Skincare

I Have Pregnancy-Induced Melasma — Here’s What I’ve Learned

All photos courtesy of Aliza Zelin Neidich

 

When I became pregnant in 2016, I was aware of — and expected to experience — some of the better-known side effects of carrying and delivering a human being. Morning sickness. Mood swings. Weight gain. The resulting baby. In my mind, the suffering from these conditions were all pretty reversible (minus the baby, that is). Saltines, meditation, post-baby workout plans, childcare. Easy.

My due date of August 28, 2017 meant that my final trimester fell over the summer, which afforded me ample time to relax poolside and tan my ever-expanding belly. As the weather turned warmer, I noticed some freckles on my face appeared darker than usual. I didn’t think much of it, since I had always turned freckly in the sun, so I made sure to slather sunscreen all over my body and continued to go about my business.

Looking back, I remember a moment in July as I was getting ready to hop in the shower (actually, “hop” implies a mobility that I no longer possessed at eight months pregnant; “inched” is more like it). Catching a glimpse of myself in the bathroom mirror, I noticed that any sort of mark on my body (previous acne spots, clumsy scrapes, pimples I had picked at) I’d acquired during my pregnancy had darkened. They covered my body in a constellation of “skinjuries” past. Most alarmingly, a splotchy brown pattern was emerging in the middle of my forehead. If I look at photos from this time, I can see it starting to take shape, like the beginnings of an ink blot before it has spread. “It’ll fade,” I reassured myself, with zero experience and lack of any empirical evidence.

Aliza Zelin Neidich

I had my baby on my due date, a beautiful boy we named Rider. In the whirlwind of half-conscious delirium that follows the few months postpartum, I barely noticed anything about my appearance, shy of my engorged breasts. But when the dust settled, and everything physically started returning back (or close) to my pre-baby normal, I had a “huh” moment as I looked in the mirror on one sleepy Saturday: my forehead spots hadn’t gone anywhere. Not only were they still very much present, but they had gotten worse. The inkblot pattern had continued its outward migration — and had also bled to connect previously-dispersed spots.

I ran to Google®, discovered the word “melasma” and I reached out to my dermatologist Dr. Nancy Samolitis at Facile® Dermatology for more information and to discuss a plan of attack.

“Melasma is one of the more common skin problems I see,” she told me. “It’s a unique type of hyperpigmentation that we see more in women because it is stimulated by estrogen [and other hormones involved in menstruation and pregnancy].” Living in sunny Los Angeles also contributed to these spots. According to Dr. Samolitis, melasma can be exacerbated by UV rays, making it more common in places where there is sun year round. Additionally, it can worsen if you use products that irritate your skin.

This explained why my pregnancy triggered it; and combined with my sun exposure, I turned into a breeding ground for the perfect melasma storm. Dr. Samolitis noted that fighting it can often feel like an uphill battle: treatments can lighten the spots, but they will likely darken again the next time you’re in the sun.

Aliza Zelin Neidich

How could something described as casually as “a common skin problem” so fundamentally change the appearance of my face? All of a sudden, the face I had known my entire life was changed. The landscape was no longer familiar to me, and I grew to detest it. Anytime I saw myself, I noticed the huge, brown patch glaring back at me from the center of my forehead. Aside from the random breakout, I had never felt the need to hide or cover up any aspect of my appearance. My hunt for a cure began.

“In a perfect world, we take a combination approach [to treatment],” Dr. Samolitis explained. “Not one treatment will work for everyone, so we kind of throw the kitchen sink at it and see what is the most effective for your skin.”

Aliza Zelin Neidich

She suggested I started with Clear + Brilliant® laser treatment, which she said acts as an exfoliant to help remove skin from the surface of your face. Its job is to enhance cell turnover so that new skin eventually replaces pigmented skin. The procedure took about 20 minutes, and I experienced very little redness and zero downtime. After a few treatments, I did notice some lightening and overall skin brightening, but I was told the best results would be from regularly scheduling treatments every six weeks.

[Editor’s note: As always, talk to your doctor before starting or stopping any new treatment.]

I was simultaneously prescribed a compounded topical treatment composed of hydroquinone and kojic acid, and told to apply nightly. Hydroquinone works by breaking down melanosomes (the pigment in melasma), and the other ingredients enhance its effect. I used it regularly for a few months and definitely noticed some lightening. However, I also went on a trip to Cabo, Mexico, at this time and — despite my best efforts — definitely ended up in the sun. I felt like I was back at square one.

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Dr. Samolitis then suggested a chemical peel to further exfoliate my skin. We went with a product called Mela Peel™, since it works to specifically target pigmentation. I had it applied in-office and left with instructions to keep the product on my face for eight hours. The initial burning quickly subsided, and although sticky, it didn’t bother me much. My face was a little red the following day, then mildly flaked for about a week. I did notice overall brightening and some lightening of my forehead, but the pigmentation was definitely still there.

Next I tried microneedling, the popular procedure which uses small needles to prick the skin to stimulate collagen and a healing response. Although not typically the go-to melasma treatment, it can be used to treat minor scars, wrinkles, pores, and age spots. “Why not?” I thought. Although my face definitely felt plumper after the treatment, it didn’t do anything for my melasma.

The one product I tried independently that I did have considerable success with was the Alpha Beta® Universal Daily Peel by Dr. Dennis Gross® Skincare ($150 for 60). The product features two pre-treated pads: the first contains a combination of exfoliating acids, and the second neutralizes the acids and delivers anti-aging ingredients. I used these nightly for about two months and my spots did lighten immensely. Sadly, I found that the results plateaued, still far from my goal of zero melasma.

Unfortunately, there are a few treatments that I haven’t been able to try that people have had considerable success with. For example, the Fraxel® laser, which works the same way that Clear + Brilliant does, but with more strength. (Bad reactions to topical numbing creams prohibit me from trying this procedure, which is said to be uncomfortable.)

[Editor’s note: Be sure to talk to your doctor before starting or stopping any new medication or supplement.]

Aliza Zelin Neidich

At this point my frustration grew. I wanted a forehead transplant — or a skin graft. Dr. Sam nailed my sentiments when during one of my visits she lamented, “I just want to take a towel and wipe it off.” I was sick of it all: using Facetune® (a photo-editing app) to blur my forehead so it looked like one color. Sick of using makeup to try to cover it. And I was really sick of not liking what I saw whenever I saw myself. So I went for a different cosmetic approach . . . I got bangs. Although I’m aware that this is a very superficial solution, not seeing my melasma as often has allowed me to defuse my frustration a bit.

Aliza Zelin Neidich

I understand that not everyone will want (or even have the luxury) of cutting their hair to hide their melasma. I also know first-hand how much trial and error it can take to treat it. To help others learn from my experience, here are some of my top takeaways from dealing with melasma.

  • The sun is the devil — avoid it. If you must brave the sun, wear sunscreen, a hat, and protective clothing. Preventative measures go a long way and reduce cleanup after the fact.
  • Heat (not just the sun!) can cause melasma to worsen. This means if you’re indoors and just hot — like in a hot yoga class or a sauna — your melasma can darken without any sun exposure at all. Being flushed on any part of your skin can make dark spots appear even darker.
  •  Sun exposure on any part of your body can affect your melasma, even if your discoloration is hidden well. This means tanning just your legs, for example, can make your hidden forehead melasma worse. This is because the sun makes your body stimulate a hormone that makes melanocytes, so you will still have that systemic reaction and your body will produce melanin.
  • Hormones play a huge role in its development. Therefore, if you’re pregnant or taking birth control pills, you’re at risk. Removing the extra estrogen stimulus from your body can help.
  •  Be careful with lasers. There are “photofacial” lasers like IPL that people use to treat pigmentation, but that type of laser can worsen hyperpigmentation. In fact, Dr. Samolitis said these photofacial lasers are the most common in-office treatment that can make melasma worse.
  •  If you’re given topical treatments, it’s important for you to keep using them in addition to any in-office treatments you have. Hydroquinone is the most effective topical treatment for melasma, and it is often combined with other ingredients like vitamin C to enhance its effectiveness.
  •  Some exfoliating treatments, like peels, can cause inflammation in your skin as part of their treatment, but sometimes this inflammation can make this melasma worse.
  • If you’re pregnant, your treatment options are limited since some skincare products and procedures can be dangerous to your baby. Talk to your doctor to see which ones might be right for you.
  • Don’t neglect it. Sometimes melasma is superficial, but if you’ve had it for a while, it can be pretty challenging to get rid of.
  • Self acceptance – and a good haircut – can go a long way.
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