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Melasma: Brown Spots on the Face

What causes brown spots during pregnancy and how to fix it


Melasma: Brown Spots on the Face

Esoterica, a skin lightening cream

I received an email from a friend recently who developed melasma, or brown spots, on her cheeks during her last pregnancy. Although they are fading, she was hoping I could recommend a product that would move the fading along a bit faster.

Causes and Symptoms of Melasma

Melasma shows up in the form of brown spots or patches on the cheeks, forehead, upper lip and nose. It is most common in women during their productive years and it tends to with olive skin that tans easily. My friend fits this risk factor because she always looks tan, even in winter. She also lives in Texas, where the sun shines strong, and too much sun exposure exacerbates and likely contributes to melasma.

Melasma is more a cosmetic concern than a health concern. These brown spots tend to develop in women who undergo a surge in hormone levels due to pregnancy, oral contraceptive use or hormone replacement therapy (HRT) during menopause. So it makes sense that my friend, who just had a baby, developed brown spots, which in pregnant women are also called cholasma, or "the mask of pregnancy."

If you're not sure if your brown spots are melasma, you can consult a dermatologist. Doctors can use a black light or Wood's light (340-400 nm) to properly diagnose melasma.

Treatment of Melasma

So what to do if you have these brown spots? the good news is the brown spots will fade a few months after birth, or once you go off oral contraceptives or HRT. But if you are like my friend, and you want a bit of help along the way, there are treatment options available. Keep in mind it is best not to use these creams when pregnant or breastfeeding. You can try to conceal the spots with concealer in the meantime, but do wait until the baby is weaned to start treatment.

Skin lightening creams with at least 2 percent Hydroquinone such as Esoterica or Porcelana are your best bet and should be applied to your brown spots twice daily. You can buy these at Sephora or pharmacies. Just look for "Hydroquinone" on the package. They tend to be less irritating and just as effective as the prescription-strength creams such as Obagi Clear, Glyquin, Tri-Luma, and Solaquin, which are made up of 4 percent Hydroquinone. Usually anything over 2 percent requires a prescription.

Your doctor may also prescribe Tretoinin, which is a form of Vitamin A, and comes in the brand forms Aberela, Airol, Renova, Atralin, Retin-A, Avita, Retacnyl, Refissa, or Stieva-A. There are generic versions available, which are likely less expensive. Many women stock up on Retin-A when traveling abroad to Mexico or across the border to Canada because you can buy Tretoinin over the counter for about $20 in other countries. If you do choose to self-medicate, do not use Tretoinin if you are pregnant.

Other treatment methods include Tazorac cream, Azelex, Differin gel, NeoStrata (glycolic acid in 10 percent form) and glycolic acid peels. Lasers have also proven effective in diminishing brown spots, but this is the priciest option.

The Importance of Sun Protection

Aside from topical treatments, the best cure for melasma is to stay out of the sun. Wear at least 30 SPF sunscreen on your face and make sure the sunscreen contains actual blockers such as zinc oxide and titanium dioxide. Stay under an umbrella when poolside or by the beach and at the very least, wear a wide-brimmed hat. More skincare help from About.com's Dermatology Website:

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