Gravidarian melasma L81.4

Non-pathological, usually blurred, large or small spots, closed or reticular hyperpigmentation (melanosis) in the facial area acquired during pregnancy. Facial pregnancy pigmentation affects brunette skin types more than very fair skin types.

Melasma gravidarum occurs in about 10% of pregnant women (Estève E et al. 1994).

This is due to the increased production of estrogens, progesterone and MSH. In exposed skin areas UV leads to an additive pigmentation effect.

Forehead, cheeks (zygomatic region), upper lip, nose, temple and lower jaw region.

Usually sharply or reticulated, irregularly shaped, often symmetrical, brown-grey to deep brown, areal, bizarrely shaped hyperpigmentations that can confluent to larger areas.

Textile light protection is recommended. Various bleaching creams are not recommended during pregnancy. After breastfeeding, persistent melasma gravidarum can be treated like any other melasma (see there).

Analogous to the Psoriasis Area and Severity Index (PASI) the Melasma Assessment Severity Index(MASI) was developed.

1. Ambros-Rudolph C (2018) Pregnancy dermatoses. In: G. Plewig et al. (ed.), Braun-Falco`s Dermatology, Venerology and Allergology, Springer Reference Medicine. S. 1521
2. Errickson CV et al (1994) Skin disorders of pregnancy. On Fam Physician 49:605-610.
3. Estève E et al (1994) Physiological cutaneous signs in normal pregnancy: a study of 60 pregnant women.Ann Dermatol Venereol 121:227-231.
4. Motosko CC et al (2017) Physiologic changes of pregnancy: A review of the literature. Int J Women's Dermatol 3:219-224.
5. Tunzi M et al (2007) Common skin conditions during pregnancy. On Fam Physician 75:211-218.