Hyperpigmentation on breast during pregnancy

Extensive hyperpigmentation during pregnancy: a case report

Journal List
J Med Case Reports
v.5; 2011
PMC3183040

J Med Case Reports. 2011; 5: 464.

Published online 2011 Sep 19. doi: 10.1186/1752-1947-5-464

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Introduction

Skin hyperpigmentation is common during pregnancy and often is due to endocrinological changes. Usual patterns include linea nigra, darkening of areola and melasma. We report a rare diffused hyperpigmentation condition in a pregnant woman of dark colored skin.

Case presentation

A 19-year-old Tanzanian primigravida at 32 weeks gestation presented at our antenatal clinic concerned about an insidious but progressive onset of unusual darkening of her abdominal skin and both breasts. Her antenatal record was unremarkable except for this unusual onset of abnormal skin color. Findings from her physical examination were unremarkable, and she had a normal blood pressure of 120/70 mmHg. Her abdomen was distended with a uterine fundus of 34 weeks. Almost her entire abdominal skin had darkly colored diffuse deep hyperpigmentation extending cephalad from both iliac fossae to involve both breasts to 2-3 cm beyond the areolae circumferentially. She had a fetus in longitudinal lie and cephalic presentation, with a normal fetal heart rate of 140 beats per minute. Other examination findings were unremarkable. The impression at this stage was exaggerated pigmentation of pregnancy. No medical treatment was offered but she was counseled that she might need medical treatment after delivery. She progressed well and had spontaneous labor and normal delivery at 38 weeks gestation. She was lost to follow up.

Conclusion

Unusual pregnancy-related skin hyperpigmentation can occur with no adverse consequences to pregnancy, although may worry a pregnant woman. Reassurance and conservative management may be all that is required to allay a patient's concerns.

Hyperpigmentation during pregnancy is commonly due to endocrinological changes. The usual pattern will be seen as linea nigra, melasma and darkening of areola, axillae and medial thighs [1-3]. Extensive hyperpigmentation, however, is unusual, especially in people with dark colored skin [4,5]. Such hyperpigmentation may sometimes be associated with hyperthyroidism [1,5]. We present a case of an unusual pattern of pigmentation in a primigravida seen in her mid-third trimester, who had an unremarkable pregnancy, labor, delivery and postpartum period.

A 19-year-old Tanzanian primigravida at 32 weeks of gestation sought care at a tertiary hospital antenatal clinic. She presented with concerns of an insidious but progressive onset of an unusual darkening of her abdominal skin and both breasts. The darkening was not associated with itching or irritation of the skin.

She booked for antenatal care at a peripheral clinic and her progress had been unremarkable except for this unusual onset of abnormal skin color. She had no previous history of allergies or family history of skin condition. She was not on any medication except for prescribed iron and folic acid tablets given during antenatal consultations. Her past medical history was unremarkable with no history suggestive of goiter or hyperthyroidism.

On physical examination, her general condition was fair. She was not pale and had no lower limb edema. She had a pulse rate of 70 beats per minute that was regular. Her blood pressure was 120/70 mmHg. Her abdomen was distended with a uterine fundus of 34 weeks. A linea nigra was clearly seen, but in addition almost the entire abdominal skin had dark colored diffuse deep hyperpigmentation, extending from both iliac fossae to involve both breasts (nipples and areolae) to about 2-3 cm beyond the areolae circumferentially (Figure ). She had a fetus in longitudinal lie, cephalic presentation with a normal fetal heart rate of 140 beats per minute. Other system examination findings were unremarkable.

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Exaggerated hyperpigmentation of pregnancy. Extensive hyperpigmentation of pregnancy involving both breast and abdominal skin.

The impression at this stage was exaggerated pigmentation of pregnancy. No medications were prescribed, but she was reassured that the condition should have no effect on her pregnancy and its outcome. She continued attending antenatal care regularly. She had spontaneous onset of labor and normal delivery of a baby girl weighing 3200 g with an Apgar score of 9 and 10 at the first and fifth minutes respectively at 38 weeks gestation.

Our patient did not return for follow-up during her postpartum period. She was contacted by phone three months after delivery and she reported that her skin condition had not resolved. We lost contact with her thereafter.

Skin hyperpigmentation is common in pregnancy and often is well described and completely benign in nature [2,5]. The physiology of hyperpigmentation appears to be related to the increased production of estrogens, and perhaps to increased levels of progesterone or a melanocyte-stimulating hormone [1-3,5]. In selected areas of the body such as the linea alba and areola, hyperpigmentation is probably related to the distribution of melanocytes, but extension of these cells beyond these parts may explain unusual patterns of distribution, as in this case [2,3,6].

The intensity of the hyperpigmentation, however, may be related to environmental factors or even intake of some drugs, although other causes may include pre-existing conditions, such as hyperthyroidism, and a genetic predisposition [1,3,5]. Nevoid hyperkeratosis of the nipple and areola should be considered in the absence of abdominal involvement. Dermal melanocytosis is another rare condition that could present similarly to our case; in this condition pregnancy and sun-exposure are thought to be the triggering factors [5].

Most pregnancy-related skin hyperpigmentation is benign and is usually resolved after delivery (usually within a year), although women may be concerned [1,2,5]. Medical treatment is rarely required. In cases where the condition persists, bleaching agents may be used [1,3,5], although at times their effectiveness may be unsatisfactory [5]. Proper counseling and assurance is the only reliable alternative in such cases [5].

Although skin hyperpigmentation is common in pregnancy, extensive pigmentation, as in this case, is rare. Patients may be cosmetically concerned, but all that is required from the health professional is reassurance that the condition has no adverse affect on pregnancy outcome.

Written informed consent was obtained from the patient for publication of this case report and accompanying image. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

The authors declare that they have no competing interests.

AM managed the patient and wrote the initial manuscript. ST performed the initial literature search. Both ST and MM reviewed the subsequent manuscripts and approved the final manuscript.

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Articles from Journal of Medical Case Reports are provided here courtesy of BioMed Central

Melasma in Pregnancy: Treatment and Causes

Your body goes through tremendous changes during pregnancy.

Your belly gets larger and your blood volume increases as your baby grows. You may experience cramping, morning sickness, and all sorts of unfamiliar aches and pains. Your hair and skin may also go through a transformation for the better — or worse. (You’re beautiful all the same.)

If you’ve noticed dark patches of skin on your face, you may have melasma. Here’s more about this condition, why it crops up in pregnancy, and how you can treat it safely.

Melasma is a skin disorder where the melanocytes (color-producing cells) in your skin produce extra pigment for some reason. In pregnancy, it’s often referred to as chloasma, or the “mask of pregnancy.”

Chloasma is a cosmetic concern. It doesn’t affect your baby in any way or indicate any other pregnancy complications.

People with more pigment in their skin — for example, those of African, North African, Middle Eastern, Latin or Hispanic, Asian, Indian, or Mediterranean descent — are more likely to develop chloasma, as they naturally have more active melanin production.

Overall, between 50 and 70 percent of people will develop some form of melasma during pregnancy.

Related: Skin color needs to be factored in when discussing skin diseases

The primary symptom of chloasma is darkening of the skin on the face. You may notice dark patches or splotches on your forehead, cheeks, chin, or around your mouth. These areas may get darker the more you’re exposed to the sun or the further along you are in your pregnancy.

Pain, itchiness, or soreness are not symptoms of melasma. If you experience these signs or develop severe irritation, you may be dealing with another condition. Bring up any additional symptoms you have with your doctor.

A dermatologist can accurately diagnose your condition using a Wood’s lamp, which helps show whether a skin condition is bacterial, fungal, or otherwise concerning.

Skin hyperpigmentation during pregnancy is very common. You may notice your nipples/areolas, armpits, or genitals become darker. You may see a line (linea nigra) extending from the pubic area over the belly, or darkening of the skin all over the body.

Changing hormones, particularly the excess of estrogen and progesterone, is the main cause of melasma during pregnancy. Beyond that, the dark patches on the face can be exacerbated by sun exposure, the use of certain skin care products or treatments, and even genetics.

Chloasma may also be worsened by hormonal imbalances that may have been present even before pregnancy.

Whatever the case, your melanocyte-stimulating hormones react to these triggers by making an excess of protective pigments (dark patches) on the skin called melanin.

Melasma may start at any point in your pregnancy, though it most commonly begins in the second or third trimester.

Again, there are a variety of factors at play when it comes to darkening pigment. Your skin color and type may make this condition more or less noticeable. How much you’re out in the sun or even the time of year when you’re pregnant may also affect when you first notice it.

The good news is that this hyperpigmentation likely won’t get worse after you deliver your child. That said, it may take time — possibly months — for it to completely fade without any targeted treatment.

Speak with your doctor about ways to treat your melasma during pregnancy. Your doctor may refer you to a dermatologist for more information.

Some experts don’t recommend treating melasma during pregnancy. One reason is that it may resolve on its own. And some treatment methods may not be safe or effective to use when pregnant.

The best course of treatment may actually be prevention, with the help of a few lifestyle changes.

Seek shade

Since the sun may trigger the development of more pigment, it’s a good idea to stay out of its rays, especially for long periods of time.

Yes, this also applies to tanning beds or any other environment where you would be exposed to UVA and UVB rays. Limit sunbathing and try relaxing under a tree or umbrella instead.

If you’re exercising, try avoiding peak sun hours in your area, generally the middle of the day. Head out early in the morning or later in the evening when the sun is low.

Wear sunscreen

This doesn’t mean you have to stay indoors when the sun is out, though. Wearing a good pregnancy-safe sunscreen with SPF 30+ is key.

Look for products that contain zinc oxide, titanium dioxide, or other physical blockers (mineral sunscreens) versus those that rely on chemical blockers. Physical blocking sunscreens tend to offer broader protection and may be less irritating to the skin.

Dress for success

Another option for sun cover is clothing with or without UV protection, such as SPF rash guards or sun protective clothing. Even if it’s hot outside, loose-fitting clothing can be comfortable and protect your skin.

What about the face? Wide brimmed hats are your best friend. And don’t forget a stylish pair of sunglasses — the bigger the better.

Use gentle skin care products

Face washes, lotions, and serums that irritate your skin may make melasma worse. Slather up with gentle products instead. Look on the label for words like “noncomedogenic,” “sensitive,” “fragrance-free,” or “dermatologist approved” if you get overwhelmed in the beauty aisle.

The same goes for makeup you may use to conceal the dark areas. Look for noncomedogenic or hypoallergenic foundations, concealers, powders, and other products.

Related: Your guide to pregnancy-safe skin care

Try at-home masks and methods

You may be able to lighten your melasma using ingredients from your pantry. While there are no specific studies on these methods for chloasma, the following topical treatments may help:

Lemon juice. Mix together a solution of half fresh lemon juice and half cucumber juice or water. The acid in the juice may help remove pigmentation in the top layer of the skin.
Apple cider vinegar (ACV). Similar idea here. Mix a solution of half ACV and half water to use as a toner on dark areas.
Milk of magnesia. After washing your face, apply milk of magnesia to dark areas using a cotton ball. Leave on the skin overnight and wash off in the morning.
Oatmeal and honey. Whip up a mask made with cooked oatmeal (let it cool down so it isn’t hot) and raw honey. Leave on the skin for 10 minutes before washing away. The mask helps to exfoliate your skin and the enzymes in the honey may lighten it a bit.

Eat well, rest, and try a few supplements

Since melasma may also be the result of hormonal imbalances, you may improve matters by giving yourself some much-needed TLC. Make sure you’re staying hydrated, eating a diet with plenty of fresh fruits and vegetables, and getting enough sleep each night.

Be sure that you’re rounding out your diet by consuming supplemental omega-3 fatty acids. And ask your doctor about any potential vitamin deficiencies. Some studies link melasma to deficiency in iron and possibly vitamin B12.

Be patient

After pregnancy, you may ask your dermatologist about other treatments if your melasma doesn’t fade on its own. Treatments include topical medications like:

hydroquinone
tretinoin
corticosteroids

Your doctor may also recommend certain acids that lighten the skin, alone or in combination. There are also some procedures — including chemical peels, microdermabrasion, laser treatments, and other light therapies — that may work.

It can be frustrating to deal with changes to your skin during pregnancy. Fortunately, chloasma generally fades within a few months after giving birth.

There are various lifestyle changes you can try to prevent the condition from progressing during pregnancy. Otherwise, speak with your doctor about the options for treatment and the benefits and risks of each. You’ll be glowing again before you know it!

Pigmentation during pregnancy is not a disease

Waiting for a little baby is the most magical and unique period in a woman's life. The expectant mother becomes mysterious, sensitive, caring and unhurried.

The body of a pregnant woman changes every day, and this is natural - after all, a small defenseless little man grows under her heart, whose life and health largely depends on her mother.

A woman already from the first weeks of pregnancy notices changes in her body: the shape is rounded, the breast becomes one size larger and more sensitive than before.

Pigmentation is a fairly common phenomenon during an interesting situation. The appearance of pigmentation on the face and body worries many women.

Some of them are interested in the causes of pigmentation on the skin, while others are trying to find ways to get rid of it. Pigment is a brown coloring matter. Pigmentation is more common in brunettes and dark-skinned women.

There is a popular belief that if a woman's skin deteriorates during pregnancy and age spots become noticeable, she will be a girl! But it is hardly possible to believe in it one hundred percent. Skin pigmentation is a temporary phenomenon, as is pregnancy itself, and age spots also happen with boys in the tummy.

Brown spots in pregnant women are called differently: chloasma, mask, hyperpigmentation of the skin. Pigmentation most often appears on a woman's forehead, cheeks, chin, and also happens above the upper lip. A woman can also notice pigmented areas of skin with sharply defined edges on the neck, chest and tummy in the form of a thin strip. If earlier, with the beginning of spring, you had freckles on your face, then most likely their appearance will intensify during pregnancy as a kind of manifestation of pigmentation.

What causes pigmentation during pregnancy? Of course, this is a hormonal restructuring of the body of the woman herself, changes in the work of all organs, primarily the adrenal cortex and pituitary gland. There are opinions that pigmentation is a genetic phenomenon, and also takes place in case of a lack of folic acid in a woman's body.

In order to prevent and prevent the appearance of pigmented areas of the skin, pregnant women are advised to take quite affordable preventive measures:

reduce sun exposure. Bright sunlight has beneficial properties, thanks to which vitamin D is constantly produced in the body, but even a short stay in the open sun can provoke pigmentation. If possible, wear light clothing that covers the body, as well as use sunscreen for children with a sufficiently high degree of protection;
carefully monitor your own health, avoid hypothermia and colds;
limit the use of cosmetics as much as possible in the summer to avoid the appearance of pigmentation and allergies;
take complex vitamins specially formulated for pregnant women, especially folic acid;
eat right, include more vegetables, fruits, cereals and dairy products in your menu;
avoid stressful situations, do not get nervous and do not "wind" yourself over trifles.

Experts believe that when pigmentation appears while expecting a child, a woman should not take measures to remove them and especially worry about this, she should try to calmly accept these changes in the body, because the spots disappear, as a rule, on their own within two months after childbirth. But for a woman in an interesting position, even such harmless spots can ruin her mood and bring her to tears.

You always want to be beautiful and well-groomed!

If during pregnancy you were “lucky” to become a carrier of specific age spots, then here are some tips to make them less noticeable:

You can prepare a mask of kefir and lemon juice. Apply such a mask to the skin, hold for about 15-20 minutes, then rinse thoroughly with warm water;
gentle curd mask is a reliable assistant in the fight against age spots: mix cottage cheese with curdled milk, apply this mixture on your face for 15 minutes, then rinse thoroughly with boiled water;
cucumber mask is good for whitening age spots. To prepare it, you need to grate the cucumber and apply on the face for 15 minutes, then remove with a cotton swab;
recommend freshly squeezed grapefruit juice and parsley juice to lighten age spots, which are applied to spots and washed off with water after 15-20 minutes. For the best effect, you need to repeat these procedures for at least one week.

In the fight against pigmentation, it is necessary to use only "folk" natural remedies that are very useful for the expectant mother and will not harm the baby.

And remember, characteristic skin changes during pregnancy are not a disease, but a natural phenomenon, just like the desire for something salty or sweet...

With the birth of a long-awaited baby, the spots will disappear and your beauty will return to you!

Consult a dermatologist. Consultation is free, appointment by phone: +7 (499) 608-88-08

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. These marks, characterized by sharp edges and irregular shape, are called melasma or chloasma by doctors.

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 inside of the 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.

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.

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 estrogen, 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.

Occasionally, chloasma is caused by oral contraceptives taken 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.

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.

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 list of ingredients in cosmetics 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.
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.