Pregnancy and Melasma: Managing the Mask of Pregnancy

ByA/Prof.Indika Alahakoon — Co-Founder, Pregnancy and Baby Co. | Specialist Obstetrician & Maternal Fetal Medicine Expert | Mum offour

You noticed it in the mirror one morning. A patch of darker skin across your cheeks. Perhaps a
shadow along your forehead, or a darkening above your upper lip that wasn't there before. You
haven't spent extra time in the sun. You haven't changed anything. You're just pregnant.
What you're looking at has a name: melasma. Known colloquially as the mask of pregnancy, it's
one of the most common — and least anticipated — skin changes of pregnancy. And while it is
completely harmless from a medical perspective, the emotional experience of watching your
face change in unexpected ways is something that many women find genuinely distressing.
In more than thirty years of specialist obstetric practice, I have had this conversation hundreds of
times. Women who noticed the darkening at twelve weeks and felt worried. Women who reached
the second trimester and watched it deepen despite everything they were doing. Women who
simply wished someone had warned them — and told them clearly what they could and couldn't
safely do about it.
This article is that conversation. Evidence-informed, pregnancy-safe, and honest about what
works, what doesn't, and what to avoid.

What Is Pregnancy Melasma?
Melasma is a form of hyperpigmentation — an overproduction of melanin, the pigment that
gives skin its colour — that results in flat, irregular patches of tan, brown, or greyish skin. During
pregnancy, it most commonly appears across the cheeks, forehead, bridge of the nose, upper lip,
and chin.
It is not a rash. It is not an infection. It doesn't itch or hurt. It is simply an area of skin where the
melanocytes — the cells responsible for producing melanin — have become more active than

usual.
The name "mask of pregnancy" is apt: the patches often form a symmetrical pattern across the
face that can resemble a mask. It typically appears during the second or third trimester, when
hormone levels are at their peak.
Melasma is also known by an older term: chloasma. The two words refer to the same condition.

What Causes Pregnancy Melasma?
The primary cause is hormonal. During pregnancy, levels of oestrogen, progesterone, and
melanocyte-stimulating hormone (MSH) all rise substantially. These hormones directly
stimulate the skin's melanocytes to produce more melanin. The result is hyperpigmentation in
areas where the skin is most exposed to stimulation — particularly the sun-facing planes of the
face.
Melasma affects 50 to 70 per cent of pregnant women, making it one of the most common skin
changes of pregnancy. That means if you're sitting in a room with five other pregnant women,
three or four of you are likely experiencing some degree of it.
Several factors increase the risk:
Sun exposure — UV radiation is the most significant aggravating factor. Even brief
incidental sun exposure can trigger or deepen melasma during pregnancy.
Skin tone — Women with medium to deeper skin tones (Fitzpatrick types III through VI)
are more prone to melasma and may experience more pronounced pigmentation.
Family history — If your mother or sister developed melasma during pregnancy, your risk
is higher.
First and second trimesters — Melasma most often begins to appear between the fourth
and sixth month of pregnancy, as hormone levels peak.
In Australia specifically, the combination of one of the world's highest UV radiation levels and a
multicultural population with a high proportion of Fitzpatrick III–VI skin types means pregnancy
melasma is both more common and more pronounced here than in many other parts of the
world. Daily sun protection is not a minor footnote in managing this condition — it is the central
intervention.

The Most Important Step: Daily Mineral SPF 50+
Before we discuss any active skincare ingredient, we need to talk about sunscreen. Because
without consistent, daily sun protection, every other step in your melasma management routine
is fighting an uphill battle it cannot win.
Daily mineral SPF is the single most important step in a pregnancy skincare routine, particularly
for managing melasma. UV exposure directly triggers and worsens hormonal pigmentation —

without consistent sun protection, every brightening step is undermined.
During pregnancy, mineral sunscreens — those containing zinc oxide and/or titanium dioxide
as their active ingredients — are strongly preferred over chemical sunscreens. Unlike chemical
filters such as oxybenzone and octinoxate, which are absorbed through the skin and have been
associated with endocrine disruption, zinc oxide and titanium dioxide sit on the surface of the
skin and physically block UV rays without systemic absorption.
What to look for:
Active ingredients: zinc oxide and/or titanium dioxide only
Broad-spectrum protection covering UVA and UVB
SPF 50+ — the highest standard available
Tinted formula — iron oxides in tinted sunscreens provide additional protection against
visible light, which can also stimulate melanin production independently of UV
Apply every morning — including overcast days, winter days, and days you plan to stay indoors.
UVA rays penetrate glass. Reapply every two hours when outdoors. Pair with a wide-brimmed
hat whenever you're outside.
No skincare ingredient — no matter how effective — can compensate for unprotected sun
exposure in someone whose melanocytes are hormonally primed to respond.

Pregnancy-Safe Active Ingredients for Melasma
With daily mineral SPF as the non-negotiable foundation, there are several evidence-informed
active ingredients that are considered safe throughout pregnancy and can meaningfully support
melasma management.
Vitamin C — The Most Valuable Pregnancy-Safe Brightening Active
Vitamin C is the most well-evidenced, widely recommended, pregnancy-safe ingredient for
addressing hyperpigmentation. It works by inhibiting tyrosinase — the enzyme responsible for
converting tyrosine into melanin. By reducing tyrosinase activity, Vitamin C slows the rate of
melanin production, supporting a more even skin tone over time.
It also functions as a potent antioxidant, neutralising the free radicals generated by UV radiation
that stimulate further melanin production. This means Vitamin C is doing two things
simultaneously: reducing the production signal (tyrosinase inhibition) and reducing the trigger
(antioxidant UV defence).
Melasma affects 50 to 70 per cent of pregnant women, with hormones triggering melanin
production. Vitamin C inhibits tyrosinase, making it the safest melasma treatment available
during pregnancy. Starting Vitamin C in the first trimester for prevention is easier than treating
established melasma — and may reduce its severity throughout pregnancy.

For pregnancy, natural Vitamin C sources — including Kakadu Plum (Terminalia ferdinandiana),
the world's richest natural source of Vitamin C — are particularly well-suited. Kakadu Plum
extract delivers Vitamin C in a naturally buffered, whole-fruit botanical matrix alongside ellagic

acid, a polyphenol that inhibits melanin production through a separate pathway. This dual-
mechanism approach makes it especially relevant for pregnancy melasma.

Our Kakadu Plum Belly Oil incorporates Kakadu Plum as its hero ingredient — and while it is
formulated for body use, the science of this extraordinaryAustralian ingredient is the foundation
of our broader skincare philosophy for pregnancy and postpartum.
Niacinamide — Barrier, Tone, and Melanin Transfer
Niacinamide (Vitamin B3) supports even skin tone through a mechanism distinct from Vitamin
C: it inhibits the transfer of melanin from melanocytes to keratinocytes — meaning it reduces
how much of the pigment that is produced actually reaches the surface of the skin. It also
strengthens the skin barrier and reduces redness and sensitivity, which is particularly valuable
during pregnancy when skin often becomes more reactive.
The three key ingredients that help with melasma are Vitamin C, niacinamide, and azelaic acid.
Niacinamide is safe throughout pregnancy and breastfeeding and pairs extremely well with
Vitamin C in a morning skincare routine.
Azelaic Acid — The Pregnancy Dermatologist's Go-To
Azelaic acid is perhaps the most underappreciated pregnancy-safe active available. It is
classified as pregnancy category B — considered safe for use during pregnancy and
breastfeeding — and has documented efficacy for both melasma and acne. It lightens
pigmentation by inhibiting tyrosinase activity and reducing the production of abnormal
melanocytes.
Azelaic acid is a go-to for pregnant women — pregnancy category B, considered safe for use
during pregnancy and breastfeeding, and one of the most prescribed ingredients for patients
with melasma and acne during pregnancy.
Available over the counter at lower concentrations and by prescription at higher concentrations,
azelaic acid is best applied in the evening after cleansing. If you are using both Vitamin C
(morning) and azelaic acid (evening), you are covering both the production and transfer
pathways of melanin from morning to night.

What to Avoid for Pregnancy Melasma
Several commonly used melasma treatments are not safe during pregnancy:
Hydroquinone — the most common conventional melasma treatment, but not
recommended during pregnancy due to its high rate of systemic skin absorption (estimated
at up to 45 per cent)

Retinoids — highly effective post-pregnancy, but not safe during pregnancy in any form
(tretinoin, retinol, retinyl palmitate, adapalene)
High-dose chemical peels — kojic acid and glycolic acid peels at professional
concentrations should be deferred until after breastfeeding
Chemical sunscreen actives — oxybenzone, octinoxate, homosalate, and related filters
The reassuring truth is that the pregnancy-safe options listed above — Vitamin C, niacinamide,
azelaic acid, and consistent mineral SPF — are not inferior substitutes. They are genuinely
effective, evidence-supported interventions. And for many women, this combination is sufficient
to prevent melasma from deepening significantly, even if it does not resolve it entirely during
pregnancy.

What to Expect: Will Pregnancy Melasma Go Away?
For most women, yes. Almost all melasma spots fade within six months following pregnancy as
hormone levels balance. It is important to keep skin protected from sun damage during and after
pregnancy to reduce the appearance of melasma.
However, continued sun exposure without protection after birth — or the use of hormonal
contraceptives — can slow or reverse that fading. Some women, particularly those with darker
skin tones or a genetic predisposition, may find melasma more persistent.
If melasma remains after you have stopped breastfeeding, the full spectrum of dermatological
treatments becomes available — including topical retinoids, professional-strength azelaic acid,
and procedures such as chemical peels. This is an excellent conversation to have with a
dermatologist post-breastfeeding if you are concerned about residual pigmentation.

Your Pregnancy Melasma Routine — A Practical Summary
Morning:
1. Gentle fragrance-free cleanser
2. Vitamin C serum (or a Kakadu Plum-rich formulation) on clean skin
3. Niacinamide moisturiser
4. Broad-spectrum mineral SPF 50+ — every single day
Evening:
1. Gentle cleanser
2. Azelaic acid serum (if using)
3. Hydrating, barrier-supportive moisturiser
Sun habits:

Wide-brimmed hat when outdoors
Seek shade between 10am and 3pm when UV is highest in Australia
Reapply SPF every two hours during outdoor activity
Remember: UVA penetrates glass — apply SPF even on indoor days

FrequentlyAsked Questions
Is melasma during pregnancy dangerous? No. Pregnancy melasma is purely a cosmetic
concern — it does not affect the health of you or your baby in any way. It is, however, a source of
genuine emotional distress for many women, and you are entirely entitled to address it.
When does pregnancy melasma usually appear? Most commonly between the fourth and sixth
month of pregnancy — the second trimester — when hormone levels peak. It can appear earlier
or later in some women.
Can I use Vitamin C during pregnancy? Yes. Vitamin C is considered safe throughout
pregnancy and breastfeeding and is one of the most valuable pregnancy-safe ingredients for
addressing melasma. Natural sources such as Kakadu Plum extract are particularly gentle and
suitable for sensitised pregnancy skin.
Will my melasma go away after birth? For most women, melasma fades significantly within six
months after birth. Continued sun protection during the postpartum period and breastfeeding
phase is essential to support that fading.
Can I use hydroquinone for pregnancy melasma? No. Hydroquinone is not recommended
during pregnancy due to its high rate of systemic skin absorption. Vitamin C, niacinamide, and
azelaic acid are the appropriate pregnancy-safe alternatives.

A Reassuring Note to Close
Your face may look different during pregnancy. That is real, and your feelings about it are valid.
But pregnancy melasma is one of the most common and most manageable skin changes of this
season — and with a consistent, evidence-informed approach, most women find it fades
significantly in the months after birth.
Start daily mineral SPF now if you haven't already. Add a pregnancy-safe Vitamin C and
niacinamide to your morning routine. Ask your GP or dermatologist about azelaic acid if your
melasma is more pronounced. And know that the women in your care at Pregnancy and Baby Co.
have thought carefully about this — from the consulting room and the nursery both.
Your skin is doing something extraordinary. Let's support it well.

Explore the Kakadu Plum Belly Oil — our hero Vitamin C formulation →
pregnancyandbabyco.com.au/products/pregnancy-belly-oil
Download your free Pregnancy-Safe Skincare Guide →
pregnancyandbabyco.com.au/pages/free-guide
Related reading:
The Benefits ofAustralian Kakadu Plum Extract in Skincare →
Pregnancy-Safe Skincare: What to Use and What to Avoid →
Stretch Marks During Pregnancy: What the Evidence Says →

This article is for general informational purposes only and does not constitute medical advice.
Skincare needs vary between individuals and pregnancies. Always consult your GP, midwife, or
obstetrician for advice specific to your circumstances, particularly if you have an existing skin
condition or medical concern.
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