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Maria, 28 years old. Pregnancy "mask".

Maria, 28 years old. Pregnancy "mask".

Co created by Dr. Christelle Besnard-Charvet, Mr. Nicolas Dutriaux, Dr. Diane Heron-Mermin, Prof. Annabel Maruani-Raphael, and Dr. Samuel Sarfati

5 min read

Clinical presentation
Quiz
Beware of preconceived ideas: True or false
Your Colleagues' Advice

Which of the following answers do you give Maria? (many possible response)

Chloasma or melasma (“pregnancy mask” or “pregnancy spots”) is hormone-dependent The birth control pill can also cause chloasma Effective sun protection will limit its appearance but will not prevent it Hyperpigmentation is due to the overproduction of melanin

True answer!

Wrong answer!

Hyperpigmentation is linked to the overproduction of melanin as a result of hormonal changes (pregnancy, hormonal contraception or menopause). It seems that exposure to short wavelengths of around 400-450 nm (the blue spectrum of visible light) is responsible for this hyperpigmentation, in addition to traditional UVA and UVB rays.

During pregnancy, it primarily affects:

- the white abdominal line (which turns brown);

- the nipples (probably to use contrast to guide the newborn during breastfeeding);

- the axillary hollows;

- and the face, where spots gradually appear on the cheeks, forehead, nose and upper lip, forming a kind of mask.

Photosensitivity can increase the appearance of pregnancy spots. These should not be confused with post-inflammatory spots (as after a burn) or lentigo (spots that appear with age and cumulative exposure to the sun, see photo).

What advice can you give Maria about exposure to the sun? (many possible response)

Apply a high-protection sunscreen (factor of 50 or more) Sun protection is only useful during pregnancy Sun creams should be avoided by pregnant women and while breastfeeding Avoid exposure to the sun, especially in the afternoon, but remember to wear a wide-brimmed hat or cap Sun protection should be lightly tinted to counteract the blue spectrum of visible light

True answer!

Wrong answer!

Mineral sunscreens are preferable to avoid endocrine disruptors – which can potentially disrupt foetal development.
Sunscreens should be reapplied every two hours.
A wide-brimmed hat and sunglasses that cover the eye sockets well are essential.
Protection shouldn’t just be for the summer! Don’t forget to use protection for winter sports too, with the reflection of the sun off the snow, and even between seasons. Low clouds can sometimes be misleading, as they do not stop UV rays or short-wave radiation.

Mechanisms of hormonal action in chloasma

Certain melanocytes are more sensitive to progesterone (in areas where the physiological spots and discolouration of pregnancy appear).
The hormonal climate of pregnancy (over)activates these melanocytes, and even without direct exposure to the sun, brown discolouration appears.
Be careful with certain topical agents, which may be photosensitising.

In the post-partum period, to erase “pregnancy spots”: (many possible response)

Medication can be taken as soon as the baby is born Laser treatment can be used for all skin types Vitamin C is fairly effective at correcting spots Pregnancy mask regresses spontaneously within a few months

True answer!

Wrong answer!

- Hyperpigmentation disappears as the weeks go by, within 12 to 18 months – this period also varies if breastfeeding is prolonged. Dermatological advice should only be sought if the condition persists for 12 months.
- A topical agent containing vitamin C can be used to diminish the spots.
- Dermatological treatment, as prescribed by a dermatologist, consists of whitening creams (hydroquinone, retinoic acid or AHAs).
- Laser treatment is a possibility, although there is no proof that it is effective, but it is not recommended for dark skin. Lastly, a peel treatment can be performed by a medical specialist. Biophotomodulation (treatment with medical LEDs or cold lasers) can also be proposed, but further studies are also needed for this indication.
- Regarding complementary medicine: SEPIA is a homoeopathic medicine traditionally prescribed by homoeopathic doctors for this indication, both for prevention during pregnancy and in the post-partum period. An average dilution of around 9CH, at a rate of 5 granules a day or one dose a week, is generally prescribed for this indication. There is no scientific proof that this treatment is effective.

The absence of sun exposure does not protect against pregnancy mask

True False

True answer!

Wrong answer!

Pregnancy mask is linked to hormonal changes

Sun protection should not stop when you give birth

True False

True answer!

Wrong answer!

It should be continued throughout the year following birth until the spots disappear.

Melasma only affects pregnant women

True False

True answer!

Wrong answer!

Children and men can also be affected. It can appear in cases of thyroid disease or when taking medication, but the risk of developing melasma is mainly due to overexposure to the sun. Sunburn should be avoided, particularly if you are taking certain treatments that can increase your hypersensitivity to UV rays, which will stimulate the melanocytes.

I have dark skin, so I don’t need to protect myself from the sun during my pregnancy

True False

True answer!

Wrong answer!

Dark skin is the most prone to melasma (“pregnancy mask”). This is characterised by clearly delimited and systemic pigmentation of the forehead, cheeks and upper lips, most often occurring during pregnancy.

Melasma treatment is not definitive

True False

True answer!

Wrong answer!

In most cases, there is sensitivity to hormonal variations that can recur (other pregnancies, menopause, thyroid disorders, etc.).

All SPF50+ sunscreens are the same

True False

True answer!

Wrong answer!

Two SPF50+ products can have different levels of protection against UVA and UVB rays. Ideally, you should use a product with a UVB/UVA ratio of 1, offering excellent sun protection against UVA rays.

Dr. Diane Heron-Mermin

Dermatologist , France

The first-line treatment is Kligman’s trio (hydroquinone, retinoids, topical corticosteroids).
Photoprotection against visible light is essential.
Milder depigmenting agents (Thiamidol, azelaic acid, AHAs, vitamin C, etc.) are adjuvant treatments but are often insufficient on their own.

Annabel Maruani-Raphael

Pediatric dermatologist , France

Photoprotection from the start of pregnancy is important to avoid pregnancy spots.

Dr Samuel Sarfati

General practitioner , France

Melasma is hormone-dependent, induced either by pregnancy or by hormonal contraception, and is aggravated by photo-exposure.
Hyperpigmentation disappears spontaneously in the months following childbirth, and topical vitamin C can diminish the lesions.
Choose mineral sunscreens to avoid endocrine disruptors.

Nicolas Dutriaux

Midwife

Inform pregnant women, especially those with pre-existing hyperpigmentation spots or multiparous women who have already experienced pregnancy mask, of the need for sun protection from the start of pregnancy.
It is advisable to wear a wide-brimmed hat, even outside the summer season.
A high-factor (>50) sun cream, preferably a mineral cream that is unlikely to contain endocrine disruptors, should be used throughout the post-partum period.

Dr Christelle Besnard-Charvet

Gynaecologist , France

Warn pregnant women from the start of their pregnancy about the risk of hyperpigmentation.
Take advantage of pregnancy to explain UV protection guidelines for her and her future baby.

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Maria, 28 years old. Pregnancy "mask".

Clinical presentation

Quiz

Beware of preconceived ideas: True or false

Your Colleagues' Advice