I Have Melasma, Thanks to Baby #2 (Here’s How I’m Trying to Combat it)

amywruble

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When I came back from my summer vacation in Hawaii, I thought everyone would notice my awesome tan. Instead, a worried girlfriend exclaimed, “What happened?  You’re all black and blue!”  I hadn’t realized, but my melasma—aka “The Mask of Pregnancy”-–had worsened due to sun exposure, and I was left with blotchy dark patches on both cheeks, like badly applied bronzer.  I had some dark patches of skin on my face during my first pregnancy, but they faded away soon after the birth. Now, 16 months after having my second baby, my skin is still patchy.

Melasma is a common skin condition affecting pregnant women that causes hyperpigmentation, or dark patches of skin. “Between 25 and 50 percent of pregnant women have some melasma, specifically on the face,” said Hadar Waldman, MD, an ob-gyn in private practice in Los Angeles.  Dark patches may appear on the cheeks, forehead, bridge of the nose or upper lip, giving the unfortunate appearance of a mustache. It’s more commonly seen when women are pregnant in their thirties and forties (me) and in sunny climates like California (me).  And contrary to what I would have guessed, women with darker complexions and dark hair are more prone to melasma. So now my roots aren’t the only thing telling the world I’m a fake blonde.

For some women, melasma is just a short term annoyance, like pregnancy heartburn or hemorrhoids.  “Hyperpigmentation usually regresses on its own for most women within one year after delivery,” said Dr. Waldman.  “However, in as many as 30 percent of affected women, it may persist for several years, sometimes requiring dermatological treatment.”  Me again!  So I spoke to some experts to investigate my options:

1. Apply sunscreen like it’s your job. Sun exposure can trigger and exacerbate melasma, says Parrish Sadeghi, MD, a dermatologist in Los Angeles. She recommends consistently using a chemical-free sunscreen with zinc oxide and titanium dioxide (a tinted formula can help mask that white filmy look you get with zinc).  Put it on at least 15 to 20 minutes before going outside and reapply every two hours (or more often if swimming). Adding a sun hat is even better. Although protecting my skin from the sun won’t reverse my melasma, it can help prevent it from getting worse. I’ve been following Dr. Sadeghi’s advice religiously and it helps a lot; I don’t get those intense black-and-blue spots, like I had after my vacation.

2. Camouflage it with some good concealer. Since I’m still breastfeeding, and can’t yet use medications for my melasma, my next stop was the makeup counter.  “It’s a quick fix,” said Nicole Orr, a beauty artist and boutique manager for Benefit Cosmetics. To cover the dark patches, which Orr compares to under eye circles, start with your foundation, then spot treat on top. To keep foundation natural and even, apply it with a brush, working from the T-zone and brushing outwards. (If you’re really not into foundation, a tinted moisturizer can do the trick.)  Then use a concealer to help tone down the melasma. Choose a soft blush color with a little glow (I love Benefit’s Rockateur) and brush it onto the apples of the cheeks. Bronzer should not be applied on top of the melasma patches (I tried that and I scared people), but it can be used strategically underneath the cheekbones. And voila, hot mama!

3. Slather on a lightening cream. Lingering melasma is a challenging skin condition, so OTC remedies likely won’t cut it.  A dermatologist can prescribe a prescription-strength lightening cream, such as 4 percent hydroquinone. Dr. Sadeghi says she often combines the lightening cream with two other topicals, a retinoid or kojic acid to remove the top layers of dead skin and allow for better penetration of the lightening agent, as well as cortisone to prevent irritation. This powerful triple cream (which costs around $100) can be used once a day for up to three months and usually shows results within a month or two. This sounded great to me, but unfortunately these medications are not considered safe during pregnancy or breastfeeding, and I’m still nursing. Once I’m cleared for treatment, I’m making a beeline to the dermatologist.

4. Zap it with laser treatments.  They can help break down the pigmentation, says Dr. Sadeghi, who noted that Fraxel or Clear and Brilliant are two lasers that work well on melasma. Lasers tend to be most effective on fairer skinned women. The caveat: This route isn’t cheap. It ranges from $350 to $900 per treatment, and needs to be done three to five times for best results. Although lasers may be safe during pregnancy, the numbing cream used prior to treatment typically isn’t, and you’re definitely going to want to be numb, so this is another treatment that has to wait until the baby is born and you’re done breastfeeding. It takes four to five days to recover from treatments, during which time your skin will appear red and flaky.

5. Go the chemical peel route. For darker skinned women, a chemical peel may be more effective than a laser, says Dr. Sadeghi. “The best peel out there is Cosmelan Peel, which has some hydroquinone in it.” It’s worn for 8 to 10 hours straight and costs about $850. The recovery time of four to five days is similar to laser treatments, but can be more intense, like a bad sunburn with “sheets of skin coming off,” in Dr. Sadeghi’s words, which some people find unpleasant. As with any of the treatments, you must be vigilant about protecting your skin from the sun, or your melasma will flare up again. And yes, it needs to wait until you’re no longer pregnant or breastfeeding.

My short-term plan is to be best friends with sunscreen and try to find five minutes in the morning for makeup — it really made such a difference in how I looked and felt. When I’ve finished breastfeeding, I’m going to start with the lightening cream because it seems easy and not horribly expensive. But if that doesn’t work, my olive skin likely makes me a better candidate for peels than lasers. Sounds a little gross, but it might just work. Maybe I’ll time my treatment around Halloween.

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Photo: Amy Wruble