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Pregnancy Skin Problems: Melasma vs. Rosacea

Pregnancy Skin Problems: Melasma vs. Rosacea

By Amalah

Dear Amy,

I am trying to have a second child, but am a bit nervous because the first pregnancy wreaked havoc on my face. (I feel like I am ready to handle the heartburn, tiredness, 7 months of throwing up, and preeclampsia again.) I developed the dreaded “mask of pregnancy”, which in my case was not a dark discoloration but fire engine red and bumpy which by the end of the pregnancy covered half of my forehead, my nose, under my eyes and some of my chin. It was so bad that before I started wearing heavy concealer, people asked me if I had burned my face (with boiling water, not the sun). I had originally thought it was a just a red rash that I would be able to treat with medicine after I gave birth, but one of the hospital nurses took one look at me and said “Oh, you have the mask of pregnancy. Mine was red too.” Not helpful. Is there any way to head off the mask of pregnancy burn that looks like I should be in the ER?

Also, while most of it faded I still have a large, really dark area smack in the middle of my forehead. People who don’t see me very often, i.e. family members who remember what I looked like, ask if it is a bruise. Any OTC products I have looked at use bleach to fade dark spots and you have to be really careful where you put the stuff so that you don’t bleach out an area of skin that doesn’t need it. I am not willing to use bleach on my face. Is there any way other than bleach to fade the current dark area? If it works, hopefully if this happens again with the second pregnancy I will have some knowledge of what to do about it.

Other information you might find useful: my child is 2 yrs old and I quit breastfeeding a year ago (therefore I have given up hope that once the hormones level out it will go away), I will turn 30 this year, I have oily, sensitive skin and don’t use much makeup. I don’t use makeup because I have yet to find an overall face product that doesn’t take much time to use and doesn’t make my face break out. Any advice would be greatly appreciated.

Dreading Pregnancy Skin

Okay, so I am not a dermatologist, but despite what that nurse said to you,  most of your symptoms are not really jibbing with melasma, aka the “mask of pregnancy.” Melasma is a general darkening of the pigment of your skin. Brown, not red. It’s brought on by sun exposure, and pregnancy hormones tend to exacerbate the symptoms. Keeping your face out of the sun and wearing a good sunblock every day, no matter what, are the best preventative bets. It typically goes away on its own, but it’s also common for a couple spots to stick around. I recommend either Murad’s Rapid Age Spot & Lightening Serum or Clinique’s Even Better Clinical Dark Spot Corrector.  A dermatologist can also treat stubborn dark spots by freezing or lasering them, or with a prescription compound cream.

But. You, OP, should probably ignore everything I just said.

What you’re describing — an all-over red and bumpy rash — was probably not melasma. That sounds more like a really severe rosacea flare-up, which (YAY OF COURSE) is also a common pregnancy skin problem. Google it and look at some pictures and see if what you had looked similar. I highly, highly recommend you make an appointment with a dermatologist to discuss this, because it’s important to know 100% what you’re dealing with.

It’s entirely possible you suffered from both (oh God, you poor thing), since the remaining darkish spot on your forehead could be melasma. Or it could still be something stemming from the rosacea (if it’s still slightly red). Either way, definitely see a dermatologist before trying to treat it with anything OTC. Rosacea is typically best treated via prescription products, and even if it IS melasma, since it’s been present for a couple years I suspect OTC dark spot products will have little effect on it anyway. And while you’re there, ask him/her your questions about possible treatment options during pregnancy if the redness/bumpiness does flare up again.

Which: Who knows. It might. It might not. I personally had a few common symptoms throughout all three pregnancies, but there were plenty of things that happened only once, or presented slightly differently each time, in terms of severeness. But hopefully a dermatologist will be able to offer you some options this time, since you’ll be prepared and at least sort of know what to expect, the next time you’re expecting.


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About the Author

Amy Corbett Storch


Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to [email protected].

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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  • Avid Amalah Fan

    August 27, 2014 at 1:16 pm

    Definitely see a dermatologist. I have rosacea, and couldn’t do anything about it while pregnant – no topical products, and no laser treatments. The dermatologist said that laser treatments while nursing were fine. They have a new product that really helps with rosacea (if that is what you have) that prevents the flushing. This products is not consistent with nursing so you would have to wait until you are done. But the upside is that there are many products that help with rosacea and a GOOD dermatologist should be able to help you. If you happen to live near Boston, Dr. Tsao at MGH Derm is amazing. Good luck!

  • Lindsay

    August 27, 2014 at 2:49 pm

    I have rosacea and during pregnancy it flares up like crazy and sounds just like what you described. Unfortunately the only combo of drugs that clears it up for me is not safe to take while pregnant or breastfeeding. With my older daughter I literally was counting down the days until I could take it again! Definitely go see a dermatologist and see what advice they can give you.

  • Kari

    August 27, 2014 at 3:44 pm

    I had keratosis pilaris during (and after) pregnancy and breastfeeding on my face because of the hormones and it kind of sounds like what you are describing.
    The things that helped me were to be gentle gentle gentle with my face – I started washing my face with oil – a mixture of olive oil, castor oil, and tea tree oil (I know, I am one of those people) and I use amlactin lotion on my face in the mornings. On my arms and legs I use a natural body wash that has tea tree oil. It has helped a TON. The dermatologist really helped me get it under control. Good luck!

  • Candace

    August 27, 2014 at 4:46 pm

    I have had trouble skin since my early 20’s, and had it under control using a Clarisonic and a natural cleanser. It wasn’t great, but it wasn’t bad. Then I started using Rodan + Fields. It’s a direct-sell company which some people don’t like (I don’t sell, I just use the product), but I truly love their products, and my skin is good enough to go makeup-free since I started using it. Then, when I got pregnant I was extremely worried about how my very sensitive skin would react- I have seen no change, and I truly think that it is due to R+F. They make products to help deal with redness as well as to help fade spots.. I would highly recommend the products.

  • Danielle

    August 28, 2014 at 12:20 am

    Oh, I had rosacea after pregnancy too! It’s awful, but can be fixed. Paula’s Choice (on-line only) worked great for me. Fragrance free, dye free, and guaranteed 30 day money back. She has an entire line devoted to rosacea.

    I am not a representative for Paula’s choice and I get nothing for this recommendation.

  • CalicoSarah

    August 28, 2014 at 1:33 pm

    I had Rosacea while I was pregnant and the dermatologist said there was only one topical cream that was approved during pregnancy and nursing. It helped a lot. I flushed right through concealer and foundation so I didn’t bother with makeup.

  • BeeBelle

    September 18, 2014 at 10:56 pm

    I had really bad rosacea that started during pregnancy. I tried oral meds and ended up with an ulcer from them (they worked, though!). By the time I went back to a dermatologist children at my daughter’s preschool would ask me what happened to my face, and the red raised areas were big enough that I could see them, and they HURT. The dermatologist took pictures and did laser treatments. He wrote it up for a journal with the after pictures. Looking at both sets you could see a huge improvement, but it was still bad! I ended up in a trial that worked but I still use Metrogel to keep it under control in a few spots.

    The real reason I popped in was to say my “oily” skin at the time was in fact dry, sensitive skin crazy over-reacting to the oily skin products I was using! Do see a dermatologist, and prepare yourself for that possibility. If true, the bright side is you get to try all new products! (If you like that sort of thing.) There are a ton of things you should NOT do if it’s rosacea, so do find out for sure. Best wishes!