Pigmentation During Pregnancy: The Mask of Pregnancy, Safe Skin Care and Treatment After Birth

During pregnancy the skin responds quickly to the large change in hormones. Pigment-producing cells become more active; areas that are already darker deepen a little further, and marks that were not there before may appear on the face. Most of these changes do no harm to the baby and lessen after the birth.

The real aim in pregnancy is to stop the pigmentation from deepening and to start treatment at the right time. At our clinic we treat protection during pregnancy and pigmentation treatment after birth as a single plan.

Which Types of Pigmentation Appear in Pregnancy?

• Mask of pregnancy (melasma): symmetrical brown patches on the cheeks, forehead, bridge of the nose and upper lip.
• Linea nigra: a dark line running down from the navel.
• General darkening: deeper colour on the nipples and the area around them, the armpits, inner thighs and genital area.
• Darkening of existing marks: freckles and old marks left by spots can become more visible.

General darkening can begin in the first months of pregnancy. The mask of pregnancy, on the other hand, tends to become noticeable in the second half and is more pronounced in women with darker skin.

Why Does the Mask of Pregnancy Appear?

The rise in oestrogen and progesterone during pregnancy stimulates pigment cells. These cells also become more sensitive to sunlight, which is why a patch can suddenly become obvious in summer or after a sunny holiday. Visible light and heat also darken the pigmentation.

The mask of pregnancy is the same condition as melasma outside pregnancy; only the trigger is different. To work out whether the mark on your face is melasma, a sun spot or freckles, have a look at how melasma, freckles and sun spots differ.

What Can You Do to Prevent Pigmentation During Pregnancy?

The most effective thing you can do in pregnancy is to protect your skin from the light and heat that feed the pigmentation:

1. Apply sunscreen every morning, including in winter and on cloudy days; when you are outdoors, reapply about every 2 hours.
2. Choose mineral products containing zinc oxide and titanium dioxide. Tinted sunscreens containing iron oxide also help against visible light.
3. Wear a wide-brimmed hat and stay in the shade when the sun is high.
4. Limit sources of heat such as saunas, the hammam, a hot kitchen and long hot showers.
5. Avoid harsh exfoliating products, scrubbing mitts and perfumed cosmetics that irritate the skin.

Everything about filter types, protection factor and how much to apply in how to choose a sunscreen applies in pregnancy too.

Which Pigmentation Treatments Are Avoided in Pregnancy?

Many pigmentation treatments are not recommended during pregnancy. This is because some active ingredients pass from the skin into the bloodstream, and their effects on the baby are not well enough known.

Creams that are avoided

• Hydroquinone: it is absorbed through the skin relatively more than other lightening creams, and its safety in pregnancy and breastfeeding has not been shown.
• Retinoids: these are vitamin A derivatives. Isotretinoin taken by mouth and tazarotene used as a cream are not used in pregnancy because they can cause birth defects. The evidence on tretinoin and adapalene is debated, so we do not recommend them in this period.
• Mixed creams with an unknown label: lightening creams of uncertain content, bought online or under the counter, may contain harmful substances such as cortisone or mercury.

Procedures that are avoided

During pregnancy and breastfeeding we do not perform laser or BBL light treatment, chemical peels, lightening mask systems such as Cosmelan, or needle-based treatments such as Dermapen and mesotherapy at our clinic. All of these can be planned after the birth; postponing them during pregnancy does not reduce the success of treatment.

Which Skin Care Is Safer During Pregnancy?

Most products that act locally on the skin pass into the blood in very small amounts. A simple routine of a gentle cleanser, a moisturiser and a mineral sunscreen can therefore be continued comfortably in pregnancy.

For mothers-to-be who are clearly bothered by their pigmentation, a locally acting cream considered safe in pregnancy, such as azelaic acid, may be an option. We recommend this cream knowing how many weeks pregnant you are, and for a controlled period. If the appearance bothers you, mineral concealer make-up is also a harmless way to hide the patch while you wait for treatment.

Does the Mask of Pregnancy Go Away After Birth?

The mask of pregnancy tends to fade in the months after the birth. In some women it disappears completely; in others a faint trace remains or it darkens again every summer. The linea nigra and general darkening also fade after the birth, but they do not always return to how they were.

Two important factors affect the course of the pigmentation: continuing sun protection after the birth, and hormonal methods of contraception. If you have started the pill after giving birth, be sure to mention this at your pigmentation appointment.

When Does Pigmentation Treatment Start After Birth?

Rather than starting treatment straight after the birth, we suggest watching for a few months to see how much the patch fades by itself. During this time sunscreen and a simple routine continue.

• While breastfeeding: we continue with creams compatible with breastfeeding and strict sun protection.
• After breastfeeding has ended: if the pigmentation is still noticeable, cream treatment, Cosmelan or, where suitable, laser and light treatments can be planned.
• Season: where possible, we schedule a plan that needs peels or laser for the autumn and winter months.

For widespread, superficial pigmentation, chemical peel sessions after breastfeeding has ended can speed up the effect of the creams. Because the mask of pregnancy tends to come back, sun protection and maintenance creams carry on even after melasma treatment has finished.

Is It Normal for Moles to Change During Pregnancy?

In pregnancy, moles can darken slightly or grow a little in stretched areas such as the abdomen; these temporary changes are usually harmless. However, a mole whose shape becomes irregular, which develops different colours, bleeds or quickly stands out from the others should be shown without waiting for the birth.

Dermoscopy is a visual examination using light and magnification, with no needles or medication. So you do not need to wait until after the birth for a mole check during pregnancy.

Pigmentation Assessment in Denizli During Pregnancy and After Birth

You can come for an examination of your pigmentation or moles at any stage of pregnancy. At the appointment we talk about how many weeks pregnant you are, the products you use and when the pigmentation began, and together we decide on care suited to this period and on the timing of treatment after the birth. To see Dr. Tuba Çelebi Kayhan, book an appointment by phone.