Stubborn discoloration: a Common Skin Problem and Solutions


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Are you searching for how to get rid of pigmented marks? If so, you have come to the right place. stubborn discoloration is a burdensome condition that affects many women – especially pregnant women. If you are dealing with the dreaded “pregnancy mask,” you are not alone. Fortunately, stubborn discoloration is a condition that can be corrected with remarkable success.

Stubborn discoloration, (also known as chloasma faciei, or the mask of pregnancy when present in pregnant women) is a tan or dark skin discoloration. Although it can affect anyone, stubborn discoloration is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications.

Signs and symptoms

The symptoms of stubborn discoloration are dark, irregular well demarcated pigmented macules to patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Stubborn discoloration does not cause any other symptoms beyond the cosmetic discoloration. Stubborn discoloration is also common in pre-menopausal women. It is thought to be enhanced by surges in certain hormones.

Stubborn discoloration Causes

Stubborn discoloration is thought to be the stimulation of melanocytes (cells in the epidermal layer of skin that produce a pigment called melanin) by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to sun. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.

Genetic predisposition is also a major factor in determining whether someone will develop stubborn discoloration.

The incidence of stubborn discoloration also increases in patients with thyroid disease. It is thought that the overproduction of melanocyte-stimulating hormone (MSH) brought on by stress can cause outbreaks of this condition. Other rare causes of stubborn discoloration include allergic reaction to medications and cosmetics.

Stubborn discoloration Suprarenale (Latin – above the kidneys) is a symptom of Addison’s disease, particularly when caused by pressure or minor injury to the skin, as discovered by Dr. FJJ Schmidt of Rotterdam in 1859.


Stubborn pigmentation is usually diagnosed visually or with assistance of a Wood’s lamp (340 – 400 nm wavelength). Under Wood’s lamp, excess melanin in the epidermis can be distinguished from that of the dermis.


The discoloration usually disappears spontaneously over a period of several months after giving birth or stopping the oral contraceptives or hormone replacement therapy.

solutions are often ineffective as it comes back with continued exposure to the sun. Assessment by a dermatologist will help guide solution. This may include use of a Woods lamp to determine depth of the stubborn discoloration pigment. solutions to hasten the fading of the discolored patches include:

  • Cysteamine hydrochloride (5%) over-the-counter. Mechanism of action seems to involve inhibition of melanin synthesis pathway.

  • Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (2%) or prescription (4%) strength. HQ is a chemical that inhibits tyrosinase, an enzyme involved in the production of melanin.

  • Tretinoin, an acid that increases skin cell (keratinocyte) turnover. This treatment cannot be used during pregnancy.

  • Azelaic acid (20%), thought to decrease the activity of melanocytes.

  • Tranexamic acid by mouth has shown to provide rapid and sustained lightening in melasma by decreasing melanogenesis in epidermal melanocytes.

  • Flutamide (1%).

  • Chemical peels.

  • Microdermabrasion to dermabrasion (light to deep).

  • Galvanic or ultrasound facials with a combination of a topical crème/gel. Either in an aesthetician’s office or as a home massager unit.

  • Laser but not IPL (IPL can make the melasma darker)

Evidence-based reviews found that the most effective therapy for stubborn discoloration includes a combination on topical agents.

In all of these treatments the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over that with only chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.

Patients should avoid other precipitants including hormonal triggers.

Cosmetic camouflage can also be used to hide stubborn discoloration.

published by Natalia Cadavid on, on: November 22th, 2017