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Myth busting: Why pregnant women develop dark patches on the face

CNA Lifestyle’s new series debunks some commonly held notions about wellness. First up: Melasma – and why they’re not caused by anything supernatural.

When it comes to the dos and don’ts in life, you’ve probably heard a few cautionary tales. Don’t walk in the rain; you’ll catch a cold. Eating chocolates will lead to acne breakouts.

Some of these make sense, but some are also old wives’ tales or myths. Sometimes, the latter persist like warts that refuse to go away because the “advice” seems medically sound on surface level (for example, many think that cracking your fingers will lead to arthritis). Others could be time-honoured practices passed down from generation to generation – so they can’t be wrong, right?

READ: What are those bits of hanging skin on your body? And how do you get rid of them?

For the first instalment of our health myth buster series, we’re taking a look at something that affects many pregnant women: Melasma, or those dark facial patches that the superstitious think are caused by evil spirits.

Yes, you may laugh at how silly the notion is but there are still people of the older generation who believe there are supernatural reasons to it. The darker the patches, the more malevolent the spirits latching on to you are. Also, that pregnant women are vulnerable because the discolouration is seen more often on their faces than non-pregnant individuals.


As you might already know, there is nothing remotely supernatural about these patches. Your skin naturally produces a pigment called melanin, which determines the colours of your eyes, hair and skin. Sometimes, your skin produces more melanin than usual when, for instance, you’ve been out in the sun.

READ: Does your face always look red? Here's what you can do to help reduce the blush

If you are prone to melasma, the higher amount of melanin will concentrate in areas such as the cheeks, forehead, bridge of the nose and chin – and create these dark patches, said Dr Angeline Yong, consultant dermatologist at Angeline Yong Dermatology. 

According to her, there are three types of melasma. And the deeper the pigmentation, the harder it is to treat:

  1. Epidermal melasma: Brown with well-defined borders and affects the top layer of skin.
  2. Dermal melasma: Blue-gray patches that affect the deeper dermis level.
  3. Mixed melasma: Brown-gray pigmentation affecting both the epidermal and dermal layers of the skin.


It can be common for mothers-to-be to develop the patches, which is also known as “the mask of pregnancy”. The reason lies with their higher levels of female sex hormones that trigger melasma, said Dr Yong. 

Similarly, situations such as being on oral contraceptives and hormone replacement therapy – both of which increase hormonal levels – can also increase your risk of melasma.

(Photo: Unsplash/Janko Ferlic)

Your complexion may also get patchy if you're using skincare products that contain alpha-hydroxy acids, or you're on certain antibiotics and antihistamines. These compounds can cause your skin to become sensitive to sunlight and cause it to pump out more melanin as protection, said Dr Yong. 

Other reasons include hormonal changes, inflammation, stress, thyroid disorders and age.

Genes also play a role; you are likely to develop melasma if your mother has it, according to a study published in the Journal Of The European Academy Of Dermatology And Venereology.


Melasma is difficult to treat because it’s a “complex condition caused by multiple factors”, said Dr Yong. “The condition also tends to relapse because the factors are not always easy to identify and control. While you can manage melasma, it has no permanent cure.”

To treat melasma, Dr Yong advocates using sun protection (including wearing a hat and a broad-spectrum sunscreen of SPF50 and above when you're out) and the following:

  • Topical treatments

These include a combination of hydroquinone, tretinoin and a steroid, said Dr Yong. Together, they exfoliate, and inhibit melanin formation and cell activity. Sometimes, azelaic acid, kojic acid, ascorbic acid and/or cysteamine hydrochloride may also be used in addition to the combo, she said.

  • Oral tranexamic acid 

It reduces heavy bleeding during surgery and menstruation, said Dr Yong, but oral tranexamic acid is also known to reduce melanin production. According to studies, said Dr Yong, twice daily doses of oral tranexamic acid showed improvements in melasma after four weeks.

  • Chemical peels 

Usually, a combination of lactic and salicylic acids is used to slough off the outermost layer of skin. This encourages cell regeneration to create a brighter and less pigmented complexion, said Dr Yong.

  • Laser treatments

"Picosecond laser treatments are another excellent solution to reduce melasma," said Dr Yong. She prefers them to traditional Q-switched lasers as there is less damage to the surrounding tissues. This also helps to prevent the pigmentation from returning with a vengeance should there be inflammation.

Can the above treatments be used on someone whose melasma is caused by a medical condition such as a thyroid disorder? Can the skin disorder be treated concurrently as the medical issue? 

“I see no harm in embarking on treatments for melasma, particularly topical agents, which do not conflict with or impair thyroid treatments that you may be taking concurrently,” said Dr Yong.

Source: CNA/bk