In plain words
Melasma is a pattern of brown or gray-brown patches on the skin. It most often shows up on the cheeks, forehead, upper lip, or nose. Pregnancy hormones and sun exposure can both trigger it. It is more common in people with darker skin, and a family history makes it more likely. Many mothers call it the mask of pregnancy. It often fades after birth, though it can take months, and sometimes it does not fully fade. Many dermatologists advise sun protection to limit darkening. It is a skin change, not a sign that something is wrong. Mention any new or changing spot to a provider, since not every dark spot is melasma.
The deeper version
Melasma is an acquired hypermelanosis of sun-exposed skin, most often malar, centrofacial, and mandibular. Estrogen and progesterone stimulate melanocytes, and ultraviolet and visible light induce pigment production. Genetic predisposition is substantial, and family history is common among patients. It is more prevalent in women with Fitzpatrick skin types III to V. Sheth and Pandya (Journal of the American Academy of Dermatology, 2011) reviewed its pathogenesis and treatment, and Handel and colleagues (2014) gave a clinical and epidemiological review. Diagnosis is usually clinical, with Wood's lamp examination used to judge depth. The main controversy concerns treatment in pregnancy, since many topical agents are avoided and evidence on photoprotection is mostly observational.
Where it comes up
- Skin in pregnancy: stretch marks, linea nigra, melasma, itchingPregnancy: Your Body
- Your changing body and how you feel about itPregnancy: Mind and Life
What mothers here say about melasma
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Sources
- Sheth VM and Pandya AG — Melasma: a comprehensive update, Journal of the American Academy of Dermatology (2011)
- Handel AC, Miot LD and Miot HA — Melasma: a clinical and epidemiological review, Anais Brasileiros de Dermatologia (2014)