The ESK blog
Why does melasma happen in pregnancy?
19 August 2024
Dr Anne Thomson
Why does melasma happen in pregnancy?
Melasma is the appearance brown patches on the face around the cheeks, nose, and forehead that happen at any time, but especially when you are pregnant.
What causes the uptick in melasma in pregnancy?
Hormone changes
What EXACTLY do oestrogen and progesterone do to increase pigmentation?
We’re not 100% sure.
During pregnancy, when there are much higher levels of oestrogen and progesterone in the body, or even when taking the oral contraceptive pill, we see rates of melasma go up and melasma fades within the year after birth as hormone levels drop.
Studies have shown that when exposed to oestrogen in a Petrie dish, melanocytes produce more pigment but not progesterone.
Genes
This is your NUMBER ONE risk factor. If your family members tend to get pigmentation, chances are you will too. The exact genes haven’t yet been identified. There are racial variations, too. Middle Easterners, East Asians, Indians, African Americans, and Latin Americans, are more affected by melasma than others, such as North Europeans, Indigenous Australians, Amerindians, and populations from Sub-Saharan Africa.
UV exposure
The sun’s UV rays directly stimulate your pigment producing cells, as well as causing inflammation that can make pigmentation worse. Both the UVB for burning and UVA for aging rays cause pigmentation.
Exposure to UV radiation accumulates over time and this cumulative sun exposure increase skin pigmentation that often persists long term.
Combatting melasma in pregnancy
If you have melasma, and you want to get rid of it, you need to understand the safety of the skincare ingredients or devices you might choose to combat the issue.
Sun protection
Get your SPF on. An ounce of prevention is worth a pound of cure. If your genes and hormones are working against you, avoiding the sun is SUPER important. Dermatologists and obstetricians recommend pregnant women use sunscreen. Apart from melasma, sunburn is not great for pregnant women. Blistering sunburn can become easily infected and taking any antibiotic can be tricky in pregnancy.
There is not one preferred sunscreen choice for pregnant women. At the moment, all are considered ok because there is no published data suggesting that any sunscreens have caused any unwanted effects on mum or her unborn baby.
Zinc Shade is a lightweight matte day cream and primer. Its non-greasy, matte finish allows for smooth application and works well under makeup. We spent countless iterations perfecting this lightweight, non-greasy formula to avoid the typical white cast and thick feel of zinc products. The results? A matte finish that works beautifully under makeup. With well tolerated matte finish, it's also well suited to irritable and blemish and bump prone skin. With SPF 15 it also provides broad-spectrum sun protection against UVA and UVB rays. Key features: Lightweight, matte formula suitable for daily use Smooth application with minimal white cast Broad-spectrum UV protection Tested SPF 15 with enhanced UVA coverage Usage: Apply evenly to all exposed areas of skin before sun exposure. Reapply as needed throughout the day.
Zinc Shade
But besides sun protection, what are the dos and don’ts of skincare in pregnancy?
The don’ts
Vitamin A
Taken as an oral tablet, Vitamin A causes birth defects in the unborn baby and should NEVER be taken during pregnancy. There is less evidence when it comes to topical Vitamin A. Studying this directly is obviously a little difficult but the studies we do have from accidental exposure for example show that that the risk is minimal when using topical vitamin A. But at this stage, the consensus is that the risk still outweighs the benefits, and all vitamin A both oral and topical should be completely avoided during pregnancy.
Hydroquinone
Hydroquinone absorbs through skin in larger amounts than other skincare ingredients and therefore should be avoided during pregnancy.
The dos
Tyrosinase inhibitors
Tyrosinase kick starts the production of melanin pigment inside the melanocytes. More tyrosinase = MORE pigmentation. Less tyrosinase = less pigmentation. So, the first step in tackling any pigmentation is often trying to INHIBIT tyrosinase!
From studies, we know that 4NB is the most potent inhibitor of human tyrosinase available. Studies have shown great depigmentation effects at 0.1% twice daily and 0.3% once daily. How effective? 84% of people get significant reduction in their pigmentation, even when used alone. It is very well tolerated and can be used long term.
Like so many ingredients, 4-n Butylresorcinol hasn’t been studied specifically in pregnancy, but human studies have shown very little is absorbed from the skin into the bloodstream and so is unlikely to reach the placenta in substantial amounts there are no safety concerns around using 4NB in skincare in pregnancy.
Enlighten is specifically designed to help reduce the appearance of pigmentation. This lightweight cream helps to gently create a more even skin tone and hydrate and improve the barrier function of the skin. While rarely used, 4-n-butylresorcinol (4nB) has some of the best evidence in this arena. Enlighten combines 4nB and Niacinamide (Vitamin B3) to create a rare combination of gentle yet effective ingredients. Enlighten helps tackle a mottled or uneven skin tone and is suitable for long term daily use
Enlighten
Featuring:
L-Ascorbic Acid (Vitamin C)
L-Ascorbic Acid (Vitamin C) inhibits tyrosinase therefore reduces the ability of the skin to make melanin. A large Cochrane review of oral vitamin supplements in pregnancy found they were not particularly helpful in pregnancy but did no harm either. So it’s considered safe to apply to the skin in pregnancy.
C Forte Morning Serum is packed with 16% L-ascorbic acid, the purest form of Vitamin C, combined with vitamin E and ferulic acid for maximum results. Vitamin C (Ascorbic Acid) is an anti-oxidant helping neutralise free radicals (associated with exposure to the sun). The result? A brighter, firmer, plumper looking skin with fewer fine lines apparent and a more even skin tone. Formulated at the ideal pH (2.5-3.5) and housed in airless, opaque packaging, C Forte ensures stability and effectiveness, delivering radiant skin with every use.
C Forte
Featuring;
- Evidence based ingredients and formulations for superior efficacy.
- Potent skin brightening ingredients
- A plumper, more hydrated and even toned skin.
Note: C Forte can exacerbate acne and may be too strong for irritable skin.
Niacinamide (Vitamin B3)
Niacinamide acts as an antioxidant plus it inhibits pigment transfer inside the skin. Like Vitamin C, topical Vitamin B3 hasn’t been studied in pregnancy. But given that it is being investigated as an oral supplement for pre-eclampsia, it is considered a safe option.
B Calm is formulated to support irritable and blemish prone skin while maintaining a healthy skin barrier. Ceramides strengthen resilience, Salicylic Acid exfoliates and calms the skin, and Niacinamide helps regulate oil and reduce the appearance of blemished skin.
B Calm
Featuring:
- Ingredients to support an improved skin barrier
- Helps manage excess oil production
- Supports a clearer-looking skin
Alpha Hydroxy Acids (AHAs)
Alpha Hydroxy Acids (AHAs) help with skin cell turnover which results in quicker pigment dispersion through the skin. are considered as category A for pregnancy, in other words, safe to use.
Smooth Serum is a night treatment formulated with 3% Glycolic acid, 1% Lactic acid, and 1% Gluconolactone. This gentle AHA blend supports the appearance of skin texture and surface renewal, helping maintain the look of even skin tone. Caution: Not recommended for very sensitive skin or skin prone to rosacea.
Smooth Serum
Key features:
Lasers, pulsed light devices and other procedures to battle pigmentation
Proceed with caution! A position paper from the European Society of Laser in Dermatology stated that lasers and pulsed light devices are very effective for treating age spots often called lentigos as well as that very deep dermal pigmentation but should only be used with great caution for melasma or post inflammatory hyperpigmentation. That’s because they can cause worse pigmentation because of their tendency to cause inflammation.
Being pregnant doesn’t have to mean putting up with melasma. With a few small tweaks to your skincare regime, you can get your pregnancy glow on!
Shop ESK Pigmentation Collection
*While 4-n- Butylresorcinol has been found in studies to have very low systemic absorption, so is usually presumed to be pregnancy-safe, it has not been specifically trialled in pregnant women.
** Please check with your clinician before using any skincare products in pregnancy.