Pigmentation in pregnancy

Pigmentation is thought to affect up to three-quarters of pregnant women.
Pigmentation is thought to affect up to three-quarters of pregnant women.  Photo: Getty Images

When I was pregnant, there were many changes that happened to my body for which I was not prepared. But one of the changes that left me feeling most self-conscious was the change that happened to my skin.

The pigmentation on my face, particularly under my eyes, became really noticeable towards the end of my pregnancy. When I look back at pictures now, it's all I can see. 

It's estimated that up to three-quarters of pregnant women develop these patches, also known as "the mask of pregnancy". In women with darker skin, the patches can be lighter than their usual tone.   

An example of the darker skin patches on a pregnant women.
An example of the darker skin patches on a pregnant women.  Photo: Getty Images

Jennifer Johnston can relate to my experience. "During my second trimester, I developed pigmentation on the right hand side of my face, right in the middle of the cheek."

Johnston says that as her pregnancy progressed, the pigmentation darkened.

"It was very noticeable how much darker it was in those 'celebrate your newborn baby' photos, but I wasn't too conscious of it at the time as I was too busy with other things."

It wasn't until later on that Johnston sought treatment for the pigmentation.

"I have had IPL [intense pulsed light laser] on it and it has faded a little," she explains. "I also use pigment lightening cosmetic products and apply loads of sunscreen."

Despite this, Johnston acknowledges that the pigmentation will likely never disappear.

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It's a similar situation for Laurey Sarkey.

"About half way thorough my pregnancy, pigmentation started to develop on my face, mainly on my upper lip, cheeks and forehead," she says.

"It got worse later in my pregnancy, and I was very self conscious about it and was always trying to cover it up."

Like Johnston, Sarkey says that even though the pigmentation on her face has faded, it is still visible. 

According to dermatologist Dr Michael Rich, pigmentation in pregnancy is linked to the rise in a woman's oestrogen levels. 

"Physiological increases in pigmentation occur in all pregnant ladies," he explains. "It is most apparent in a line down the centre of the abdomen, called linea nigra, around the nipples and areolae, and around the genitalia and perineum."

It also occurs in places that are affected by the sun - "on the face, typically on the cheeks and above the upper lips", as Dr Rich points out - because the body can respond to sunlight by making too much melanin, the tanning hormone that causes dark skin. 

More extreme cases are referred to as melasma - something Bec Derrington experienced in her third pregnancy.

"I had no form of pigmentation in my first two pregnancies, but in my third I had melasma, predominantly on my cheeks," she says.

Derrington says that despite using creams to try to fade it, the melasma is still present. She says she has to be diligent in shielding her face from the sun all year round.

So is there a way of preventing pigmentation during pregnancy?

"Because the changes are hormonal, there are not many preventative measures that can be taken," explains Dr Rich.

"Avoiding the sun and being vigilant with sunscreen application can help to minimise the effects."

For women who have delevloped melasma, strict sun avoidance is recommended.

Because the prominence of melasma can also increase with use of the oral contraceptive pill, Dr Rich recommends that woman look at non-hormonal methods of contraception or consider the progesterone-only pill, known as the mini pill.

Looking at to the longer term, Dr Rich says that while the darker patches will stick around for some women, it often starts to fade a few months after pregnancy.

Melasma, however, may remain.

"Referral to a specialist dermatology clinic can be helpful," says Dr Rich. "A variety of treatments are available, which range from topical bleaching agents that can be applied at home, to peels applied in the clinic."

"Laser treatments can also be beneficial, but care must be taken in selecting which laser treatments to use as any irritation of the skin can cause post inflammatory hyperpigmentation."