Combating Skin Pigmentation During Pregnancy

By Dr Sachin Dhawan, MD, D.V.D, Consultant Dermatology, Fortis Memorial research Institute, Gurgaon

Pregnancy is a tumultuous time for the expecting mother, both mentally and physically. During this upheaval of hormones and growth factors, most people expect the pregnant women’s skin to ‘glow’ as per the accounts of the elderly. This is also true in most cases due to a surge in the female hormones , the skin becomes more supple, shiny and stretched , in part also due to the face appearing fuller due to initial weight gain.

However a significant number of women also experience significant pigmentary alteration, mostly hyper pigmentation, i.e.darkening of skin. This is of mainly four varieties:
1. Melasma gravidarum/ Chloasma ( mask of pregnancy).
2. Pinpoint pigmentary changes like freckles and Dermatosis Papulosis Nigra.
3. Acanthosis Nigricans or darkening of skin folds like neck, underarms and the pubic area.
4. Linea Nigra or appearance of a dark line from navel to the pubic area.

These happen due to an increase in Melanocyte Stimulating Hormone (MSH) and Blood Insulin levels. Some of them are fully or partially reversible like the Linea Nigra and even the darkening of folds, but some like melasma , freckles etc rarely go away fully even after the baby is born.

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Before we look at solutions, let’s look at the causes and possible preventive measures especially for facial pigmentation/ Melasma .
1. Genetics: If your mother or siblings have had pigmentary changes during their pregnancies, then you are also a likely candidate.
2. Sensitive skin: If your skin gets red easily with heat/ sun exposure/ kitchen work and facial treatments, you have to take extra care with these triggers as prolonged redness can trigger pigmentation.
3. Sun exposure: if your profession / routine demands spending time in the sun, you need to take extra care with physical sun protection methods like hats, scarves, umbrellas besides a broad spectrum sunscreen.
4. Computer exposure / halogen lamps: If you spend more than 30 minutes in a day on the computer, you need a broad spectrum sunscreen to cut down the visible light and UV light esp UVC the the screens produce. Large Smartphone screens also will do the same to some degree.
5. Excess weight / lack of moderate exercise/ intake of sugary food and high glycemic index food: some women think that the more weight they put on during pregnancy, the healthier it is for the baby. The above mentioned foods can increase insulin hormone , which triggers the growth of skin cells leading to skin darkening in the folds and small pinpoint elevated pigmented patches (Dermatoses Papulosis Nigra).  Indeed it is important to eat healthy, but one should also lay emphasis on a balanced diet.
6. Strong chemicals/ perfumed products like make up, creams, scrubs, and bleaches etc.In fact sometimes even natural products like lemon juice can be strong enough for some people’s skin and can trigger pigmentation.
7. Cosmetic procedures like strong chemical peels and medicated lightening creams containing retinoic acid, hydroquinone can cause subclinical skin sensitivity which along with sun exposure can lead to darkening, and as such should be avoided during pregnancy.
8. Stress: stress produces stress hormone cortisol and initiates a cascade of changes both psychological and chemical that can cause pigmentation.
9. Medication: sometimes in unstable pregnancy progesterones and other hormones are given which can aid pigmentary changes.

Best way to minimise chances of getting pigmentation and reducing its impact once you get it are:
1. Diet: make sure you eat antioxidant laden foods which in order of quality of antioxidants are
Pomegranates
Black grapes
Green tea
Strawberries and other berries
Papaya, pineapples etc.
Antioxidants help to fight the oxygen free radicals that cause microscopic skin inflammation caused by stress and pollution which makes the skin susceptible to pigmentation.
2. Sun protection:
UVB light causes sunburns and the protection is measured by the Sun Protection Factor (SPF) of a sunscreen . An SPF of 30 is adequate sufficient for indian skin types (Type 4-6) as it cuts down 99% of UVB light.   But applying the sunscreen in adequate quantity (e.g. 5 ml on face, 10 ml on arms) and the frequency of application (once in four hours on a normal day, once in 1-2 hours if you on on the beach) are important factors determining the effectiveness of your sunscreen.
What is more important for Indian skin type is the UVA protection that is measured in PA +/++/+++/++++. Choose at least PA+++ for adequate protection against UVA radiation as this is what causes pigmentation/ tanning to happen.
Also visible light from tube lights, CFL lamps and computer screens need to be protected against by using a physical sunscreen containing Zinc Oxide or Titanium Dioxide. In this regard, the humble tungsten lamp bulb which is now almost obsolete and out of fashion, produces the least UV light.
Use of broad rimmed hats, scarves and umbrella is most important especially because most people do not use sunscreens in the right way.
3. Yoga / meditation:
It is the best way to calm the mind and gently work on the hormones
4. Avoid scrubs / chemicals / hair colours/ strong cosmetics and make up products.
5.  Use only gentle skin lightening agents like azelic acid , kojic acid and tetrahydrocurcumin ( turmeric extract) , strictly avoiding hydroquinone and tretinoin as these stronger medicines can spread the pigment by making the skin more sensitive. Meeting a dermatologist as soon as one sees pigmentation developing is a must.
6.  Gentle home remedies can be tried provided that you have no allergies to the home products. Some of the more Useful   Therapies are as follows:
Aloe Gel:  Apply it on the affected area for 15 – 20 minutes and then wash it off using warm water. Repeat the on daily basis.
Cucumber Juice: Cucumber juice mixed with milk when applied on pigmented skin gives great results. It can be applied to any skin type and also gives you a soothing affect
Almonds and Honey: Mix some almonds and honey and make a fine paste. Apply it on skin and wash it after 15-20 minutes.
Vitamin E: is very essential for skin. You can massage affected area using Vitamin E based oil.
Papaya: is very beneficial for skin. Prepare a pack with 2tbsp Papaya, 1 tbsp honey and 1tbsp aloe pulp. Apply it on pigmented skin and wash off after 30 minutes. Papaya helps to break down the dead cells and treat pigmentation.
Papaya with Yogurt: Papaya face mask with yogurt. Make a face mask by adding ½ cup of mashed ripe papaya pulp, 1 tsp of honey and ¼ sup of yogurt and apply a thick layer over the skin. Wash it off after 30 minutes with warm water and pat dry.
Potato: You may cut the potato in two pieces and gently rub it pigmented skin.
Mint leaves: Make a paste of mint leaves using some water. Apply it over the dark spots and rinse off after 15 minutes. Repeat twice or thrice in a week for better results.

Add some quantity of sandalwood powder, turmeric powder and milk to make a paste. Spread it gently on affected area. Wash after some time.
Avocados: Mashed Avocados or its juice if applied on pigmented skin on a regular basis, gives noticeable results. These remedies will work slowly and moderately.
Post pregnancy some of the pigmentation will fade out, but for the stubborn pigmentation, the following treatments are available:
1. Glycolic/ yellow peels:  for Melasma
2. Mesotherapy:  where vitamin shots are given on the skin to lighten pigmentation in a gentle manner.
3. Laser toning with Q switched Nd: YAG laser.
4. TCA peels: for underarms pigmentation.
5. Q switched Nd:YAG laser: for freckles
6. RF cautery: for DPN’s.

With all the treatments available, pigmentation can be easily dealt with. So enjoy your pregnancy.

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