Mask of pregnancy – what melasma treatment options are available?

Melasma (brown skin) is a skin condition that causes increased, usually blotchy and irregular pigmentation to occur.

During pregnancy, the steep escalation of oestrogen (primary female sex hormone) causes an increase in pigmentation on the face – thus why the condition is commonly referred to as the mask of pregnancy.

There are three types of Melasma:

• Epidermal melasma. The most superficial and thus the easiest to treat. Occurs on the outermost layers of cells on the skin. It is usually dark brown in colour and has a well-defined border. This form of Melasma is more visible under black light.
• Dermal melasma. Occurs in the deeper mid-layer of the skin. It has an ill-defined border and is light brown or bluish in colour. Dermal Melasma responds poorly to treatment and is more persistent.
• Mixed melasma. This is the most common type of Melasma and as the name suggests, has properties of both Epidermal and Dermal Melasma. It is characterised by a combination of bluish, light and dark brown patches. With treatment, this variant of the condition improves partially.

Senior Dermatologist and previous Deputy Medical Director at the National Skin Centre, Dr. Tham, Tham Siew Nee Skin Clinic (Gleneagles Hospital), explains how the rise in oestregon during pregnancy triggers excess melanin (responsible for skin and hair colour) production.

This explains why you’re having dark skin during pregnancy. Apart from the face, Melasma also affects other areas of the skin such as the nipples, areola and vulva. Your existing moles and freckles may darken and there is likely to be a dark line down the centre of your abdomen (linea nigra).

The good news about the Mask of Pregnancy

Melasma that occurs in pregnancy is a very common condition and there is nothing about it that is serious enough to cause you to be a bundle of nerves or make your blood run cold.

The hyperpigmentation usually disappears after delivery or at times, when you stop breastfeeding. It is an aesthetic problem more than anything else.

The bad news about the Mask of Pregnancy

As Melasma is not exclusive to pregnancy, there are chances that it may reappear later in life. It is generally caused by hormonal changes and as such, throughout your reproductive age, you remain susceptible to the condition.

Signs and Symptoms

Dr. Tham describes Melasma to be an asymptomatic (a disease or infection with no symptoms) condition. It is mainly a cosmetic problem appearing as irregular pigmentation mostly on the cheeks, nose and forehead.

Patches of discoloration, darker than your normal skin colour tend to appear on your face in a symmetrical manner.

Melasma causes coloured patches to appear on your cheeks, chin, forehead, the bridge of your nose and at times even your upper lip. Other areas of your skin such as your neck and forearms, which are in more contact with sunlight may also face discolouration.

Melasma typically presents itself as freckle-like spots or larger, flat and brown patches. It appears symmetrically on both sides of your face with an irregular border. At times you may also encounter reddened or inflamed forms of melasma.

Causes of Melasma

As in the case of many medical conditions, it is difficult to pinpoint the exact cause of Melasma. There are however a number of factors that increase the likeliness of it occurring.

• Hormonal changes. Oestrogen and progesterone sensitivity are commonly associated with Melasma. As such, pregnancy, the consumption of birth control pills and hormone therapy (hormone replacement, intrauterine device and implants) are responsible for about a quarter of Melasma cases.
• Genetic Predisposition. In her 30 over years of practice, Dr. Tham has observed that many patients with Melasma report a family history. If your mother had Melasma during her pregnancy, there are high chances that you too might. Melasma is linked to the presence of over-active melanocytes (cells that produce melanin which gives our skin its colour).
• Exposure to Ultraviolet Rays. Ultraviolet A (long-wave) and Ultraviolet B (short-wave) rays are known to stimulate the production of melanin. Constant and frequent exposure to the sun in itself, or in conjunction with other triggers can cause Melasma to occur.
• Cosmetics. Scented cosmetics and skin products, deodorants, soaps and toiletries may cause a phototoxic reaction (chemically induced skin irritation) which in turn triggers Melasma. Melasma that occurs as a result of this may persis in the long run.
• Hypothyroidism. Low levels of thyroid hormone in the body, along with stress has also been linked with the occurrence of Melasma.

Risk Factors

Dr. Tham states that Melasma can just about affect anyone, but the following groups of people face higher risks:

• Women in their reproductive age. Though not restricted to, women between the age of 20 to 40 are more likely to develop Melasma. This is due to the link between Melasma and hormonal changes.
• People with tanned skin. Melasma occurs more commonly among people like Asians and Hispanics, who tan well or have naturally brown skin. People with very fair or black skin are less likely to get Melasma.
• People who live in tropical climates. As Melasma is closely linked with sun exposure, people living in tropical climates and who are always under the sun are highly susceptible to Melasma. Which of course means that Singaporean women are ‘likely candidates’!

In her practice, Dr. Tham notes that Melasma is a common condition in Singapore and that all the racial groups seem to have equal chances of developing it. She emphasised that Melasma is definitely more common among those who are constantly outdoors.

So mums-to-be, it might be a good idea to give the tanning a break and head indoors instead!

Continue reading to find out about Melasma treatment options available.