Melasma - The Mask of Pregnancy

As a mom-to-be, the sudden appearance of dark spots or patches on your face can be quite a scary experience and is sure to cause several anxious moments. And while your more experienced relatives and friends may dismiss it as just ‘the mask of pregnancy’, we know that you have a lot more questions running in your mind about this sudden pigmentation on your skin.

Fret not! We are here to answer all your questions on melasma and what you can do to deal with this skin condition.

So, what is melasma?

Melasma, which translates from the Greek word ‘dark’ is exactly as it sounds—the appearance of grey or brown patches, predominantly on the face. It is a common skin condition that is generally associated with the hormonal changes that are part of pregnancy. Research into this skin pigmentation condition shows that as many as 15% to 50% of women experience some amount of skin darkening during pregnancy.

Why is it called the mask of pregnancy?

Melasma is often referred  to as Chloasma or a ‘mask of pregnancy’ because the skin darkening most commonly appears on the face around the chin, cheeks, nose, upper lip or other cranial areas—giving it the appearance of a mask covering your face.

What causes melasma?

Scientists are still not one hundred percent clear on what causes this skin condition. Several triggers have been found.

Hormones: One major trigger is estrogen and progesterone sensitivity. A change or sensitivity to these hormones can lead to an increased production of melanin—which we all know is responsible for the shade of our skin. This change in hormones is generally experienced when you are pregnant or if you are on birth control pills or hormone therapy.

Stress: Doctors have also noticed that stress, thyroid disease, and phototoxic and anti-epileptic drugs can trigger melasma. Both stress and thyroid disease can cause some hormonal imbalance, which in turn can cause melasma.

Sun Exposure: Sun exposure is considered one of the most important factors involved in the pathogenesis of melasma. UV light and in some cases, visible light can start an inflammatory cascade involving different layers of the skin and the blood vessels that eventually result in melasma.

Finally, it can be a combination of two or more of the above mentioned factors that can cause melasma.

What are the most common areas where melasma appears?

You may see the appearance of melasma in any of the following locations or in a combination of these areas on your skin:

• Centrofacial or on your forehead, cheeks, nose and upper lip
• Malar or on your cheeks and nose
• Mandibular or the jawline
• Lateral cheek pattern, where the melasma can be seen on both cheeks
• Neck area especially in people over 50, where melasma is seen appearing on all sides of the neck
• Brachial or on your shoulders and upper arms

 What is the difference between melasma and other types of hyperpigmentation?

Since both melasma and other types of hyperpigmentation are quite similar to each other in appearance, it can be quite confusing to differentiate between the two! But despite some visual similarities, there are key differences between the two conditions and knowing the differences will help you get the right treatment.

Hyperpigmentation simply refers to any type of darkening of the skin. This can include freckles, acne scars, discolouration caused by eczema or psoriasis, or prolonged exposure to UV and infrared rays. Melasma, on the contrary, is primarily due to hormonal imbalance (caused by the many conditions listed above).

Another difference between other types of hyperpigmentation and melasma are the areas where they appear. Hyperpigmentation can be present anywhere on the skin as spots or patches, whereas, melasma appears usually in the six areas listed above.

Will melasma go away after childbirth?

 Most probably, yes! In most cases melasma fades after childbirth, especially in cases where the mother has never experienced it beforehand. If the mother had melasma before her pregnancy, the dark patches might not fully fade on their own.

And in cases where melasma is caused by other triggers such as birth control pills, it has been seen that melasma may fade when the medication is stopped.

Is melasma treatable?

 Thankfully, yes! Melasma is treatable. Since melasma can be triggered by so many causes it is best to talk to your dermatologist who will assess your condition and guide you on the best possible treatments. There are several creams or ointments that your dermatologist may advise you to apply that can lighten dark patches. Some oral antioxidants may also be recommended.

If your melasma is severe, your dermatologist may suggest any one or a combination of the following treatments

• Chemical peels like Glycolic Peel, TCA Peel, Amelan, Inno Peel, Yellow Peel, Jessner Peel or Ferulac Peel
• Minimally invasive treatments like Microdermabrasion , RF Microneedling, Fractional Radiofrequency, or fractional lasers
• Non-invasive laser treatments like Q-switch Laser or NdYAG laser
• Microneedling treatments with tranexemic acid, glutathione or Vitamin C
• Skin recovery treatments with hyaluronic acid

 Can melasma be prevented from spreading further?

It can be minimised to a certain extent. Do try,

• Consuming more folic acid – You can add folic acid (Vitamin B9) to your diet. Research has shown that folate deficiency can lead to melasma. Make sure you eat more green leafy vegetables, citrus fruits, legumes, whole-wheat bread and whole-grain cereals. Talk to your physician about taking a prenatal folic acid supplement, if you are pregnant.
• Protecting yourself from the sun – Sun exposure can worsen melasma. It is advised to wear a broad-spectrum sunscreen with an SPF 30 or higher with a good UVA and visible light protection on your face every day even if you are not going out. Make sure you opt for a mineral-based sunscreen that blocks light and heat instead of just a chemical sunscreen. It is important to use the right amount and reapply every few hours.
• Seeking an expert opinion – Your dermatologist can help you confirm if the darkened skin patches are indeed melasma and recommend a treatment accordingly.

What are some of the effective home remedies to deal with melasma?

Several tried and tested home remedies have brought relief to countless women. The most popular ones are:

• Turmeric – The ancient ‘golden herb’ contains a strong antioxidant called curcumin that lightens the skin’s dark patches. For quicker results, milk mixed with turmeric using a 1:2 ratio can be applied as a paste to the affected areas. Let it dry entirely, before washing off with water.
• Aloe Vera – Aloe Vera, an important ingredient used in many skin products, has an anti-inflammatory and hydrating effect.  Slit the leaf, apply the pulpy gel, leave it on for 15 minutes and rinse off with water.
• Papaya – The ingredient Papain, present in papayas can help fade your pregnancy mask. Mix honey with mashed pieces of ripe papaya. Apply the mixture to the dark patches and leave it for approximately 20 minutes.
• Cucumber – Cucumber is high in water content which lightens the pigmented skin. You can simply grate the cucumber and apply it to the affected areas. Rinse it off with warm water after 20 minutes.

However, before starting on any home remedy, it’s always best to check with your dermatologist.

 Which vitamins are best for melasma?

Apart from folic acid (Vitamin B9) mentioned above, there are quite a few other vitamins and supplements that can help in fading your melasma patches.

• Vitamin C – Known as ascorbic acid, the water-soluble vitamin, Vitamin C is responsible for the growth, repair, maintenance, and development of various body tissues. Research has proved that the application of 5% ascorbic acid-based cream can improve melasma.
• Vitamin E – This fat-soluble vitamin with the capability to neutralise free radicals does a lot in maintaining healthy skin. A study reports that vitamins A, C and E supplements can be effective to treat melasma.
• Vitamin A – Another fat-soluble vitamin that maintains healthy skin. Vitamin A derivatives called retinoid acid can be effective in treating melasma. Retinol is also found in various foods such as whole milk, animal liver and fortified foods.
• Vitamin D- Research shows that Vitamin D3 deficiency can increase melanin production. Do include high Vitamin D foods such as meat, cereals, oily fish and eggs in your diet. Alternatively, you could also take a supplement.

 A word of caution: Never take over-the-counter vitamin supplements. Always check with your physician who will prescribe the right vitamin in the right dosage.

Live with it or get rid of it! It’s your choice

Yes, melasma can be bothersome. But the good news is that in most cases it is a harmless skin condition that can be controlled with treatment. Also you don’t have to just grin and bear it. Thanks to advances in dermatology, it can be treated successfully.

Got more queries? Speak to a dermatologist at Kaya Skin Clinic to understand how you can clear your skin of melasma.