Advice from Dr. Weiss: When Dark Spots Appear

Q: This is my second pregnancy, and a dark spot that cropped up on my forehead during my first pregnancy has reappeared with a vengeance. It never really went away, and now it’s so dark people ask if something’s on my face. Is there anything I can do about it while I’m pregnant?

A: I recommend you show the dark spot to your doctor. It may be a type of skin discoloration called melasma, which is usually first noticed in pregnancy or once you start taking birth control pills. But, if the darkening is limited to a small area, it could be any number of skin conditions. Melasma often spreads around the eyes, forehead, and cheeks, which explains its other common name, “pregnancy mask.”

If your spot is melasma, a dermatologist will usually recommend delaying treatment until several months after delivery because the pigmentation often fades, as yours did, when your hormones normalize. Pregnancy hormones are the true cause of the discoloration—they stimulate additional melanin, the pigment that darkens skin when it’s exposed to sunlight. During pregnancy, staying out of the sun and using a broad-spectrum sunscreen daily can help decrease the discoloration.

Treatment after pregnancy includes kojic acid, azelaic acid, and tretinoin creams, which have been shown to improve the appearance of melasma. Occasionally, chemical peels or topical steroid creams work. In severe cases, a doctor might recommend laser treatments. In any case, it’s important to ask your doctor about the spot.

Stephen H. Weiss, M.D., is an ob/gyn and instructor at the Emory University School of Medicine in Atlanta.

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