If I’m fortunate enough to have my question chosen, I know you’ll need a headline. I guess mine would be, “What is the ideal treatment regimen for post-pregnancy dark spots?” The longer explanation is I’m 35, and this pregnancy (a rainbow baby, who, despite my bitching, I am extremely grateful for) has kicked my ass.
My first pregnancy I was religiously using Drunk Elephant and Elta MD, but this time around, it’s an actual miracle if I wash my face once a day. My prized, pregnancy-safe SkinCeuticals haul is rotting in a drawer while I attempt to survive raging heartburn that is apparently triggered by oxygen, lower back pain that has given me a peg leg, and absolute exhaustion. So I know this is a less-than-ideal foundation for my post-pregnancy attack on dark spots and melasma, but here we are.
I am willing to do anything and spend almost anything once I have reasonable control over my faculties again, and I know you will have the most up-to-date, well-researched, and innovative advice on the block.
Kudos to you for keeping up with your skin care during your first pregnancy, and even bigger kudos for recognizing that it’s not going to happen this time around. Just bookmark this page to come back to after your baby’s here, go lie down — in whatever position is the most comfortable and least-heartburn-inducing — and let go of any guilt. Even if you had been slathering on skin care and sunscreen from day one of this pregnancy, it wouldn’t guarantee you’d end up with your skin looking the same as it did last time. Every pregnancy is unique. Whatever state your skin is in after this, it will be fixable. So I’ll see you back here in a few months.
[To be read after your pregnancy:]
Hey, Kara, welcome back! I hope the rest of your pregnancy went well and that you’re not too burned out. If your skin is still spotty and you’re ready to treat it, the first thing to do is find a sunscreen you like (sounds like yours might be Elta MD) and apply it every single damn day. Without fail. Whether you’re dealing with little freckles, big dark spots, or melasma (which we’ll get to), sun protection is key. Aesthetician Shani Darden, who got melasma above her upper lip after the birth of her first daughter, swipes a thick layer of Supergoop’s Sunnyscreen Stick on that area when she’s outside. And speaking of the great outdoors: Get a tightly woven, wide-brimmed hat (I love this one) and wear it whenever you’re in the sun for extended periods.
Next up, get back on a skin-care regimen. Your spots are caused by an excess of melanin, and melanin biosynthesis is a complicated process, so there’s not one magic ingredient. You need several ingredients that target the different pathways to pigmentation, according to dermatologist Shereene Idriss, M.D., who has struggled with post-pregnancy pigmentation and researched the topic extensively (watch this video for proof). She says the topicals with the best proven track record are “kojic acid, alpha arbutin, and tranexamic acid; chemical exfoliation using glycolic or lactic acid; and retinol.” You’re not going to find all of those ingredients in one product — nor would you want to. The first three are skin brighteners, which you can use every day, or even twice a day, depending on the type of product you get (most likely a serum or moisturizer). The glycolic and lactic acids and the retinol should be in separate products so you can adjust how frequently you use them, depending on how your skin reacts.
If you like SkinCeuticals, its Discoloration Defense (serum) plus Phyto A+ Brightening Treatment (moisturizer) would get you the first three ingredients. And Drunk Elephant’s A-Passioni could serve as your retinol. For chemical exfoliation, PillowtalkDerm’s Major Fade Flash Mask would be perfect; it’s a gentle blend of glycolic and lactic with some added skin brighteners in the mix. Give yourself at least a month on whatever regimen you choose, and if you don’t notice any improvement, head to a dermatologist. Your spots may benefit from a prescription retinoid or other prescription-strength topicals.
A dermatologist can also determine if you have melasma, irregularly shaped blotches of light- to dark-brown pigmentation that often show up during or after pregnancy. “It can be a lot more stubborn than general hyperpigmentation,” says Darden, who ended up on a prescription treatment for her own melasma. Or, as Idriss likes to say: “Melasma is a bitch.”
If your dermatologist diagnoses you with the condition, they’ll likely start you on a prescription for hydroquinone, which “needs to be used cyclically under the supervision of a board-certified derm,” says Idriss. (FYI: Hydroquinone may not be for everyone and is not recommended if you are breastfeeding.) If that doesn’t help, Idriss says the next step, after speaking with your OB/GYN, would be to try oral tranexamic acid (TXA) pills. In low doses, oral TXA can slow melanin synthesis and help to reverse some of the pigmentation caused by melasma. And if that doesn’t do the trick, they’ll talk to you about laser treatments. But “lasers are a last resort because results aren’t long term,” says Idriss. “Melasma is a condition you have to consistently treat.”
So even if you end up with a melasma diagnosis and get the in-office treatments, you still have to keep up with the at-home skin care and sun protection. Idriss actually wears a full-face UV shield when she’s outside (hers is from Oidon). And Darden says heat can also exacerbate melasma, so you’ll want to do everything you can to stay cool (she likes to use a portable fan when she’s in the sun).
I know all of the above sounds like a lot of trial and error and a lot of work — I’m sorry I don’t have a quick fix to give you! Skin-cell turnover takes 40 to 65 days, so it can be six to eight weeks before you start to see improvements. But think of it this way: You’ve just been through a difficult pregnancy and you’re raising two kids, so you know how to do hard things. Good luck, and drop me a line to let me know how it’s going.