Second Trimester? Check. Melasma? Check

This week we officially entered the THIRD trimester of this pregnancy. 28-weeks!!!! So many milestones. Lots of pee tests. Lots of blood tests. Lots of skin changes. I’m not going to do a countdown list because I really haven’t bought a lot of new skincare. What I have had to do is figure out how to use my current products differently for my skin changes. The biggest change is the development of Melasma or ‘The Mask of Pregnancy’.

At 28-weeks I have found out I do not have gestational diabetes and I need to consume more iron. Baby girl seems to be doing awesome and she’s doing a great job of hosting dance parties in my uterus between the hours of 9pm and 6am every day.

By 28-weeks most pregnant women will have had a glucose tolerance test to check for gestational diabetes. It’s not a horrible test and its a pretty non-invasive way to make sure you and your baby are healthy because there can be serious risks for mom and baby if gestational diabetes isn’t managed. The 1-hr glucose tolerance test makes you feel bad. It’s not the worst thing to have occurred in my life but that drink is pretty bad. It’s twice the amount of sugar in a can of soda, flat, and orange flavored. I felt pretty out of it all day yesterday. But I got my result back this morning and we’re in the clear!

One of the newest changes to my skin is the mask of pregnancy. It sounds like some kind of sexy Zorro like effect of pregnancy. Sadly, Antonio Banderas isn’t riding in in Tornado to rescue me and I’m not Catherine Zeta-Jones.


One of the most well known of skin changes in pregnant women is called the ‘pregnancy mask’ or melasma/chloasma. The mask of pregnancy is hyperpigmentation that affects women typically during pregnancy although men can also be affected by melasma. The reason it’s called mask of pregnancy is because around 50-70% of women are effected particularly around you T-zone and it tends to go away within a few months of giving birth. It’s hypothesized that progesterone, estrogen, MSH (melanocyte-stimulating hormone) all interact making women in their third trimester at a higher risk of developing melasma.

Tulchinsky et al. 1972. Am J Obstet Gynecol.

As you can see progesterone begins to really rise during the third trimester as does estradiol and estriol (both forms of estrogen). Studies in post-menopausal women who were taking hormone replacement therapy showed those women who were given hormone replacement therapy that contained progesterone had a higher occurrence of melasma than those who received estrogen only hormone replacement therapy.

Patches of melasma have started to form on my face. Since my mom had melasma, I’m sure I’m at a higher risk of developing it. Safe to say that she doesn’t have those patches anymore and it did go away a couple of months after she gave birth, so not a huge deal. Women are at highest risk during their third trimester but melasma is something that can affect women regardless of pregnancy status. Its just most commonly seen during pregnancy.


Treatment of melasma during pregnancy relies entirely on prevention if you’re pregnant. Staying out of the sun as much as possible. Using a wide brimmed hat, using an SPF sunscreen of 50+ that contains zinc or titanium oxide. In one study, the use of an SPF 50+ broad spectrum sunscreen brought the occurrence of melasma down from 53% to 2.7%. Vitamin C has shown limited response in treatment of melasma; however, is known to improve the effect of sunscreens and could improve performance when paired together

After you give birth there are other options available including hydroquinone which remains the gold-standard. Use of hydroquinone is not advised to be used during pregnancy. Using AHA, BHA, and azelaic acid have also been used successfully. Laser resurfacing isn’t always suggested because of the postinflammatory hyperpigmentation response that can occur particularly in darker skin individuals but has shown promise.

My Melasma Experience

As of right now, I only have melasma in one little area under my right eye. I had it during my first pregnancy and didn’t have enough time for it to go away before I became pregnant again which may have slowed it’s fading. Based on what I’ve seen from other women, my melasma is not that bad and it isn’t noticeable either. I see it because I look at my face everyday. I’ve been using Philosophy’s Vitamin C Booster and Dior’s Dreamskin Fresh & Perfect Cushion Broad Spectrum SPF 50. I mix my Vitamin C booster powder with Lancome’s Tonique Confort which is a wonderful, milky, hydrating toner. I highly recommend putting this toner on your fingers, not a cotton pad. It doesn’t absorb well into cotton but it absorbs beautifully into the skin.

I expect my melasma to get worse as my pregnancy continues. It’s early spring in the US, we’re vaccinated and outside more. We have outdoor craft festivals that are starting. My baby shower is going to be outdoors (weather dependent). Minimizing sun exposure is the best way to decrease the risk which is easier said than done in the spring after a quarantined winter.

My Melasma Plan: SPF 50+ sunscreen, hats, Vitamin C, and a mask.

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