eXPecting

c2c expecting

pregnancy

The Mask of Pregnancy

By ElIZaBEth sMocK, Msn, aRnP

Melasma is a common, benign skin condition that presents most commonly in women. It is characterized by irregular patches of hyperpigmentation that can vary from tan to brown or darker discoloration. This discoloration occurs as a result of stimulation of the pigment producing cells called melanocytes. This process can be triggered by a combination of factors including sun exposure, a change in hormonal status (e.g., pregnancy, thyroid disorder) and genetic predisposition.

Exposure to ultraviolet light from the sun can lead to an increase in melanocytes, therefore contributing to not only the development of melasma, but exacerbation of this condition as well. Minimizing direct exposure to the sun and utilizing sunscreen regularly is key. When selecting a sunscreen it is important to choose one that offers broad-spectrum protection against UVA and UVB rays and has a minimum sun protection factor of 30.

Changes in hormone levels of estrogen and progesterone can also contribute to the onset of melasma. When this occurs in a pregnant woman it is called chloasma, or “the mask of pregnancy.” Other shifts in hormone levels caused by medications, such as contraceptives and hormone replacement therapy, or perimenopause and menopause can also trigger the development of melasma. Typically this discoloration can spontaneously resolve or fade after giving birth or stopping the associated trigger.

Genetics also play a role in the development of melasma. Those with a known family history of melasma and darker skin, such as those with an Asian or Hispanic ethnicity, are at an increased risk of developing it. People

with darker skin are more prone to melasma because they have more active melanocytes.

Unfortunately treatment for melasma can be difficult and frustrating because of its high rate of recurrence.

Avoidance of the sun and consistent sunscreen use is a must.

Topical medications may also be used to help regulate melanocytic activity and melanin production. Some common topical medications include hydroquinones, tretinoins and retinoids, kojic acid and azelaic acid. In addition to topical medications, procedures such as chemical peels and microdermabrasion can help by increasing exfoliation of the skin.

Melasma is a chronic condition and even with treatment, improvement is often gradual and can take months for one to notice a significant improvement in the overall appearance. Management can be challenging and requires a long-term treatment plan. Education and understanding of the above is important for increased compliance with a treatment plan and, in turn, an overall successful result. 

...AND DID YOU KNOW?

Melasma is most common in women of childbearing age.

It appears as tan to brown spots (hyperpigmentation) on the face.

It is caused by a combination of sun exposure, hormonal changes and genetic predisposition.

Topical creams, such as hydroquinone, are a mainstay for treatment.

Melasma prevention requires sun avoidance and protection with hats and sunscreen.

É Elizabeth smock is a dedicated wife and mommy who received her undergraduate and graduate degrees from the university of Florida, has been a board certified adult nurse practitioner for nine years and is on staff at Dermacare laser and skin care clinic.