Most people with melasma have a history of daily or intermittent sun exposure, although heat is also suspected to be an underlying factor. The agents listed above rarely eradicate all of the melasma. 2011;57(6):665-667. Look for products that say fragrance-free, for sensitive skin, or non-comedogenic on the label. How much youre out in the sun or even the time of year when youre pregnant may also affect when you first notice it. This doesnt mean you have to stay indoors when the sun is out, though. These areas may get darker the more youre exposed to the sun or the further along you are in your pregnancy. To tell the difference between skin conditions, your healthcare provider may perform a biopsy, which is where a small piece of your skin is removed and examined. There are a few tricks you can try to minimize melasma, including the following: Exposure to the sun will make your pregnancy mask more pronounced. The second path to take is topical medications. Eat a variety of healthy, whole foods, drink plenty of water and get sufficient rest. Melasma (chloasma or mask of pregnancy) may be the most cosmetically troublesome skin condition associated with pregnancy ( Figure 2). Is there a history of melasma in your family? Wear abroad-spectrum sunscreen with an SPF of 30 or higher on your face all day, every day, even if youre not going outside, since harmful rays can come right through your windows. As mentioned, pregnancy melasma is a skin condition thats pervasive among pregnant people. Other agents that are being studied to improve melasma include: Dermatitis is a side effect of hydroquinone and tretinoin. Estrogen and progesterone, which are thought to trigger it, start building after 12 weeks and peak around 32 weeks. NIH. There are also some procedures including chemical peels, microdermabrasion, laser treatments, and other light therapies that may work. If your hyperpigmentation is accompanied by consistent itching, irritation or discomfort, its important to note that these are not symptoms of melasma. 2019 Jun;45(6):818-828. doi: 10.1097/DSS.0000000000001912. For more brightening oomph, they may recommend exfoliating treatments, such as microdermabrasion or chemical peels, which slough away dead skin cells to promote skin rejuvenation. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Thank you, {{form.email}}, for signing up. Unfortunately, there is no definitive treatment that will automatically make melasma disappear. A dermatologist will be able to perform treatments that your usual healthcare provider may not be able to. Originally coined in Latin, it loosely translates into black spot. While melasma doesnt actually cause black spots to appear on the skin, it does create brown or blue-gray discolorations that are grouped together to form larger patches. Learn more aboutour editorial and medical review policies. This common condition occurs in 50-70% of pregnant women. The association between melasma and iron profile: A case-control study. Many women notice their hair becomes thicker during pregnancy. Other possible causes of melasma include: Melasma causes light brown, dark brown, and/or bluish patches or freckle-like spots on your skin. These steps may prevent your melasma from getting worse. Birth control pills, pregnancy, and hormone therapy can all help trigger melasma. 2020;1(2):65-67. doi:10.5606/jebms.2020.75614. Skin care products that irritate your skin. This is because radiation from ultraviolet rays acts as a catalyst for melanin production. There are various lifestyle changes you can try to prevent the condition from progressing during pregnancy. Pregnancy melasma is a pretty straightforward skin condition. Learn more about this common pregnancy skin change that you may experience when you're expecting. Fluctuations in certain hormones can cause melasma, which is why it commonly occurs during pregnancy. There are three types of melasma and they have to do with the depth of the pigment. (Other hormonal alterations, such as birth control medication and hormonal replacement therapy can also trigger melasma in nonpregnant people.). Non-pregnancy related hormonal changes like oral contraceptives may also cause skin hyperpigmentation. Last reviewed by a Cleveland Clinic medical professional on 07/27/2020. Some people may feel embarrassed to allow others to see their skin condition. There are several topical, procedural, and oral therapies to manage melasma during pregnancy. It often presents as a darkening in skin color around the mid or upper forehead, lateral cheeks, and upper lip. Utilization of Laser Therapy During Pregnancy: A Systematic Review of the Maternal and Fetal Effects Reported From 1960 to 2017. So easy and delicious. Youre also at a higher risk for it if you a have darker skin tone. What makes breast cancer come back? Its caused by hormonal changes that take place during pregnancy, which affect the skins pigment-producing melanocytes. ), Visitation, mask requirements and COVID-19 information. You may notice your nipples/areolas, armpits, or genitals become darker. Undated. American College of Obstetricians and Gynecologists. Some of the topical options include hydroquinone, corticosteroids, and tretinoin. All rights reserved. Discover what they are here. What Are Some Ways To Help Cope With Pregnancy Melasma? Wear protective clothing and sunscreen as needed. Melasma appears most commonly on your cheeks, nose, chin, above the upper lip and the forehead. Melasma is harmless. Int J Womens Dermatol. Accessed 7/23/2020. However, there are skin cancers that may mimic melasma, so seeing your dermatologist is often recommended to confirm the correct diagnosis. Again, there are a variety of factors at play when it comes to darkening pigment. Laser is a great option, he shares. (Typically only 2 messages sent per month. Are you interested in prescriptions that may improve your melasma? How to Identify & Treat a Melasma Mustache, What to Know Before Getting Melasma Laser Treatment, Understanding Pityriasis Rosea vs. Guttate Psoriasis, Hyperpigmentation Around the Mouth: Everything to Know, Skin Discoloration: Causes and Treatments, Melasma: a clinical and epidemiological review, A review of laser and light therapy in melasma. Sometimes the patches can become red or inflamed. All rights reserved. There are preventative measures you can take. Fairer-skinned people are less likely to be affected by melasma than those with darker brown skin or those who tan well. How Many Types of Pregnancy Melasma Are There? Your skin is made up of three layers. In turn, the addition of vitamin C serum to skincare routines helps fight free radical damage, brightens the skin, and improves skin tone. BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. No. Slather up with gentle products instead. Basit H, Godse KV, Al Aboud, AM. Topical therapy using tyrosinase inhibitors prevents new pigment formations by stopping the formation of melanin (the dark color). . It depends on the person and the medication used. Melasma is usually flat. LED light from your television, laptop, cell phone and tablet. Although most skin-lightening ingredients are off-limits during pregnancy, talk to your doctor about whether you can apply topical azelaic acid to your skin for melasma. It doesn't affect your baby in any way or indicate any other pregnancy complications. Learn about special offers, current clinical research studies, and more. Beyond that, the dark patches on the face can be exacerbated by sun exposure, the use of certain skin care products or treatments, and even genetics. Can Melasma Be Prevented During Pregnancy? Pregnancy woes: 4 common skin issues Melasma, or chloasma, as it's called during pregnancy, appears mostly on the face, on sun-exposed areas like your cheeks, nose, upper lip and forehead, says Raymond. Call your provider if you have changes in skin pigmentation as well as pain, tenderness, redness, or bleeding, or if you notice any changes in the color, shape, or size of a mole. Some of the skin conditions you may notice, such as stretch marks and melasma (dark spots and patches), are caused by pregnancy, and will fade over the next few months. Hydroquinone is a prescription product to lighten skin or reduce skin pigmentation that occurs from melasma and chloasma, which can be brought on by pregnancy. These hormones are thought to contribute to your melasma. Even if its hot outside, loose-fitting clothing can be comfortable and protect your skin. When you are pregnant, your body shows several changes. It usually goes away after you give birth. When did see the discoloration in your skin? Your melasma is likely to go away when youre no longer pregnant. Melasma is also sometimes referred to as the mask of pregnancy because the splotches typically show up around your upper lip, nose, cheekbones, and forehead in the shape of a mask. Speak with your doctor about ways to treat your melasma during pregnancy. 2014;89:771-782. doi:10.1590/abd1806-4841.20143063. Fractional lasers are commonly used for treating melasma. Fortunately, chloasma generally fades within a few months after giving birth. However, it is not likely to go away while youre pregnant or taking hormone contraceptives. Learn more about. 2) Stopping the transfer of that pigment to the surface of the skin where it appears as dark spots. In addition, melasma can make skin that is already darker even more so. Melasma is especially common in darker-skinned women or those of Asian and African descent, who have more pigment in their skin than fair-skinned people. Head out early in the morning or later in the evening when the sun is low. What's more, skin that's already more pigmented such as your nipples, freckles, scars, and the skin of your genitals may become even darker during pregnancy. ClinicalTrials.gov. Bring up any additional symptoms you have with your doctor. Melasma. This frittata is high in protein and rich in essential nutrients your body needs to support a growing baby. Stretch marks are easier to prevent than erase. The worse it gets, the harder it will be for treatments to work. The best course of treatment may actually be prevention, with the help of a few lifestyle changes. StatPearls: Melasma. 2015;4:13240-13247. Harvard Medical School, Harvard Health Publishing. They can appear as flat patches or freckle-like spots. Melasma can sometimes be mistaken for another skin condition. Related: Your guide to pregnancy-safe skin care. From the What to Expect editorial team andHeidi Murkoff,author ofWhat to Expect When You're Expecting. In pregnant people, melasma often goes away on its own within a few months after giving birth. Theyre also commonly mistaken for freckles or age spots, however, those tend to be smaller. Hormones (including hormonal medications). Chemical peels address discoloration by exfoliating the top layers of skin, allowing newer and more evenly toned skin cells to rise to the surface. Treatment once you have finished breast- feeding can take the normal course, which normally begins with topical bleaching . Melasma is a very common skin disorder, especially among pregnant women. Epidermal melasma resides in the surface of the skin. Commonly occurring during pregnancy, melasma is sometimes referred to as chloasma, or the mask of pregnancy because dark patches on the face can resemble a mask. If it doesnt, pursue treatment options with your healthcare provider. 1997-2023 BabyCenter, LLC, a Ziff Davis company. Make sure youre staying hydrated, eating a diet with plenty of fresh fruits and vegetables, and getting enough sleep each night. While pregnancy is a primary cause of melasma, eating a well-balanced diet and getting plenty of sleep can prevent hormonal imbalances or vitamin deficiencies that arent pregnancy-related. Group Black's collective includes Essence, The Shade Room and Naturally Curly. Loosely translated, the word means black spot. If you have melasma youre probably experiencing light brown, dark brown and/or blue-gray patches on your skin. During pregnancy or while youre breastfeeding, you should also avoid at-home peels, bleaches or other chemical-based lightening treatments, since they can all potentially penetrate the skin. Melasma is common, normal and harmless, but it can be bothersome. They can be safely used with topical medications, but only by specialists who have experience treating melasma. Safety of skin care products during pregnancy, Utilization of Laser Therapy During Pregnancy: A Systematic Review of the Maternal and Fetal Effects Reported From 1960 to 2017, Sunscreen: How to Help Protect Your Skin from the Sun. If youre susceptible to pregnancy melasma, unprotected sun exposure can worsen it. ), (https://dermnetnz.org/topics/drug-induced-photosensitivity/), (https://www.aad.org/public/diseases/a-z/melasma-overview), (https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/appendix-12/), (https://www.ncbi.nlm.nih.gov/books/NBK279255/#:~:text=What%20does%20skin%20do%3F,as%20germs%20and%20toxic%20substances. Where are the discolorations located on your body? Results: The prevalence of melasma was 15.8%[95% confidence interval (CI) 12.3-19.4]. This skin disorder can affect your social life if youre feeling self-conscious about it. 6.4 EltaMD UV Clear SPF 46 Face Sunscreen. Our. During your pregnancy, avoid spending too much time in the sun. Skin color needs to be factored in when discussing skin diseases, aad.org/public/diseases/a-z/melasma-overview, acog.org/womens-health/faqs/skin-conditions-during-pregnancy. Melanin in the dermis within melanophages. Read our. Shipping, Melasma During Pregnancy: Causes, Prevention and Treatment, Non-pregnancy related hormonal imbalances. Melasma is a very common skin disorder, especially among pregnant women. Healthline Media does not provide medical advice, diagnosis, or treatment. Melasma can appear at any time during pregnancy, but it develops most often during the second or third trimester when certain hormone levels are increasing. If you're seeking a preventive, we've gathered a few of the best stretch mark creams for pregnancy. We believe you should always know the source of the information you're reading. Your belly gets larger and your blood volume increases as your baby grows. Since its unknown what causes melasma, aside from the things that trigger it, it can be difficult to prevent it. Examples of tyrosinase inhibitors and other types of helpful agents include: The combination of hydroquinone, tretinoin and a moderate topical steroid has had the best effect on melasma. They can appear anywhere on the body but are most common on the stomach, hips, breasts, and thighs. Melasma appears in six locations or a combination of locations on your skin: Your healthcare provider will decide for sure if you have melasma or another type of skin disorder. ), document.getElementById("ak_js_2").setAttribute("value",(new Date()).getTime()), document.getElementById("ak_js_3").setAttribute("value",(new Date()).getTime()), 2023 Westlake Dermatology & Cosmetic Surgery. Melasma is a skin condition characterized by brown or blue-gray patches or freckle-like spots. However, you can take certain precautions to lower your risk of developing it while pregnant or otherwise. What is known is that there is a genetic component in the development of melasma. Privacy Policy Read our, Why Does Melasma Develop During Pregnancy. In pregnancy, it's often referred to as chloasma, or the "mask of pregnancy.". She served as Chief Resident at one of the nations top dermatology programs The University of Texas at Houston and M.D. You might have your thyroid checked because there does seem to be an association between thyroid disease and melasma. The linea nigra will probably fade back to its pre-pregnancy color several months after you deliver your baby, but may not completely disappear. Another, less common name for melasma, is chloasma. The most important one is something you should be doing every day, year-round, anywaywearing a broad-spectrum sunscreen, and reapplying it every two hours or after swimming or sweating. Your skin color and type may make this condition more or less noticeable. Yes, but use cosmetics that include sunscreen and pay attention to any that may aggravate your melasma by irritating your skin. The same increased production of melanin that causes the facial splotches of melasma also causes the linea nigra, or dark line that you may notice running down your belly. The most effective way to treat pregnancy melasma is to see your dermatologist as soon as you start to see its hallmark patchwork appear. Get useful, helpful and relevant health + wellness information. It doesnt itch or hurt, and it doesnt become malignant. Her favorite pastimes include experimenting with new foods, libations, and restaurants, as well as traveling the world with her two college-age children, husband, extended family, and friends. The outer layer is the epidermis, the middle is the dermis, and the deepest layer is the subcutis. Careful sun protection is key. 2020;1(2):65-67. doi:10.5606/jebms.2020.75614. It sometimes affects your arms, neck and back. In fact, melasma can affect any part of your skin that is exposed to sunlight. Does pregnancy melanoma go away on its own? Cat is a linguistic alchemist and expert wordsmith who has written and edited for some of the world's biggest brands. However, a skin-friendly diet including adequate amounts of vitamin D is likely to help. Careful sun protection is key. You can help make your sun protection efforts even more effective if you wear protective clothing, such as long-sleeved shirts, pants, a hat, and sunglasses, and limit your time in the sun, especially between its peak hours between 10 a.m. and 2 p.m. Depending on the person, melasma may go away on its own, it may be permanent, or it may respond to treatment. 6.7 AOBBIY Hyperpigment Remover. However, it can make people self-conscious about their appearance. American Academy of Family Physicians. Use the treatment and management advice from your dermatologist or another healthcare provider. 2005-2023Everyday Health, Inc., a Ziff Davis company. Read on to learn about what causes melasma during pregnancy and how to treat it. Other home remedies may actually make melasma worse. A biopsy is quick, safe procedure routinely performed during a normal visit to your healthcare providers office. American Academy of Family Physicians. The heart has to work harder during pregnancy to pump blood to both the mother and the growing fetus. Therefore, wear sunscreen, even on cloudy days. Despite the fact that pregnancy melasma isnt a dangerous condition, it can do a number on your self-esteem and confidence. Signs of melasma during pregnancy Melasma occurs most often on the face as brown or grayish-brown patches that sometimes look blotchy. It fades slowly, so it could take a few months. Are darkened spots on skin during pregnancy ever a sign of illness? Can i use 2% hydro quinine during pregnancy for melasma. Your soap? our editorial and medical review policies, dark line down the center of your abdomen (the linea nigra), Skin Darkening and Discoloration During Pregnancy. Maternal adaptations to pregnancy: Skin, hair, nails, and mucous membranes https://www.uptodate.com/contents/the-skin-hair-nails-and-mucous-membranes-during-pregnancy [Accessed September 2020], UpToDate. Chloasma is a cosmetic concern. Your skin is your barricade. An increase in estrogen levels can worsen melasma. Melasma will likely fade within three months after youre no longer pregnant. Treatments include topical medications like: Your doctor may also recommend certain acids that lighten the skin, alone or in combination. Women are more likely to get melasma than men: about 10% of those who get melasma are men, 90% women. 5 Tips to Prevent Constipation During Pregnancy, How to Cope With Anxiety During Pregnancy, A Complete Guide to Pregnancy-Safe Skincare, Breastfeeding Safe SkincareWhat to Use and Avoid When Nursing Your Baby, The 11 Best Pregnancy-Safe Skincare Products Dermatologists Love. AAD. Most importantly, try and remind yourself that you likely notice and dwell on your pregnancy melasma more than anyone else, and that youre far from alone in experiencing it. Related: Skin color needs to be factored in when discussing skin diseases. (2020). Melasma is a skin condition that causes grayish-brown patches to appear, mostly on the face. Always listen to the advice of your healthcare provider and follow your treatment plan carefully. Lasers, which can be irritating especially during pregnancy, are no-nos too. For many people, pregnancy melasma can improve after youre no longer pregnantonce your hormonal levels return to their normal, pre-pregnant levels. 2 We avoid using tertiary references. A few alternative remedies, like turmeric and aloe vera, have shown at least some success at improving melasma. Although this disorder is completely harmless, it understandably makes some people feel self-conscious. If the skin changes are bothersome, consider another birth control option. This can be a trigger for melasma. Melasma is harmless, physically, but can have an emotional impact. There are three main methods of treatment for melasma: 1) Slowing down or stopping the creation of the pigment melanin. There are three types of melasma, categorized by how deep the darker pigment goes into the skin: During pregnancy, melasma usually appears on the face as patchy or spotted areas of skin that are tan, brown, or sometimes blue-gray. Coll Antropol. Women with darker complexions are more likely to have melasma than women with lighter skin. And make sure youre getting the right treatment by confirming the diagnosis with your healthcare provider. Melasma during pregnancy is very common. It may take several months for your hormones to balance and skin pigmentation to fade. Treatments for melasma include topical creams, chemical peels, as well as gentle skin resurfacing procedures. Melasma is hard to treat. What to Expect supports Group Black and its mission to increase greater diversity in media voices and media ownership. Use of this site is subject to our terms of use and privacy policy. Theyll use a Woods lamp (a black light) to see changes in the color of your skin. Yes. Verywell Health's content is for informational and educational purposes only. It protects your bones, muscles, organs and everything else from the cold, from germs, sunshine, moisture, toxic substances, injury and more. Then apply your foundation to the rest of your face, avoiding the patches. You may notice dark patches or splotches on your forehead, cheeks, chin, or around your mouth. It usually starts between 20 and 40 years of age. But, keep in mind, once you experience this patchwork discoloration, youre more susceptible to it recurring if you become pregnant again. There are dermatologists who can help you. (We know, weve felt that knee-jerk instinct at times, too.) They include medications, makeup, and cosmetics that irritate your skin or make it more sensitive to sunlight, the blue light emitted from your devices, and underlying thyroid disease. (2020). Chloasma may also be worsened by hormonal imbalances that may have been present even before pregnancy. Melasma is a skin condition in which some skin cells become darker. Anderson Cancer Center. Methods: A cross-sectional study was carried out by clinical examination and questionnaire on 400 pregnant women. You can also try other camouflaging makeup and skincare products, like concealers, full-coverage foundation, and skin-brightening products. They are generally tan or brownish in color, but can look blue-gray on people with naturally darker skin color. Yes, it's common to develop blotchy spots of darker skin when you're pregnant, a condition called melasma or chloasma. Bolanca I, Bolanca Z, Kuna K, Vukovi A, Tuckar N, Herman R, Grubisi G. Chloasmathe mask of pregnancy. It is very common in pregnant people and tends to appear during the second or third trimester. Bolanca I, et al. Malar pattern . Azelaic cream, lotion, or gel can sting. Melanin is what gives skin its color. You may experience cramping, morning sickness, and all sorts of unfamiliar aches and pains. We'll tell you the best pregnancy-safe sunscreens so you and your, When you're expecting, pregnancy-safe skin care can help ensure the health of you and your baby. The intensity of pregnancy melasma can fluctuate throughout the year, darkening in the summer and lightening up in the winter. It is common, harmless and some treatments may help. How can I prevent melasma from getting worse during pregnancy? You're also more likely to develop melasma if it runs in your family. What causes these skin changes during pregnancy? Yes, this also applies to tanning beds or any other environment where you would be exposed to UVA and UVB rays. Try the following home remedies to reduce the appearance of melasma after pregnancy; Mix a solution of half apple cider vinegar and half water to use as toner. Created for people with ongoing healthcare needs but benefits everyone. Milk, almond milk, and orange juice can help too. Between 1.5% and 33% of the population may get melasma and it happens more often during a woman's reproductive years, and rarely happens during puberty. Retinoid treatments and many chemical peels sometimes used to treat hyperpigmentation in facial treatments are a no-go when youre expecting. Pregnancy melasma, and melasma in general, fall into three categories based on how deep into the skin the dark spots are: epidermal, dermal, and mixed. Ask them questions and voice your concerns. When your skin heals from the treatment, it may cause even more discoloration. Treasure Island (FL): StatPearls Publishing; 2020. PMID: 30998530. Unmasking the Causes and Treatments of Melasma, Treatment of Melasma and the Use of Intense Pulsed Light: A Review, Topical Vitamin C and the Skin: Mechanisms of Action and Clinical Applications, A Review of Laser and Light Therapy in Melasma, New Changes in Pregnancy and Lactation Labelling: Review of Dermatologic Drugs, Melasma: An Up-to-Date Comprehensive Review, reviewed by our medical review board and team of experts. Dr. Arlo Miller answered Dermatology 17 years experience Avoid: I would not recommend it. Skin conditions during pregnancy. (This can occur whether or not you choose to breastfeed, because estrogen and progesterone are not the hormones involved in lactationthose would be prolactin and oxytocin.). 5 How to Prevent Melasma. Yes, its possible that your melasma will go away on its own within a few months. U.S. National Library of Medicine. National Institutes of Health, National Library of Medicine, National Center for Biotechnology Information. The most common type, mixed melasma, is exactly what it sounds likeits both brown and bluish in appearance, has a mixed pattern under black light, and is somewhat responsive to treatment. Melasma can occur at any point in a pregnancy, although it typically develops during the second or third trimester. Your healthcare provider may administer the test. You may be able to lighten your melasma using ingredients from your pantry. Accessed 7/23/20. 1. While pregnant, be careful to only use topical and oral treatments that are approved for pregnant women. Make-up labeled as non-comedogenic or hypoallergenic is less likely to irritate skin and worsen melasma. Face washes, lotions, and serums that irritate your skin may make melasma worse. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. Y. ou can also be sure to eat a healthy, skin-friendly diet that contains plenty of nutrients and vitamin D. Foods that fit the bill include eggs (only if theyre fully cooked), yogurt, meat (fully cooked), fish high in fatty acids (also fully cooked), and mushrooms. Ask your healthcare provider if youre concerned about another condition. But you may be able to avoid the factors listed above which make melasma worse. Experts think that increases in the levels of the hormones estrogen and progesterone during pregnancy may trigger melasma. What medications and/or vitamins can I take to help heal my melasma? You may see a line (linea nigra) extending from the pubic area over the belly, or darkening of the skin all over the body. It largely affects people who were assigned female at birtha whopping 90% of themduring their reproductive years, when theyre 20 to 40 years old. Between 1.5% and 33% of the population may get melasma and it happens more often during a womans reproductive years, and rarely happens during puberty. What Bodily Changes Can You Expect During Pregnancy? Pregnancy comes with a host of emotions and physical changes. Bonus: You can. Depending on the person, melasma may go away on its own, it may be permanent, or it may respond to treatment within a few months. At this time no medication can completely prevent melasma. Melasma. As youve likely already inferred from its alternate moniker, becoming pregnant puts you at a higher risk of developing pregnancy melasma. Even after melasma is treated and improved, I recommend use of a daily topical cream and oral antioxidants to maintain results long-term, advises Dr. Nazarian. Pain, itchiness, or soreness are not symptoms of melasma. Your healthcare provider might test your vitamin D levels to make sure that youre getting enough of it from high vitamin D foods such as meat, cereals, oily fish and eggs. In pregnant women, it most often appears on the: Forehead Cheeks Upper lip Nose Chin Other skin changes often occur with melasma during pregnancy, including: Darkened nipples, armpits, and genitals Otherwise, speak with your doctor about the options for treatment and the benefits and risks of each. It might be appropriate for you to use a different medication to avoid the side effects.

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