Dermatology, Laser & Vein Specialists Answer Our Questions About Melasma: The Mask of Pregnancy

It’s no myth, pregnant women do have a radiant glow. That glow is caused by increased levels of hormones, extra blood circulating through their body and maybe a dash of pure joy.  However, pregnancy can also wreak havoc on a woman’s complexion. One such bothersome condition is melasma (pronounced mu-LAZ-muh).  A blotchy darkening of the skin on the face sometimes referred to as “the mask of pregnancy”. It isn’t painful or harmful but it IS annoying especially when instead of glowing skin you have blotchy skin.  We reached out to client Dermatology, Laser & Vein Specialists of the Carolinas to find out more.

Greeted by a spa-like atmosphere and an upbeat staff, I took my seat in the waiting room and observed. Patients of all ages (men and women) were called back quickly–very little waiting involved. All procedures; peels, lasers, surgeries are done “in house”. We spoke to Dr. Payman Kosari at Dermatology, Laser & Vein Specialists of the Carolinas and he filled us in on melasma.

Let’s start at the beginning—what is Melasma?

Melasma is a common acquired skin condition causing brown, tan or gray patches to appear on the cheeks, nose, forehead and chin. It can also appear on the forearms, neck and chest. It typically occurs in a symmetrical fashion and women with darker complexions are more prone to develop melasma than women with lighter skin tones. The increased pigment can be located in the epidermis (surface) or dermis (deeper in the skin). The location of pigment can be important when determining treatment options.

 

Melasma is called  “the mask of pregnancy”. Why does it occur during pregnancy?

Why some are more predisposed to develop melasma than others is not entirely clear. The cause of melasma is likely multi-factorial. Causes include a genetic predisposition, being female, darker skin complexion, pregnancy, certain medications and excessive sun exposure. Melasma occurs when the color-making cells in the skin (melanocytes) produce too much color.These changes may be triggered by hormonal changes during pregnancy, which stimulate an increase in your body’s production of melanin, the natural substance that gives color to hair, skin, and eyes.

How am I diagnosed?

Melasma can be diagnosed through a simple exam. At Dermatology Laser &Vein Specialists of the Carolinas (DLVSC) the dermatologist will diagnose and suggest a course of treatment during an exam/consultation. The treatment will depend on how deep the melasma is in the skin (dermis or epidermis) and might require topical creams, lasers, or chemical peels. All can be done in our office.

What is the treatment? Is it painful? Most importantly…is it safe?

The first course of action is to avoid sun exposure and when you do venture into the sun, wear sunscreen or a wide brimmed hat. Always, look for a broad-spectrum sunscreen with an SPF of 30 or more to protect against both UVA and UVB rays.  Make sure to reapply sunscreen every 1-2 hrs if you expect to be outdoors for an extended period of time.

Here are the treatment options for melasma at Dermatology, Laser & Vein Specialists of the Carolinas:

*Topical Creams include lightening agents, melanin blockers and vitamin A derivatives such as Tri-Luma cream. We sell Tri-Luma in our store and recommend it for nearly every patient that has melasma. The product is applied 1-2x daily and can produce dramatic lightening of the pigmented areas. Tri-Luma is not typically used during pregnancy and it is always recommended to consult with your Ob/Gyn before initiating therapy

*Lightening/anti-inflammatory creams containing azelaic acid  can be prescribed during pregnancy. Products containing azeleic acid are thought to be effective because of their ability to interfere with the production of melanin. Results may be noticed  in as little as 2-3 months with twice daily use.

*Laser or light-based treatments are also an option if topical creams do not work. Often, topical lightening agents are used in conjunction with laser therapy. The laser specifically and safely targets the melanin in skin. It is a short procedure requiring minimal to no downtime. Depending on the device used, multiple treatments may be required but the results are dramatic and always satisfying.  Be sure to discuss the safety of laser treatments with your Dermatologist and Ob/Gyn.

*Chemical peels done by an esthetician will require multiple visits (probably every 4 weeks). The chemicals used during a peel are not recommended during pregnancy so this one will have to wait until your bundle of joy arrives.

 

 

What treatments are safe during pregnancy?

Every case is unique and requires a thorough clinical assessment. If you feel your melasma needs attention, make sure to consult with your dermatologist to create a treatment plan that caters to your personal needs.  Some treatments may not be indicated during pregnancy but there are definitely options available.

Will it go away on its own or once the baby is born?

Melasma is quite unpredictable. Some cases of melasma will fade after delivery, while others will maintain the pigment. Remember, many factors are responsible for the development of the melasma. Although, it may appear during pregnancy, it may be that there is an underlying predisposition to hyperpigmenting and pregnancy merely brought it to surface.  Early sun protection and treatment is the key to controlling melasma.

Most importantly, the staff at Dermatology, Laser & Vein Specialists make themselves available to consult, diagnose and treat melasma with the patient and their unborn child in mind.  The atmosphere is comfortable and accessible and we encourage any patient with concerns regarding melasma, to make an appointment to discuss treatment options.

Payman Kosari, MD

Dr. Kosari is a board-certified dermatologist.  He received his Bachelor of Science degree in Biology from the University of California, Los Angeles before earning his Medical Degree from the Chicago Medical School. He completed his internship at Cedars-Sinai Medical Center and relocated to North Carolina for his Dermatology residency at Wake Forest Baptist Health. Dr. Kosari specializes in the treatment of pediatric and adult disorders of the skin, mucosal membranes, hair, and nails and has had extensive training in the diagnosis and treatment of skin cancers including malignant melanoma. He has a particular focus in venous disorders & associated treatments such as endovenous laser ablation and sclerotherapy.