Areolar Hyperpigmentation During Pregnancy
Yes, pigmentation around the areola (areolar hyperpigmentation) does increase during pregnancy and is a well-recognized physiologic change that occurs in the majority of pregnant women.
Normal Physiologic Changes
Areolar hyperpigmentation is one of several benign pigmentary changes that commonly occur during pregnancy 1. This darkening of the areola represents a normal physiologic response to the hormonal changes of pregnancy, particularly elevated levels of estrogen, progesterone, and melanocyte-stimulating hormone (MSH) during the third trimester 2, 3.
Common Pregnancy-Related Pigmentary Changes Include:
- Darkening of the areola - occurs in the majority of pregnant women 1
- Secondary areola formation - additional pigmentation extending beyond the primary areola 1
- Linea nigra - vertical hyperpigmented line on the abdomen 4, 3
- Melasma (chloasma) - facial hyperpigmentation affecting 50-70% of pregnant women 2
- Pigmentary demarcation lines 1
Clinical Significance and Reassurance
It is critical to recognize that areolar hyperpigmentation during pregnancy is physiologic and benign, requiring only reassurance rather than intervention 1. This distinction is important because:
- The pigmentary changes are self-limited and typically resolve partially or completely postpartum, though resolution may take months 2, 3
- No medical treatment is required during pregnancy 4
- These changes should not be confused with pathologic conditions requiring biopsy or treatment 1
Important Clinical Caveat: Distinguishing Benign from Concerning Changes
While areolar hyperpigmentation itself is benign, any melanocytic nevus (mole) on the breast that changes in a manner concerning for malignancy should be evaluated identically to how it would be in a non-pregnant patient 5, 1.
Key Distinction:
- Nevi on the breast and abdomen may appear larger due to skin stretching - this is expected and benign 5
- However, evidence is lacking that melanocytic nevi actually darken or enlarge during pregnancy when not on areas subject to skin expansion 5, 1
- Any changing nevus that would raise concern in a non-pregnant patient should raise equal concern during pregnancy 1
Any changing or otherwise concerning melanocytic nevus in a pregnant woman (not as a result of stretching on the breasts or abdomen) should be evaluated clinically with dermoscopy, and if worrisome, subjected to biopsy using standard practice 5.
Hormonal Mechanism
The hyperpigmentation is attributed to hormonal stimulation of melanocytes in areas with greater melanocyte populations, such as the areola 6. Progesterone appears to play a particularly critical role, as postmenopausal women given progesterone develop melasma while those given only estrogen do not 2.
Postpartum Course
Most pregnancy-related hyperpigmentation, including areolar darkening, undergoes spontaneous partial or complete resolution after delivery, though this process may take several months 4, 2, 3. No specific treatment is required, and patients should be counseled about the expected benign course 4.