Patrick Hudson MD, FACS

Changes in skin pigmentation, chloasma,  are common on the face during pregnancy. Some studies suggest that up to three in four pregnant women may develop these changes. Similar changes are seen in about a third of women on birth control pills.

The changes are characterized by a blotchy brown increase in pigment. Although they are clearly seen the edges are irregular.

Several factors are involved in the development of chloasma including race, sun exposure and hormones (both estrogen and progesterone stimulate pigment formation).

Although chloasma occurs throughout the face, three main patterns are seen. The most common (63%) is in the center of the face (centrofacial). This involves the forehead cheeks, nose, lips and chin. Less common is malar, or cheek and nose, pigment (21%). Least common is a pattern along the edge of the jaw(mandibular) which occurs in 9%. Sometimes there is also an increase in pigment around the nipple, in scars, in the perineum or around the anus.  

A most important distinction from the patient's perspective is the depth of the pigment within the skin. In about three out of four patients it is superficial in the epidermis. In the remainder the pigment lies deep in the dermis or is a mixture of dermal and epidermal pigment.It is sometimes possible to distinguish the this pattern using special type of light called a Wood's lamp.

If the pigment is in the epidermis it is often helped by bleaching agents such as hydroquinone. However, this is only effective if used for several weeks. Some doctors feel that the hydroquinone is more effective when combined with retinoic acid. Deep pigment in the dermis does not respond well to bleaching agents.

Resurfacing procedures such as chemical peels and lasers may help some of these problems but the results are not always consistent.

More information about postpartum plastic surgery.

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