7 Natural Tips to Help Treat "Pregnancy Mask" Chloasma
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7 Natural Tips to Help Treat "Pregnancy Mask" Chloasma

Dr. Josh Axe — Food is Medicine
Sep 7, 2018

Run these natural tips to help treat chloasma by your OB-GYN or midwife before starting anything new.


Have you ever heard of the mask of pregnancy? It refers to a skin condition that’s triggered by hormonal changes and develops around your forehead, lips, nose and cheekbones. It’s actually common for pregnant women to develop dark, blotchy spots on their face — a condition known as chloasma or melasma. Changing hormone levels stimulate an excess production of melanin, which leads to hyperpigmentation.

Even though chloasma is pretty common among pregnant women, or women taking birth control pills and receiving hormone therapy, it can still be frustrating and embarrassing.

Although the most common form of therapy for chloasma is a combination of topical agents, prolonged use of these agents can lead to side effects like depigmentation and skin irritation. Thankfully, there are some safer alternatives that are out there. Whether it’s focusing on eating nutrient-rich foods that are already part of a healthy pregnancy diet, or using natural skin care remedies, when it comes to improving symptoms of chloasma, you don’t necessarily have to wait until after delivery.

What Is Chloasma? 

The term chloasma is used to describe the occurrence of melasma during pregnancy. Melasma, which comes from the Greek word “melas,” meaning black, is a skin condition that causes brown, blue-gray or tan patches on the face. Studies have estimated that the prevalence of melasma in the general population is about 1 percent and 9–50 percent in the higher-risk population. (1)

Research shows that chloasma can affect 50–70 percent of pregnant women, but the exact reason why pregnancy affects the production of melanin pigments in the skin is unknown. (2)

In some cases, chloasma lesions disappear within a year after pregnancy or other types of hormonal stimulus, like taking birth control pills. But in persistent types of chloasma, the symptoms are still present one year after the hormonal stimulus is removed and it’s caused by exposure to UV rays.

Signs & Symptoms

Chloasma symptoms generally include:

  • Symmetric, hyperpigmented lesions that have irregular and serrated borders
  • Lesions that range in color from light brown to dark brownish-black
  • Lesions that develop on the face, especially the forehead, cheeks, upper lips and chin

The condition can occur in the following three facial patterns: (3)

  • Centrofacial: Occurs in 50–80 percent of cases and affects the forehead, nose and upper lip
  • Malar: A facial pattern that’s restricted to the malar cheeks, which includes your cheeks and bridge of the nose
  • Mandibular: A pattern that’s present on your jawline and chin

There’s also a newer pattern of melasma that’s called extra-facial melasma, which can develop on non-facial body parts like the neck, sternum, forearms and upper extremities.

Chloasma Causes & Risk Factors  

There are multiple factors that are known to cause melasma, including female hormonal activity. This is why there’s an increased frequency of chloasma occurrence in pregnancy and among women who are taking birth control pills, or undergoing estrogen replacement therapy. It can also occur in men undergoing estrogen treatment for prostate cancer.

Researchers believe that the presence of estrogen receptors on the melanocytes, which are melanin-forming cells in the skin, may stimulate the cells to produce more melanin, causing the dark patches to develop.

One of the most important factors in the cause and development of chloasma is prolonged exposure to ultraviolet rays from sunlight or other sources.

Here are some facts about the risk factors associated with melasma/chloasma: (4)

  • Melasma is much more common in women during their reproductive years, but it does occur in men, who make up about 10 percent of melasma cases.
  • The average age of onset for melasma ranges between 20 and 30 years.
  • Chloasma can affect pregnant women of any race, but it’s much more common among women with darker skin types than in those with lighter skin.
  • Having a familial history of chloasma may increase your risk of developing the condition.
  • Chloasma is most common in people of Asian and Hispanic origins.

Conventional Treatment

There are many topical medications that are used to treat the various stages of melasma, including the following:

  • Hydroquinone: This is the most commonly prescribed topical agent. It’s used to lighten dark patches on the skin. Long-term use of hydroquinone can lead to adverse side effects, including depigmentation (lightening of the skin) and blue-black pigmentation (called exogenous ochronosis).
  • Azelaic acid: This is often recommended as an alternative to hydroquinone for the treatment of skin pigmentation.
  • Kojic acid: Kojic acid, which is actually made from different types of fungi, is used in cosmetic products as a skin-lightening agent. For some people, it can lead to contact dermatitis and make your skin more susceptible to sunburn.
  • Retinoids: Retinoids like tretinoin are commonly used in photoaging therapy and to reverse skin aging. However, some patients experience irritant reactions when using retinoids, including burning, scaling and dermatitis. (5)
  • Topical steroids: Topical corticosteroids are commonly used in conventional medicine for a variety of skin conditions because of their anti-inflammatory properties. They are sometimes used in combination with hydroquinone to suppress melanin production. (6)
  • Glycolic acid: Glycolic acid is often used in chemical peels or dipigmentation peels. It is a powder made of crystals, so it’s commonly added to cosmetic products as an exfoliating agent.
  • Mequinol: Mequinol is often used in combination with a topical retinoid called tretinoin for skin depigmentation. But mequinol should not be used by women who are pregnant because it may cause birth defects.
  • Arbutin: Arbutin, which is extracted from the bearberry plant, is used to prevent the formation of melanin and is commonly added to skin-lightening products. However, there’s not enough evidence to fully understand the mechanisms of arbutin for skin care. (7)

Combination therapy is preferred among dermatologists, with the most common combination being hydroquinone, a topical steroid and retinoic acid, according to research published in the Indian Journal of Dermatology. (8)

Aside from topical agents, some other conventional treatments for chloasma include chemical peels, laser therapy or intense pulse light sources. These types of treatments are not considered safe during pregnancy and should be avoided by women with chloasma. (9)

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