Clare Simmons* first noticed a few dark patches on her cheeks during her honeymoon in Italy. “It was like I had dirt on my face that I couldn’t clean off,” she says. A few years later, when she was 30 weeks pregnant with her son, the patches darkened and new ones started to appear on her forehead. “I have a map of Australia on my forehead and the Maldives islands on my cheeks,” she says with a laugh.
The marks were prominent enough that Simmons made a point to cover them up. “I would feel self-conscious if I went out without makeup, because I think it would be hard for people not to stare,” she says. She made an appointment with the dermatologist, who confirmed that she melasma—also known as the mask of pregnancy.
Melasma is a skin condition that causes dark spots on the face, but the exact cause isn’t known. One theory is that the melanocytes (the cells that produce skin colour in your body) start producing too much colour. But what stimulates the cells to go into overdrive? Any changes in your hormones, like taking birth control or being pregnant, can trigger melasma, explains Elin Raymond, an OB/GYN in Toronto.
Sun exposure is another major risk factor for the skin condition. “UV rays can trigger the onset of melasma and worsen it in someone who already has it,” explains Allison Sutton, a dermatologist in Vancouver.
Melasma, or chloasma, as it’s called during pregnancy, appears mostly on the face, on sun-exposed areas like your cheeks, nose, upper lip and forehead, says Raymond. Occasionally, you might get it on the chest or arms, but that’s unusual. Melasma patches are usually symmetrical, appearing on both sides of the face. Fifty to 70 percent of pregnant women will get chloasma—typically just a few patches. It’s seen more often in people with darker skin tones, particularly those who have Asian, Mediterranean or Latin backgrounds.
There is no surefire way to prevent melasma, but you can help minimize flare-ups through sun protection. “Less light exposure will hopefully lead to less melasma, fewer flare-ups and lighter hyper-pigmentation,” Sutton explains.
So if you haven’t been using sunscreen daily, it’s time to start. “You need to be super diligent,” she says, “which means applying sunscreen every morning, no matter what the weather is like, and reapplying every two hours.” Sutton suggests using 50 or 60 SPF.
She also recommends wearing a wide-brimmed hat and large sunglasses outside—you’ll even need to protect yourself in the car. “If you’re sitting by a window or taking a long car ride, remember your sunscreen.” This is particularly important when you are pregnant, since the increase in melanocytes in your body makes your skin extra sensitive to the sun.
You should also avoid using any skincare products that irritate or inflame your skin, such as exfoliants. “Waxing or hair removal, in particular, can exacerbate it,” says Raymond.
Besides covering up the patches with concealer, treatment options are limited during pregnancy. Most prescribed topical medications, such as retinoids and hydroquinone, haven’t been tested on pregnant women, so it’s unclear if it’s safe to use them during pregnancy. Sutton recommends women use plant-based products instead. “Products with vitamin C, arbutin, glycolic acid, soybean extract and licorice extract can be helpful,” she says.
Following pregnancy, Sutton suggests a treatment plan that includes both the prescription and plant-based products, and sometimes chemical peels to reduce the dark patches.
But many women naturally see an improvement postpartum, as their hormones return to normal, although it’s not guaranteed. Simmons actually found her case got worse after her son was born. It’s a good idea to talk to your doctor about alternatives to hormonal birth control, which can be a trigger for melasma.
Chloasma can be treated at any time, but if you’ve got plans for future pregnancies, you may want to wait until your family is complete before you try to clear it up, otherwise you might be buying expensive products only to have the patches come back. “If you’ve developed melasma during a pregnancy, there is a higher chance of a reoccurrence,” explains Raymond.
Simmons, who now uses sunscreen every day, does worry that her case could become worse if she were to have another child. In the meantime, she recognizes that her son doesn’t know her any other way and loves her skin just as it is, melasma patches and all.
*Name has been changed
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