Pregnancy Melasma: How to Treat the "Pregnancy Mask"

Somewhere around your second trimester, you may catch your reflection and notice a blotchy, brownish patch spreading across your cheeks, forehead, or upper lip—almost like a shadow that won't wash off. Welcome to melasma (dramatically nick-named the"mask of pregnancy"). It's one of the most common skin changes of pregnancy, showing up in up to 75% of pregnant people, yet most people have never heard of it until it lands on their own face. While it’s no fun dealing with skin issues (especially when your arsenal of allowable treatments is so limited), pregnancy melasma harmless, and there are ways to manage it safely while expecting.

What is pregnancy melasma?

Melasma is a patch of hyperpigmentation—skin that's darker than the tone surrounding it—that tends to show up symmetrically across the centrofacial areas (cheeks, forehead, nose bridge, chin, and above the upper lip). The patches themselves are flat, painless, and not itchy. They're also not a sign of any underlying skin disease! Melasma is not cancerous and won't turn into skin cancer. It's purely a pigmentation issue. Certain cells in your skin, called melanocytes, are simply producing extra melanin (the pigment that gives skin, hair, and eyes their color).

What causes melasma during pregnancy?

Melasma is what dermatologists call multifactorial, meaning several things are working together to cause it. During pregnancy, the two biggest drivers are hormones and sunlight. Rising levels of estrogen and progesterone appear to make melanocytes more responsive to ultraviolet (UV) and even visible light, so skin that's exposed to the sun darkens more easily and more unevenly than it would otherwise.

Genetics also play a role. Melasma tends to run in families and is especially common in people with medium-to-deep skin tones, because their melanocytes are already more active. That's on top of the hormonal shift of pregnancy itself, which is why so many people develop melasma even without a family history.

Who's most likely to get melasma during pregnancy?

While melasma can happen to anyone, a few factors raise the odds: darker or olive skin tones, a parent or sibling who's had melasma, plenty of unprotected sun exposure, and a history of dark patches while on hormonal birth control.

Is melasma dangerous—or will it just go away?

Melasma is entirely benign, and for most people, it's temporary. Encouragingly, it resolves on its own after delivery in about 90% of cases, typically fading over the months as hormone levels return to their pre-pregnancy baseline. That said, it can be stubborn! It may take several months postpartum to fully disappear, and it's known to resurface with future pregnancies or with hormonal birth control.

How to Safely Treat Melasma During Pregnancy

The tricky part about pregnancy melasma is that many of the most effective treatments dermatologists reach for outside of pregnancy—like hydroquinone, tretinoin, and oral tranexamic acid—aren't recommended while you're expecting. Here's what's considered safe, and what to hold off on.

Make sunscreen non-negotiable.

Since UV and visible light are melasma's biggest triggers, daily sun protection is arguably the single most useful thing you can do. Look for a mineral (aka physical) sunscreen with zinc oxide or titanium dioxide, since these ingredients sit on top of skin rather than absorbing into it. Mineral sunscreens aren't absorbed through the skin and may be the more reassuring choice, since some chemical sunscreen ingredients are absorbed into the bloodstream in small amounts and haven't been well studied in pregnancy.

For extra credit, look for a tinted sunscreen containing iron oxides. Dermatology researchers have found that visible light, not just UV rays, can worsen melasma, and iron oxides help filter that visible light in a way that plain sunscreen doesn't. Reapply every two hours you're outdoors and pair it with a wide-brimmed hat.

Try azelaic acid.

Azelaic acid is one of the few pigment-fading ingredients considered safe to use during pregnancy, and it's a go-to for pregnancy acne (a true skin win-win!). It works by calming the enzyme that produces excess melanin. Expect a gradual improvement over weeks, not overnight results.

Skip certain ingredients for now.

A few melasma treatments are best set aside until after pregnancy and breastfeeding:

• Hydroquinone, the most commonly prescribed skin-lightening cream, hasn't been well studied in pregnant people, so it's typically avoided as a precaution.
• Tretinoin and other topical retinoids are generally recommended against during pregnancy. While only a small amount is absorbed through the skin, tretinoin is chemically related to oral isotretinoin, a medication known to cause birth defects, so the more cautious approach is to avoid it until after delivery.
• Oral tranexamic acid, an increasingly popular option for stubborn melasma, is specifically flagged against in anyone who is currently or might soon be pregnant, due to its effect on blood clotting.

Rethink a few daily habits.

Small, everyday tweaks may help, too! Swap scented or irritating soaps and skincare products for gentler, fragrance-free ones, since irritated skin tends to darken faster, and go easy on hair removal methods like waxing over affected areas, since the inflammation can trigger more pigment.

When to See a Dermatologist About Melasma

Because melasma is a clinical diagnosis, it's worth a quick check-in with a dermatologist or your prenatal care provider, especially if the patches are widespread, unusually dark, or you're not sure whether what you're seeing is melasma versus another skin condition. They can also help you build a plan for after you deliver (or finish breastfeeding), when the full toolkit of treatments is back on the table.

The Bottom Line

Melasma is common, harmless, and—for most folks—temporary. While pregnant, your best strategy is rigorous daily sun protection paired with pregnancy-safe brighteners like azelaic acid, while saving the stronger treatments for after delivery. If the patches bother you, a dermatologist can help you find relief now and build a longer-term plan for later.

More Pregnancy Tips:

• Pregnancy Skincare: What Ingredients Are Safe for Pregnancy?
• Linea Nigra During Pregnancy: What You Need to Know
• Can I Get a Gel Manicure While Pregnant?
• Hair Care During Pregnancy: Safety Dos and Don’ts

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• Common Skin Conditions During Pregnancy, American Family Physician, Feb 2023
• Cleveland Clinic: Melasma—Treatment, Causes & Prevention
• National Library of Medicine, National Center for Biotechnology Information: Melasma
• The Organization of Teratology Information Specialists MotherToBaby: Screening Your Sunscreen During Pregnancy
• The Organization of Teratology Information Specialists MotherToBaby: Topical Tretinoin

Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.