Hyperpigmentation & Pregnancy
Intro
Skin changes can happen during pregnancy. A study completed in 2018 where 1935 pregnant females were asked to fill out a questionnaire concerning their skin during pregnancy, 74.78% of females reported skin changes during pregnancy, with: 77.4% of them experiencing stretch marks, and 21.6% of them experiencing acne. Another study completed in 2016 with 600 pregnant females saw that 99% of those females experienced skin changes, and that the most common skin changes were hyperpigmentation (87.6%) and stretch marks (72.8%).
In addition to these common skin changes, pregnant females can also experience:
Vascular changes
Changes to the skin of the vulva and the vagina
Gingivitis
Facial and/or body growth
& more!
This is an ongoing series on skin health during pregnancy, and we have been focusing on the more-common skin changes in pregnancy. In this blog post you will learn more about:
What science has to say about why hyperpigmentation happens during pregnancy
What science has to say about skin support
If you want to read the first part of this series, click here to learn about stretch marks during pregnancy.
If you want to read last week’s post, click here to learn about acne during pregnancy.
NOTE: THIS BLOG POST IS MEANT TO BE EDUCATIONAL ONLY, AND IS NOT MEANT TO DIAGNOSE, PREVENT, TREAT, OR CURE. PEOPLE SHOULD ALWAYS CONSULT THEIR TRUSTED LICENSED PROVIDER BEFORE TRYING ANY NEW TREATMENTS
Hyperpigmentation during pregnancy
According to science, 90% of females experience pigmentation changes to their skin, such as hyperpigmentation, during pregnancy. Hyperpigmentation is defined by the NIH as a “common, usually harmless condition in which patches of skin are darker than the surrounding skin.” According to the American Academy of Family Physicians (AAFP), hyperpigmentation during pregnancy is more pronounced in females of darker skin complexion, and common areas of hyperpigmentation during pregnancy are the nipples, armpits, and genitals.
Linia nigra during pregnancy
A common hyperpigmentation condition that can occur during pregnancy is called linea nigra, which the AAFP describes as “the line that often forms when the abdominal linea alba darkens during pregnancy.”
Melasma during pregnancy
Melasma is another hyperpigmentation condition that has been associated very close to pregnancy, and has been called the “mask of pregnancy.” Science indicates that melasma can occur in 50-70% of pregnant females typically arising in the second trimester, and typically happens symmetrically on the face on the lips, cheeks, jawline, forehead, and more.
According to scientific literature, melasma can resolve on its own after 1 year of delivery, with recurrence occurring with future pregnancies. However, there are various factors that would make melasma more persistent, such as genetics, hormonal birth control, UV radiation, and more. And, with the relapsing/chronic nature of melasma, science indicates that those with melasma can affect quality of life and impact emotional wellbeing.
Pregnancy-associated melanoma (PAM)
Other than linia nigra and melasma, PAM can occur in pregnant females. According to the Australian Journal of General Practice, “Pregnancy-associated melanoma (PAM) has been defined as a diagnosis of melanoma made during pregnancy or in the first 12 months postpartum,” and authors continue to say, “Melanoma is the most common malignancy in pregnancy, accounting for one-third of pregnancy-associated malignancies in Australia.” With this, if someone is experiencing concerning pigmentation changes to their skin and/or are seeing changes in size and color of moles they had in the past, they should consult their doctor.
For the remainder of this blog, we will focus on melasma during pregnancy.
Melasma and hormones
We know that there is a connection between hormones and melasma since melasma happens more in those who are pregnant and those who are taking oral contraceptives. However, we are still yet to fully understand how hormones cause melasma. There is some interesting literature that helps us connect the dots, which suggest how hormones could cause melasma.
There is literature that shows that there is a higher number of estrogen and progesterone receptors in the skin with those who have melasma. And, there is literature that reveals that estrogen can activate melanin-producing cells (called melanocytes), which leads to darkening of the skin. So, it could be suggested that estrogen is a driving factor in melasma. But, what about progesterone? So, the jury is still out on understanding how hormones contribute to melasma!
Melasma and sunlight
Sunlight can cause melasma in different ways. First, we know that visible blue light in sunlight directly stimulates melanocytes. Literature tells us that visible blue light activates opsin-3 in melanocytes, which activates melanogenesis-associated transcription factors, tyrosinase, and dopachrome in those same cells. This then causes melanin production. However, tyrosinase and dopachrome can combine together to make a long-lasting protein complex in those same cells, which leads to long-lasting tyrosinase activity, and causing sustained melanin production and hyperpigmentation - leading to what we see in melasma.
Second, we also know that there are higher numbers of mast cells and increased skin dysfunction in the skin of those with melasma, which could explain another way sunlight could cause melasma. Chronic exposure to sunlight and UV radiation can activate mast cells to produce histamines and tryptase to contribute to the development of melasma.
Skin support during pregnancy
According to scientific literature, melasma can resolve on its own after 1 year of delivery, with recurrence occurring with future pregnancies. There are other factors that can worse melasma and play a role in the development of melasma outside of pregnancy, such as UV radiation/chronic sunlight exposure. So, looking at methods that address these aggravating factors may be of benefit for those experiencing melasma. And, it could be beneficial to use topical lightening or topical camouflaging agents for those experiencing meslasma. Although, it should be noted that topical treatments commonly used for melasma for those who are not pregnant may not be safe during pregnancy, and therefore it is worthwhile for pregnant individuals to speak to their providers before starting anything new!
NOTE: THIS BLOG POST IS MEANT TO BE EDUCATIONAL ONLY, AND IS NOT MEANT TO DIAGNOSE, PREVENT, TREAT, OR CURE. PEOPLE SHOULD ALWAYS CONSULT THEIR TRUSTED LICENSED PROVIDER BEFORE TRYING ANY NEW TREATMENTS
Addressing aggravating factors of melasma:
UV exposure/sunlight & sunscreen:
Photo-protective agents are meant to prevent exacerbation of melasma by sunlight by acting as a physical shield. In regards to sunscreen, there is evidence that shows that UV-visible light sunscreen with an SPF of at least 30, specifically iron oxide sunscreens, blocks visible blue light to prevent the effects of UV on melasma.
topical Lightening agents:
Azelaic acid:
Literature indicates that azelaic acid reduces the severity of melasma by blocking the tyrosinase enzyme. This skincare ingredient was mentioned in my last blog post about acne during pregnancy, and to echo what I said in that post, azelaic acid is “thought to be safe to use during pregnancy” by the American Academy of Dermatology. Azelaic acid is categorized as Pregnancy Category B, which means “No risk to human fetus despite possible animal risk; or no risk in animal studies and human studies not done.”
Glycolic acid:
Glycolic acid is an alpha-hydroxy acid that can be derived from sugarcane. Research indicates that glycolic acid can be helpful for melasma, and has been extensively used for melasma at varying concentrations for non-pregnant individuals. Glycolic acid works by inhibiting melanin production and disperses already-produced melanin on the skin to reduce the appearance of hyperpigmentation. Now, how safe is glycolic acid?
Like azelaic acid, glycolic acid is also categorized as Pregnancy Category B. Before trying glycolic acid, make sure to speak to your doctor to learn what is best for your personal skin goals and personal health and wellness.
Vitamin C:
Vitamin C, also known as ascorbic acid, is commonly found in skincare products touting that it is helpful for hyperpigmentation. But, what does science have to say about this?
Science indicates that topical vitamin C is effective for hyperpigmentation. A small study completed in 2020 revealed that the use of vitamin C with a 100% mineral tinted broad-spectrum protection SPF 45 sunscreen moisturizer during summer months led to a 33.7% improvement in hyperpigmentation. Now, how safe is ascorbic acid during pregnancy?
Vitamin C is categorized as Pregnancy Category A, which means “Controlled studies show no fetal risk.” Note: Certain vitamin C strengths could lead to skin irritation. With that, make sure to speak to your doctor before buying and trying a vitamin C skincare product to see what is worth your while.
Skincare actives to avoid during pregnancy:
There are some commonly-used topicals for hyperpigmentation and melasma that are usually used during pregnancy due to their pregnancy category. Some of those topicals are:
Hydroquinones:
Classified as a Pregnancy Category C, which means that is it “Risk cannot be ruled out; human studies have not been performed; animal studies may or may not show risk; potential benefits may justify potential risk.”
Retinoids:
Also classified as Pregnancy Category C.
Summary & Takeaways
According to science, 90% of pregnant females have been shown to experience pigmentation changes to their skin, such as hyperpigmentation. And, according to the American Academy of Family Physicians (AAFP), hyperpigmentation during pregnancy is more pronounced in females of darker skin complexion, and common areas of hyperpigmentation during pregnancy are the nipples, armpits, and genitals. Some hyperpigmentation conditions that take place during pregnancy that were covered in this blog are: Linia nigra, Melasma, and Pregnancy-associated melanoma.
In regards to melasma, scientific literature indicates that melasma can resolve on its own after 1 year of delivery, with recurrence occurring with future pregnancies. However, melasma can affect quality of life and impact emotional wellbeing, pushing some people to seek options to reduce the appearance of melasma. Managing melasma is 2-pronged, with using topical photo-protective agents and using topical lightning agents. Topical photo-protective agents involves the use of sunscreen and other sun-protective measures. And, in regards to topical lightning agents, there are various options that pregnant individuals can speak to their providers about, such as: Azelaic acid, glycolic acid, and vitamin C.
This is the last blog post of my 3-part series on skincare during pregnancy! Thank you so much for reading!
Click here to learn about stretch marks during pregnancy.
Click here to learn about acne during pregnancy.
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