Chloasma (Splotchy Face During Pregnancy)

When you're pregnant you expect to see certain changes in your body -- say, an expanding waist or bustline. One thing you may not expect to see is a change in your complexion. But for about 70 percent of pregnant women, dark patches on the face go hand in hand with pregnancy. Sometimes called "the mask of pregnancy," this condition is known to dermatologists as chloasma, and it's more likely to happen if you have dark skin to begin with.

Cells called melanocytes give your skin its natural color. Ultraviolet light from the sun stimulates these cells to produce more pigment, which is what makes us tan. But in some people, pregnancy hormones make melanocytes increase in number and produce more pigment than they usually do. This results in brown or gray-brown patches, usually on the face.

Usually the patches appear on the cheeks, forehead, upper lip, the bridge of the nose, and chin. Less commonly, they appear on just the cheeks and nose, or along the jaw and the sides of the cheeks. Sometimes patches can develop on the forearms as well.

How can I keep from developing chloasma?

Since ultraviolet rays stimulate your pigment-producing cells, staying out of the sun as much as possible will help. When you go outside, always wear a sunscreen that protects against both UVA and UVB rays and has an SPF of 30. For even better protection, wear a sunblock that contains zinc oxide or titanium oxide. These ingredients put up a physical barrier between your skin and the sun's harmful rays. Check the labels of sunblocks and sunscreens to be sure you're getting the protection you need, and wear them even if you're sitting next to an open window or driving.

Irritating the skin can also kick melanocytes into overdrive, so dermatologists advise avoiding skin creams, cleansers, makeup, and ointments that irritate your face.

What can I do if I get chloasma?

Be patient. In most cases chloasma will fade gradually after your baby is born. Continue to use sunblock or sunscreen whenever you're exposed to the sun's rays.

If you don't notice an improvement in a few months, you can try over-the-counter bleaching creams containing low doses of hydroquinone. (These work best on mild splotches.) The creams don't actually bleach your skin, but can slow down the production of pigment by the revved-up melanocytes. You may not notice an improvement for several months.

When to seek professional advice

In more pronounced cases of chloasma, where the darker pigment extends deep into the skin, you'll probably need to see a dermatologist for stronger treatment than you can get at your corner drugstore. A dermatologist can prescribe a cream that contains a higher dose of hydroquinone or one that combines hydroquinone with other ingredients such as tretinoin (Renova), steroids, or glycolic acid. Some of these ingredients can be irritating to the skin, so it's important to follow your dermatologist's instructions precisely, and call if you have problems. You shouldn't use any prescription-strength creams while you're still pregnant unless your doctor approves it. According to the March of Dimes, there have been a few reported cases of birth defects in babies born to women who used topical tretinoin while pregnant, although the cause of the defects wasn't certain.

If you are nursing your baby, check with your doctor before using prescription creams, because it is possible the medicine could be excreted in your breast milk. These products aren't known to be harmful to nursing infants, but your doctor can discuss any potential risks with you and help you make the best decision.

If topical creams don't work for you, your dermatologist may recommend a chemical peel, dermabrasion, or laser treatment. Unfortunately, none of these treatments is guaranteed to make chloasma disappear -- and they might even make the condition worse.

During a chemical peel, a solution is applied to the skin that causes it to blister and peel over several days, as if you had a severe sunburn. New skin that is hopefully free of dark patches grows in its place.

If you opt for dermabrasion, your dermatologist will remove surface skin cells with a rapidly rotating brush. This procedure can leave your skin red and tender, and your doctor may prescribe a pain reliever to keep you comfortable. Microdermabrasion uses the same process, but is only applied to specific skin patches. Because your skin will be tender after dermabrasion, you'll need to stay completely out of the sun for three to six months. In some cases, dermabrasion can cause scarring or result in patches of permanently lightened skin. If you choose to have this procedure done, ask your dermatologist how many procedures he or she has done and how successful it has been.

Laser treatments are another option for treating chloasma. In this procedure, a laser beam zeroes in on pigmented cells and vaporizes them. Results and side effects vary, so be sure to do your homework and ask questions of your doctor before you proceed.

Dermabrasion, chemical peels, and laser treatments should only be performed by an experienced, licensed dermatologist. You might want to consult more than one doctor, and discuss the possible benefits and side effects of each procedure before you make your decision. Sometimes a combination of a topical cream and one of these skin resurfacing techniques will give better results than either by itself. But before you embark on any course of treatment, give your skin to recover naturally. After your baby is born and your hormones settle back into their normal groove, you may find your skin returning to normal, too.

References

American Academy of Dermatology. Melasma. http://www.aad.org/public/Publications/pamphlets/Melasma.htm

Stulberg, Daniel L.. Common hyperpigmentation in adults: Part II. American Family Physician. November 15, 2003.

American Academy of Dermatology. Expecting a Baby? Expect Some Changes in Your Skin and Nails. http://www.aad.org/

March of Dimes. Accutane and other Retinoids. http://www.marchofdimes.com/professionals/681_1168.asp

American Academy of Dermatology. Cosmetic Procedures. http://www.skincarephysicians.com/agingskinnet/cosmeticpro.html

University of Michigan Health System. Skin and Hair Changes. http://www.med.umich.edu/obgyn/smartmoms/discomforts/skinchange.htm

University of Miami School of Medicine. Medication and Prescriptions. Tretinoin, Retin A. http://www.med.miami.edu/glossary/art.asp?articlekey=2062

Whitaker, Dr. Elizabeth. Microdermabrasion. Emedicine.com http://www.emedicine.com/ent/topic739.htm

American Academy of Family Physicians. Medications in the Breast-Feeding Mother. http://www.aafp.org/afp/20010701/119.html

American Academy of Dermatology. Melasma. http://www.aad.org/public/publications/pamphlets/common_melasma.html

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