What can be done to manage hyperpigmentation and melasma during pregnancy?

A woman's body undergoes tremendous changes during pregnancy, many of which are cutaneous (i.e., relating to the skin) in nature. One such change could be pigmentation, wherein certain parts of the skin grow darker in colour due to more melanin being produced. Physiological changes in melanin pigment production, due to oestrogen stimulation and elevated levels of melanocyte-stimulating hormone, are responsible for the common pregnancy-induced pigmentary phenomena (Friedman et al, 2019), which include linea nigra, an increase in pigmentation, and melasma (pigmentation particularly in the face, otherwise known as chloasma or the ‘mask of pregnancy’) (Oakley and Stanway, 2021). Linea nigra and other forms of hyperpigmentation generally appear in the first trimester and affects up to 90% of pregnant women, particularly those of colour, while melasma typically develops in the second half of pregnancy in 70% of women (Oakley and Stanway, 2021). While melasma and hyperpigmentation are not associated with adverse physical or pathological effects to either mother or baby, the psychological and psychosocial impacts of these conditions of the expectant mother can be significant. In a Brazilian descriptive study investigating physiological dermatological changes in pregnancy, 54% of the study population reported feelings of discomfort with these changes; 41.5% reported an impact on their self-esteem, and 18.7% felt that their social life had been compromised (Silva et al, 2022). However, only 14.6% received medical advice and 14.1% underwent treatment (Silva et al, 2022). This indicates the need for information on efficacious treatment modalities that do not present risk to either the pregnant woman or her developing foetus.