contraceptives, it is necessary to discuss with the gynecologist the possibility of their cancellation.

A number of drugs and cosmetics have a photosensitizing effect - they increase the sensitivity of the skin to sunlight. The doctor will help you choose their analogues, which will minimize the risk of further development of chloasma.

Sources:

Melasma - European recommendations.

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Pigmentation during pregnancy: how to get rid of it - Parents.ru

Pregnancy

Photo: DiMedia/Shutterstock

Pigmentation is the darkening or, conversely, lightening of skin areas, which occurs due to failures in the production of melanin, the pigment responsible for the color of the skin. The appearance of such signs suggests that a woman is pregnant. Whether the spots appear dark or light, depends on the original skin color. Such marks, characterized by sharp edges and irregular shape, are called melasma or chloasma by doctors. nine0013

During pregnancy, they can appear both on the face (on the forehead, chin, around the eyes, on the upper part of the cheeks, on the upper lip), and on other parts of the body: on the inner thighs, areolas of the mammary glands, on the abdomen.

"Pregnancy mask" on the face: what is it

In some areas, the skin begins to darken in the very early stages of pregnancy. Sometimes the manifestation of this particular symptom prompts a woman to think about pregnancy. First, the nipples and areolas around them, the area of the labia and the clitoris darken. nine0013

In the second trimester, pigmentation becomes brighter and some expectant mothers get the so-called “pregnancy mask” - pigmentation occurs on the face during pregnancy. The spots appear on the cheeks, on the nose, on the forehead, cheekbones, under the eyes, above the upper lip and on the chin and can be arranged symmetrically. If a woman is prone to the appearance of freckles, then you need to be prepared for the fact that during the bearing of the baby they will become brighter, and their number will increase.

Pigmentation during pregnancy on the abdomen appears at about the same time. This brown stripe, which stretches from the navel to the pubis, the so-called Alba stripe, exists in every woman, it just becomes more noticeable during the bearing of the baby. nine0013

Why pigmentation occurs

The color of human skin depends on many circumstances, but the most important is the concentration of coloring substances, or pigments, one of which is melanin. It accumulates in special molecules called "melanosomes", which act as a natural filter that protects the top layer of the skin from the harmful effects of ultraviolet rays.

During pregnancy, the production of melanin changes, because the adrenal glands begin to synthesize more estrogens, progesterone and melanocyte-stimulating hormone. Because of this, more melanin is released, which is concentrated in certain areas of the skin. As a result, the woman develops hyperpigmentation. nine0013

Occasionally, chloasma is caused by taking oral contraceptives before pregnancy or a lack of folic acid. Pigmentation can also indicate problems in the functioning of the liver, pituitary gland, ovaries, incorrect cosmetic procedures, the use of low-quality cosmetics or perfumes. Stress also plays an important role in the appearance of spots on the skin.

Genetics also matter. If the mother had such a problem during pregnancy, then it is possible that age spots during the period of bearing the baby will appear in her daughter. nine0013

Expectant mothers often ask how pregnancy pigmentation affects the baby. If its cause is not an exacerbation of chronic ailments, then age spots will not have any effect on the unborn child.

Photo: Konstantin Aksenov/Shutterstock

Age spots during pregnancy: a boy or a girl?

There is a popular belief that age spots during pregnancy appear more often in expectant mothers of girls. This is justified: a girl developing in her stomach takes estrogens from her future mother, and their level in the woman's body decreases. But how then to explain that age spots appear in expectant mothers of boys? In a word, than to guess according to folk signs, it is better to do an ultrasound. It definitely won't go wrong. nine0013

How to reduce the risk of age spots

Age spots are a temporary phenomenon, but not so pleasant. What rules should the expectant mother follow in order to reduce the likelihood of their occurrence?

Since pigmentation becomes more noticeable under the influence of ultraviolet rays, protect the skin from the sun: in summer, wear wide-brimmed hats, sunglasses, use sunscreen intended for children;
Carefully read the ingredients list of cosmetic products and choose those that do not contain vitamin A, which stimulates the formation of age spots: : green leafy vegetables, cabbage, quality vegetable oil, cereals, fish, liver and beets;
But fatty foods are best avoided, because they make the liver work in an enhanced mode, and this threatens with hyperpigmentation. nine0013
Do not disregard the recommendation of the gynecologist to visit an endocrinologist. This is necessary to check the functioning of the thyroid gland.

Will we be treated?

Many experts believe that during pregnancy you should not take any drastic measures to combat hyperpigmentation, and advise you to calmly wait until it disappears by itself some time after childbirth. But among the doctors there are those who do not mind the use of traditional medicine. In that case , the expectant mother should understand that it is unlikely that it will be possible to completely get rid of this problem during the bearing of the baby, the pigmentation will only become less noticeable. And most importantly, before using any remedy, you must always consult a doctor.

These tips, of course, do not apply to cases where chloasma is caused by an exacerbation of chronic diseases. If this is the reason, serious attention should be paid to the treatment of the disease and strictly follow the recommendations of the attending doctor.