When I became pregnant with my son in 2014, I knew to expect sore boobs and swollen ankles — but it was the changes to my skin that really took me by surprise. Before I even knew I was pregnant, I woke up one morning and discovered a large patch of brown, darkened skin on my forehead. I initially put this change down to a very localized bout of sunburn and tried to ignore the fact that it was the middle of winter — albeit in temperate Sydney, Australia — and that the patch showed no sign of fading. If anything, it was getting worse.
It wasn’t until I was around six months pregnant that I learned what the dark patch of skin was. "Oh, you have melasma!" a fellow sufferer said. "Me too!" She pointed to the dark patches of skin on her own face, no doubt exacerbated by our sunny, waterside location. Sometimes referred to as "the mask of pregnancy," I began to feel increasingly self-conscious of my melasma, which seemed to get worse as my pregnancy progressed, something London-based dermatologist Dr. Justine Kluk explains further.
"Any skin condition can flare up during pregnancy, but the two I encounter most frequently are melasma and acne," she says. "People who suffer from melasma almost always find that it flares up during pregnancy, if not occurring for the first time ever."
As my passport photo slowly emerged from the photo booth, I stared at it agog. The melasma had left me looking like a mustachioed adolescent boy.
This made sense to me. If I popped out to get a sandwich at lunch, my colleagues would comment on my skin when I walked back into the office, as the condition can be aggravated by just a few minutes of sunlight. The combination of the SPF 30 and thick foundation I was wearing to help combat the problem while hiding it left my skin feeling greasy and clogged. I assumed that my melasma would fade after my son was born, and hoped that moving back to the less sunny climes of the UK would help get rid of the condition altogether.
However, when I had a passport photo taken shortly after my son’s first birthday, I realized that not only did I still have melasma, but that it was worse than ever. As the image slowly emerged from the photo booth, I stared at it agog. I could clearly see that the melasma had gone from being a patch on my forehead to a sprinkling on my nose and, most noticeably, a dark upper lip, leaving me looking like a mustachioed adolescent boy.
Now, over four years after the first dark patch of skin appeared, I'm desperate to know if I’ll ever be free of melasma. As Dr. Kluk tells me, it may not be so simple.
"We have to think of melasma more along the lines of a long-term condition," she says. "We know that it is a condition that is predominantly caused by hormonal changes, due to, for example, taking a contraceptive pill or pregnancy. We know from experience that while you may be able to get it under control for a period of time — whether that’s through skin care, prescription treatments, or procedures — very frequently, it does come back." Dr. Kluk also notes that it’s common for its appearance to improve during the winter months, only to flare up again come summer.
The good news is that there is plenty we can do to manage the condition. "As a dermatologist, we use things like a prescription retinoid cream or sometimes a skin-lightening agent called hydroquinone," Dr. Kluk notes. The bad news? Neither of those should be used during pregnancy. That said, prescriptions or over-the-counter products that contain azelaic acid are effective at treating melasma, and are thought to be safe to use during pregnancy — but you should always check in with your doctor first.
As I’m currently breastfeeding my second child, my best options are strict sun avoidance and optimizing my skincare regime. "Make sure you use SPF 30 or 50 every morning — the higher, the better," Dr. Kluk tells me, adding that using a vitamin C-based serum or cream will also help regulate pigmentation, and can be used safely during pregnancy and while breastfeeding.
While it’s impossible to predict how your skin will react to pregnancy, Dr. Kluk urges anyone with an existing skin condition to seek advice from a dermatologist before starting a family to know what to expect. "My top tip would be: If you have the time to plan for it and things aren't great with your skin to start off with, it may be worth giving some thought towards trying to get things as well-controlled as possible before you actually conceive," she says, and concludes that it's definitely worth visiting a qualified dermatologist or your primary-care doctor to assess the situation. "This," she says, "will help you establish a better baseline."