This condition is known as melasma or cholasma gravidarum. It occurs when melanocytes, the cells that give skin its color, increase their production of melanin, the skin color pigment. Hormonal changes during pregnancy can induce melasma. It usually fades away within few months after delivery.
There is a number of topical treatments available and safe for use in pregnancy:
1- Hydroquinone 2-4% is the 1st line of treatment, it works by preventing new pigment formation by inhibiting formation of melanin by the melanocytes. It's available as cream or lotion, applied accurately to pigmented areas at night for 2 to 4 months. It could cause contact dermatitis (stinging and redness in 25%). It should not be used in higher concentration or for a long duration as it has been associated with ochronosis (a bluish grey discoloration).
2- Azelaic acid cream, lotion or gel can be for long periods of time, and is safe even in pregnancy. This may also sting.
3- Ascorbic acid (vitamin C) inhibits pigment production. It has a safe profile but is highly unstable, so is usually combined with other agents.
4-Topical corticosteroids such as hydrocortisone, act fast to fade the brown color and reduce the likelihood of a contact dermatitis caused by other agents.
5- Soybean extract may be useful.
6- Peeling: with creams based on glycolic acid and lactic acid.
Currently, the most effective has been a combination of hydroquinone, tretinoin, and moderate potency topical steroid. In your case, since you cannot use tretinoin (it causes birth defects), you could resort to hydroquinone plus steroids.
Don't forget to use sunscreen (at least 30 SPF) daily.
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Annual Checkup
It is recommended that all individuals see a Family Doctor for a full medical examination annually. Adults should get their blood pressure checked (US Preventive Task Force), a flu vaccine (CDC) and more each year.
The American Dental Association recommends dental cleanings for adults at least twice annually. Some stains can only be removed by a professional cleaning.
It’s recommended by the American Academy of Ophthalmology that every adult between the ages of 18 and 80 does an eye examination at least once every two years.
It's recommended by the American Cancer Association that every adult between the age of 20 and 80 does an annual skin screening by a licensed dermatologist.
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