Melasma (the Pregnancy Mask)

By trimester

Weeks 1–13

1st trimester

Melasma often shows up for the first time in the first trimester, as hormone levels climb. Starting a daily broad-spectrum sunscreen now, plus a wide-brimmed hat outdoors, is the most useful habit you can build early. Save hydroquinone, tretinoin, and other active ingredients for after delivery, and ask your provider first.

Weeks 14–27

2nd trimester

Patches can get darker in the second trimester, especially with more sun exposure. A tinted mineral sunscreen with iron oxide covers both UV rays and the visible light that plain sunscreen misses. Reapply every couple of hours outside, and don't stress about makeup to even out your skin tone in the meantime.

Weeks 28–birth

3rd trimester

Melasma is often at its most visible in the third trimester. Keep up the daily sunscreen and hat habit through delivery. Most patches fade on their own over the weeks and months after birth, though for some people they linger longer, so a dermatologist visit is a reasonable next step if yours doesn't fade.

What does the evidence show for melasma?

• Wearing sunscreen and a wide-brimmed hat every day, even when it's cloudy, is the main habit that keeps melasma patches from getting darker. 1
• Rising estrogen and progesterone are the main drivers behind melasma, and both UV rays and visible light, especially blue light, can make patches worse, which is why a tinted mineral sunscreen works better than a clear one. 2
• Melasma shows up in somewhere between about a third and three-quarters of pregnancies, and starting sunscreen from the first trimester is linked to fewer new patches. 3
• Options like tretinoin, hydroquinone, and steroid creams are generally saved for after delivery, since melasma patches often fade some on their own once hormones settle. 4
• Skin-lightening creams with hydroquinone aren't legally sold over the counter in the U.S., so a dermatologist-prescribed version is the safer route if patches don't fade after delivery. 5

When should I call my provider about melasma?

Melasma is described as symmetric, irregularly bordered brown-to-gray patches on sun-exposed facial skin, and as nonscaly, not firm to the touch, and symptom-free. A pigmented patch that breaks that description earns a dermatology look rather than more sunscreen: one sitting on a single side, one that feels raised or firm, one that scales, itches, or keeps shifting. Pigment that follows an inflammatory rash or a new medication may be post-inflammatory hyperpigmentation or drug-induced pigmentation instead, and those are handled differently. Blue-black darkening after long stretches of hydroquinone is its own flag, since exogenous ochronosis works against the reason the cream was there. If you are ever unsure which side of the line you are on, make the call. Obstetric teams handle these check-ins as routine, not as overreacting.