After having my first child I was surprised at how much pregnancy affected my skin. There are so many changes that, even as a dermatologist, I was totally unaware of until it actually happened to me. The most common complaint my patients have during pregnancy is acne. The good news is that acne during pregnancy usually gets better after the first trimester. The bad news is that there are only a few treatments available during pregnancy. While pregnant, women can typically usually use benzoyl peroxide and topical antibiotics. I also frequently prescribe azaleic acid which is safe during pregnancy. Topical retinoids cannot be used during pregnancy and I also do not recommend chemical peels. Microdermabrasion is a better option.
Another common complaint is hyperpigmentation. In women with darker skin, the hyperpigmentation can occur almost everywhere. The underarms, neck, and abdomen are very common locations, however, even the posterior thighs can get darker. This is a natural process and is likely due to an increase in estrogen. Fortunately, generalized hyperpigmentation does resolve after pregnancy, although it can take up to one year for some parts of the body to go back to the normal skin tone.
Melasma are the brown patches on the face that some women get during pregnancy. This is more common in Latina and Asian women but can occur in any skin type. This condition is so common during pregnancy that it used to be called “the mask of pregnancy”. While pregnant the best way to address melasma is to wear a lot of sunscreen to prevent it. The good news is that for most women, melasma resolves after pregnancy. For the unlucky few who have persistent melasma, there are many treatment options available.
There are many ways to protect yourself from the sun…sunscreen, hats, umbrellas. But did you know that there are pills that offer sun protection also? These pills contain potent antioxidants that reduce free radical damage from harmful ultraviolet rays. Oral antioxidants do not replace sunscreen but prevent damage from the rays that do reach the skin.
In one study in women with melasma, they demonstrated improvement in the melasma with daily use of an oral antioxidant pill. I also did a study with polypodium leucotomos compared to a placebo pill for melasma and found that the participants that took the antioxidant pill improved. Polypodium leucotomos is an antioxidant that comes from a tropical fern. Heliocare and SunPill are two brands that contain this antioxidant. Other studies have been done with ellagic acid (pomegranate extract) and demonstrated similar results.
Based on these studies, even simply consuming a diet rich in fruits and vegetables likely has beneficial effects. For the ultimate in sun protection, add an oral antioxidant to your daily regimen. This simple intervention can help to protect against wrinkles, uneven skin tone, and hyperpigmentation caused by damaging ultraviolet light.
Recently you may have noticed that many sunscreens are adding antioxidants to their formulations. This is a trend that is based on interesting new research. Recent research has shown that when antioxidants are applied topically to the skin they protect the skin from free radical damage caused by the sun. These studies have been done with many antioxidants including green tea and emblica, a natural fruit extract. They have been able to show that the skin gets less red (and therefore less damage) when you add an antioxidant to the sunscreen. It is important to understand that antioxidants don’t replace sunblock because they don’t block the sun’s rays from entering the skin. However, they are excellent when combined with sunscreens because they minimize the damage caused by the ultraviolet light that does get through to the skin. So for those of you with hyperpigmentation, melasma, or uneven skin tone, using a sunscreen with an antioxidant is the best first defense.
Hydroquinone is a naturally occurring chemical that inhibits the enzyme that makes pigment in our skin. When used appropriately it offers a safe and very effective therapy to treat hyperpigmentation and dark spots. In my practice I use hydroquinone frequently for many of my patients that complain of uneven pigmentation, dark marks from acne, and melasma.
So you might ask, why does hydroquinone have such “bad press”. Well there are many reasons for this, some are valid and some are not so valid. The main problem with hydroquinone is that with continued long term use, hydroquinone has been associated with a paradoxical darkening of the skin. This condition is called ochronosis and is more common in other parts of the world where hydroquinone is used extensively without regulation. To avoid this rare but significant side effect, I educate my patients on its use.
First and foremost, hydroquinone should not be used for long periods of time. I try to limit treatment to 1 to 3 months. Then I switch to an alternative therapy to maintain results. Secondly, hydroquinone must be used with sunscreen. Many dermatologists believe that sun exposure (without sun protection) may be implicated in ochronosis. Last but not least, I always emphasize to patients that if there is any significant irritation they should discontinue use. Some patients mistakenly believe that if the skin needs to be red or peeling for the product to work, however, with hydroquinone this could represent an allergic reaction that can heal with dark patches.
Following these simple rules, one can safely use hydroquinone to treat dark marks and hyperpigmentation. The good news is that new treatments are being developed that may offer the benefits of hydroquinone without all of the side effects. This is a big area of research in dermatology right now. I will keep you posted!