From the Guidelines
For pregnant women with melasma, the primary recommendation is to focus on prevention and gentle treatments, prioritizing strict sun protection and avoiding direct sun exposure, especially between 10 AM and 4 PM, as many standard melasma medications are contraindicated during pregnancy. The most important preventive measure is daily application of a broad-spectrum SPF 30-50 sunscreen (preferably mineral-based with zinc oxide or titanium dioxide), wearing wide-brimmed hats, and avoiding direct sun exposure. Safe treatment options during pregnancy include topical azelaic acid (15-20%), which can help reduce pigmentation, and vitamin C serums, which have antioxidant properties 1.
Some studies have explored the use of platelet-rich plasma (PRP) and tranexamic acid (TXA) for the treatment of melasma, showing that both can be effective in improving melasma in terms of mMasi scores, with PRP revealing higher efficacy in some cases 1. However, these treatments are not typically recommended during pregnancy due to limited data on their safety in this population. After pregnancy and breastfeeding, more aggressive treatments like hydroquinone, retinoids, or chemical peels may be considered. Melasma often improves after pregnancy as hormone levels normalize, though it may not completely resolve. The condition occurs because pregnancy hormones (estrogen and progesterone) stimulate melanocytes to produce more melanin, particularly when exposed to UV radiation, which explains why sun protection is so crucial for management.
Key considerations for managing melasma during pregnancy include:
- Strict sun protection
- Gentle treatments that are safe for use during pregnancy
- Avoidance of standard melasma medications that are contraindicated during pregnancy
- Consideration of alternative treatments after pregnancy and breastfeeding
- Monitoring of the condition as hormone levels normalize after pregnancy. It's also worth noting that while some studies have investigated the use of autologous platelet concentrates in aesthetic medicine, including for melasma, the current evidence does not support their routine use during pregnancy due to safety concerns and the lack of high-quality data on their efficacy in this context 1.
From the Research
Melasma in Pregnancy
- Melasma is a benign but emotionally distressing skin condition that reduces patients' quality of life, with prevalence rates during pregnancy ranging from 36.4% to 75% 2.
- The condition can persist after delivery, with up to 30% of cases reported to persist even ten years later, and recurrence and aggravation are common in subsequent pregnancies 2.
- The etiology of melasma is still unknown, although there are several triggering factors related to its onset, including sun-exposure, genetic factors, hormonal activity, stress, and some cosmetic products and drugs containing phototoxic agents 3.
Risk Factors and Prevention
- Photoprotection, including the use of sunscreens from the first trimester, plays a critical role in reducing the incidence of melasma 2.
- Discontinuation of the use of birth control pills, scented cosmetic products, and phototoxic drugs coupled with UV protection are also beneficial in clearing of melasma 3.
- Sun-exposure and genetic factors are important risk factors for melasma in both sexes, while hormonal activity has a more important role in females 3.
Treatment Options
- Triple combination cream (hydroquinone, tretinoin, and corticosteroid) remains the most effective treatment for melasma, as well as hydroquinone alone 4.
- Chemical peels, particularly glycolic acid, are safe and effective in the management of melasma 5.
- Oral tranexamic acid is a promising new treatment for moderate and severe recurrent melasma 4.
- Topical agents such as hydroquinone, kojic acid, and azelaic acid receive grade A recommendation for the treatment of melasma 6.