The Mask of Pregnancy- What is Chloasma?

The Mask of Pregnancy- What is Chloasma?

Did anyone ever tell you about the mask of pregnancy? It is actually a skin condition stimulated by hormonal changes and is predominantly seen on your forehead, nose, lips, and cheekbones. 

Many pregnant women develop blotchy spots on their face- a disease known as melasma or chloasma. During pregnancy, the abnormal hormonal changes lead to an excess production of melanin, leading to hyperpigmentation. 

It is extremely common for pregnant women, or women on birth control pills and getting hormone therapy. Yet, it can be extremely embarrassing or frustrating for several women to develop chloasma.  

The most common therapy for chloasma involves a combination of topical agents. However, using them for a long period of time may lead to side effects such as skin irritation and depigmentation. 

Keep reading to know about this disease and different ways to manage it. 

What is Chloasma? 

The term “chloasma” is used to indicate the occurrence of melasma during pregnancy. The word melasma has been derived from a Greek word “melas” which means black. It is a skin disorder in which brown, tan, or blue-gray patches appear on your face. 

Studies have shown that the prevalence of this skin condition in the general population is around 1 percent. On the other hand,9 to 50 percent of the population is at a great risk of developing it. 

Research has also indicated that chloasma can occur in about 50 to 70 percent of the pregnant women. However, the exact reason why pregnancy affects the rate of melanin synthesis in your skin is not known yet.  

In certain cases, the chloasma lesions tend to disappear a year following the pregnancy. In other cases, these lesions are reduced due to the reduction in other types of hormonal stimuli, such the use of birth control pills. 

However, in persistent forms of chloasma, the symptoms stick around, even a year after the removal of the causative hormonal stimulus. This is usually due to an increased exposure to UV rays. 

The Mask of Pregnancy- What is Chloasma?

What are the Signs and Symptoms? 

The symptoms of chloasma generally include: 

  • Symmetric, hyperpigmented lesions with serrated or irregular borders 
  • Lesions ranging in color from light brown to dark black-brown shade 
  • Lesions developing on the face, especially covering the cheeks, forehead, chin, and upper lips 

The lesions associated with chloasma may occur in any one of the following facial patterns: 

  • CentrofacialThis pattern tends to occur in 50 to 80 percent of the cases and primarily affects the upper lips, forehead, and nose areas 
  • Malar:  This facial pattern includes lesions restricted to the malar cheeks i.e. the area covering the bridge of your nose and cheeks 
  • Mandibular: A pattern that is present on your chin and jawline 

A newer pattern of chloasma has been discovered which is now termed as extra-facial melasma. This mainly develops on various non-facial body parts such as the neck, forearms, sternum, and upper extremities.  

Causes and Risk Factors of Chloasma 

There are a number of factors known to trigger melasma, the female hormonal activity being on the top of all. This is why the frequency of chloasma occurring in females who are pregnancy, undergoing estrogen replacement therapy, or are taking birth control pills is extremely high.  

The problem also occurs in males undergoing estrogen treatment to cure prostate cancer. 

Researchers suggest that the occurrence of estrogen receptors on the melanocytes, the melanin-forming cells found on your skin, may trigger the cells to synthesize more melanin. This eventually causes dark patches to appear on the skin.  

RELATED: Understand Pregnancy week by week

Another important factor causing the development of chloasma is an exposure to the ultraviolet rays coming from the sun or any other source for a long time. 

Mentioned below are some of the facts related to the risk factors of melasma or chloasma: 

  • Melasma tends to be much more common in women in their reproductive years.  
  • About 10 percent of the melasma cases tend to occur in men 
  • The average age for the onset of melasma is somewhere between 20 to 30 years 
  • Chloasma may affect a pregnant woman belonging to any race. However, it is most commonly seen in women with darker skin type as compared to those with a lighter one. 
  • Melasma is much more common in people having a Hispanic or Asian origin 
  • Having a family history of chloasma may increase your risk of developing this condition 

How do you Treat Chloasma? 

A lot of topical medications are available to treat different stages of melasma. Some of these medicines include: 

  • Hydroquinone: This is one of the most commonly prescribed topical treatment for melasma. It works by lightening the dark patches on your skin. The use of hydroquinone for a longer duration of time may, however, lead to adverse side effects such as depigmentation (lightening of the skin) or exogenous ochronosis (blue-black pigmentation of the skin). 
  • Azelaic Acid: This medicine is often recommended in place of hydroquinone to treat skin pigmentation. 
  • Kojic Acid: Kojic acid is an agent made from various forms of fungi. It is often used in different cosmetic products intended to lighten the skin tone. Using kojic acid may cause contact dermatitis in some people. For others, it can increase the susceptibility to sunburn. 
  • Retinoids: Retinoids such as tretinoin are frequently used as a part of photoaging therapy to reverse skin aging. However, some patients develop irritant reactions while using it, such as dermatitis or burning and scaling of the skin.
  • Topical Steroids: Topical corticosteroids are usually used in conventional medicine to treat a number of skin disorders, particularly due to their anti-inflammatory effects. Sometimes, they are prescribed together with hydroquinone to decrease the production of melanin. 
  • Glycolic acid: Glycolic acid is used in different chemical or depigmentation peels. It is actually a powder made up of crystals and is commonly added to various cosmetic products as an exfoliating agent. The Mask of Pregnancy- What is Chloasma?
  • MequinolMequinol is often prescribed in combination with a topical retinoid such as tretinoin for skin depigmentation. However, it must not be used during pregnancy as it may lead to birth defects in the fetus. 
  • Arbutin: Arbutin is a drug extracted from the bearberry plant. It is used to prevent the synthesis of melanin and is often a part of various skin-lightening agents. However, its mechanism of action for skin care has not been studied completely yet. 

Most of the dermatologists recommend combination therapy to manage any case of melasma/chloasma. The most commonly prescribed combination therapy included hydroquinone, retinoic acid, and a topical steroid.  

In addition to the topical agents mentioned above, other types of conventional treatments used for chloasma include laser therapy, chemical peels, or intense pulse light sources. Such types of treatments are usually not considered as a safe option during pregnancy and must be avoided by all pregnant ladies. 

Precautions 

In some cases, the treatment for chloasma needs to be put on hold until after the delivery. This is mainly because of the reason that most of the treatments meant for chloasma are not considered safe during pregnancy. Another reason is that in many cases, chloasma disappears on its own as soon as the hormonal triggers are removed. 

You can always rely on home remedies to get rid of this problem. If you consider this option, it is best to talk to your OB-GYN first. 

 

 

Nancy holds a Pharmacy degree from University of Michigan and Masters of Science MS in Infectious Disease and Global Health (MS-IDGH) from Tufts University. She worked as a lecturer for three years before she turned towards medical writing. Her area of interest are infectious diseases; causes, mechanism, diagnosis, treatments and prevention strategies. Most of her writings ensure an easy understanding of uncommon diseases.

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