"Fluctuations in hormones can lead to hyperpigmentation or melasma, and this occurs most commonly in women," says Dennis Gross, MD, board-certified dermatologist in New York and founder of Dr. Dennis Gross Skincare. "Estrogen and progesterone, the female sex hormones, stimulate the overproduction of melanin which leads to dark spots. Dark spots due to hormonal fluctuations are more prevalent in darker skin tones—the skin is already creating melanin, which is what gives it a darker color, and when hormones trigger an increase in this melanin production, you're more susceptible to hyperpigmentation."
While not all hormones can play into different types of hyperpigmentation, the most common is melasma. "It's the skin condition where hormones play a huge role—so those dark patches on the cheeks, sometimes the forehead, and the upper lip typically occur during pregnancy and when taking birth control," says Heather Woolery-Lloyd, MD, a Miami-based dermatologist. "We think it's the estrogen. Estrogen interferes with how we make melanin, so high-in-estrogen conditions like pregnancy or taking birth control can lead to melasma."
According to Dr. Woolery-Lloyd, pigmentation issues can get more pronounced in pregnancy, even if it's not directly melasma. "When women are pregnant, whether they get melasma or not, they tend to see parts of their body get darker," she says. "The abdomen gets darker, you'll sometimes see a line from the bellybutton down, the underarms get dark, and the neck gets dark. That's very common in pregnancy due to hormones. But as soon as the baby comes out, the pigmentation returns to normal, in most cases."
For those whose spots remain, it can be really hard to treat (as is the case with other forms of hyperpigmentation. "You need to be gentle enough to ensure that you don’t irritate or inflame the skin to the point where you are causing post-inflammatory hyperpigmentation," explains Dr. Gross. The best way to go about it? Allowing for slow, gradual change, using brightening skin-care products. Think vitamin C, chemical exfoliating acids, and retinol.
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