When you're pregnant, many of the changes your body undergoes are designed to nourish, cushion, or otherwise support your baby during development. But some things happen during pregnancy that are simply side effects. One of them is the appearance of dark patches on the face, sometimes called "the mask of pregnancy." Known in dermatological circles as chloasma, these patches affect about 70 percent of pregnant women and are more likely to occur in those with dark skin.

Doctors don't understand exactly why it happens, but they know that hormonal changes during pregnancy cause increased production of pigment-generating cells when a person goes out in the sun. Called melanocytes, these cells create the pigment that gives your skin its color and makes you tan in sunlight. During pregnancy, not only do these cells increase in number, they go into overdrive, producing more pigment than usual.

At this point, your face may begin looking splotchy because the melanocytes accumulate in dark patches, almost always on your face. Typically, the excess pigment appears in one of three patterns: Most commonly, 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.

Doctors agree the best way to avoid chloasma is to stay out of the sun as much as possible. When you go out be sure to wear a good broad-spectrum sunscreen (which protects against both UVA and UVB rays) and has an SPF 30. Even better, wear sunblock that contains zinc oxide or titanium oxide -- these ingredients form a physical barrier to the sun's ultraviolet rays.

Some experts say that even strong indoor light can trigger chloasma and that pregnant women should wear sunscreen or sunblock even indoors. Just sitting next to an open window can expose you to the sun's rays, so to play it safe you may want to put on sunscreen every day, whether you plan to go out or not.

The best thing to do is wait. Chloasma often goes away a few months after your pregnancy is over. In the meantime, avoid using any facial cleansers, skin creams, or makeup that irritate your skin -- they can make chloasma worse. And, of course, stay out of the sun.

If the dark patches don't fade a few months after your pregnancy, you can try over-the-counter bleaching creams containing low doses of hydroquinone. (These work best if the darker pigmentation is a mild form, limited to the top layers of skin cells.) The creams don't actually bleach your skin, but rather prevent melanocytes from overproducing pigment. It takes several months of using the creams to notice an improvement.

If the chloasma extends into deeper layers of skin cells, over-the-counter products are unlikely to help. A dermatologist can prescribe a higher-dose hydroquinone cream or one that combines hydroquinone with other ingredients such as tretinoin (Renova), steroids, or glycolic acid. Some of these ingredients may irritate your skin, so be sure to follow to the letter the product instructions and your dermatologist's advice. Most important, don't use any of these products while you're pregnant unless your doctor gives you the go-ahead. 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 topical drug hasn't been proven to be the culprit.

Similarly, nursing mothers should be cautious when taking this (or any) drug, because some medicines are excreted in breast milk. Though there isn't any evidence that topical tretinoin is harmful to your baby, discuss the benefits and potential risks with your doctor.

If topical creams don't help your chloasma, your dermatologist may recommend a chemical peel, dermabrasion, or laser treatment, though none of these treatments is consistently effective against chloasma -- 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 grows to replace the blistered skin.

Dermabrasion involves removing surface skin cells with a rapidly rotating brush. As you might expect, this leaves your skin red and tender, and your doctor may prescribe a pain reliever to ease any discomfort. (When only small patches of skin are targeted, it's called microdermabrasion, though the process is the same.) You'll also need to stay out of the sun for three to six months after the procedure. Sometimes dermabrasion can leave patches of permanently lightened skin and can cause scarring.

Some dermatologists recommend laser treatments, which use narrowly focused laser beams to vaporize targeted skin cells. Side effects of the laser method vary from person to person.

These three procedures should only be performed by an experienced, licensed dermatologist. Be sure you fully understand the possible benefits and side effects of a procedure before you embark on it, so you know what to expect afterward. Often a combination of topical creams and one of these skin resurfacing treatments will work better than either option alone. However, before you head for the dermatologist, give your skin plenty of time to recover on its own -- once your hormones return to normal after pregnancy, it's likely your skin will, too.

-- Nancy Montgomery is an associate editor at Consumer Health Interactive.

References

Last updated March 30, 2009
Copyright © 2005 Consumer Health Interactive

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