Melasma, or the mask of pregnancy, is an embarrassing discoloration of the face. Dark, irregular areas slowly appear on the cheeks and nose. Sometimes they also form on the upper lip and forehead. This discoloration most commonly appears during pregnancy, but it can also appear on women taking oral contraceptives or hormonal replacement therapy.



Melasma is thought to be the result of female hormones sensitizing the pigment-producing cells to sunlight. Melasma requires both female hormones and exposure to sunlight to develop. It usually develops slowly as the cells respond to the double stimulation by gradually producing more pigment (melanin). Of course, not all women develop melasma during pregnancy.


Women with light brown skin who live in areas with intense sunlight are those most likely to develop melasma. A genetic predisposition and thyroid disorders can also contribute to the development of melasma.


Clinical Course 

In most women, the discoloration will gradually fade away over the course of several months after giving birth or after discontinuing the hormone-containing medication.


Any sun exposure at all during this period will intensify the discoloration and delay the eventual fading of the mask. Some women retain the discoloration for years after it forms.


Sun Exposure 

The best treatments for pigmentation of this type involve avoiding sun exposure. Any pregnant woman who notices the beginning stages of melasma can prevent it from progressing by diligently avoiding the sun. Once the pigmentation has developed, no treatment will be successful unless sun exposure is successfully stopped. Staying indoors, wearing hats, and always using broad-spectrum sunscreens that include both chemical agents and physical blockers such as zinc oxide are necessary to stop the cells from producing more melanin.





Applying depigmenation creams that contain hydroquinone can fade the color away. Hydroquinone blocks an enzyme called tryosinase that is essential for formation of melanin. The safety of hydroquinone use during pregnancy and while breast-feeding is unclear; therefore, to be completely safe, it is best avoided until the infant is weaned. This complication makes hydroquinone rather difficult to use to treat melasma caused by pregnancy.




Chemical Peels 

An alternative to hydroquinone is a glycolic acid peel. Glycolic acid is derived from fruits and is thought to be quite safe to use during pregnancy and breast-feeding. A glycolic acid peel removes the outer layer of skin, including the pigmented cells. A program of monthly glycolic acid peels combined with strict sun avoidance can fairly quickly fade away all signs of excess facial pigmentation. Often only two or three peels are necessary, but sun protection will need to be continued for many months to prevent the pigmentation from recurring.




At Home Peel

Deep peels should be performed only under medical supervision. However, a mild glycolic acid peel can safely be performed at home. Purchase or prepare a 30% glycolic acid solution. Dissolve a half-cup of baking soda in two cups of water. Apply petroleum jelly to the lips and around the eyes- anywhere you don’t want the acid to touch. Carefully wipe the acid onto the face.

After five minutes, begin washing the face with the baking soda solution. Use up all of the solution, and then wash the face well with plenty of water. Pat dry and carefully moisturize. The skin may become reddened after this treatment, as if it had received a sunburn. After it heals, the pigmentation should be noticeably reduced in intensity if sun exposure was successfully prevented. Peels can be repeated every four weeks until the pigmentation resolves.