What effective melasma treatment is safe during pregnancy and breastfeeding?

Thanks for this excellent question. Treatment of melasma during pregnancy can be difficult. At our office we use a combination of strict sun protection with a physical sunscreen (titanium dioxide and zinc), azelaic acid, and the ZO non-hydroquinone bleaching system. This system is free of retinol and hydroquinone and utilizes skin brightners that are safe during pregnancy. It is very important to note that sun exposure anywhere on the body can exacerbate melasma. I hope this is helpful.
Kevin Cavanaugh, MD

Melasma treatment during pregnancy and breastfeeding can be challenging because treatment is limited. Azelaic acid, a topical prescription medicine, can be used during pregnancy as it is a pregnancy category B drug (which means animal studies have failed to show a risk to the fetus but there are no controlled studies on pregnant women). It can also be used during lactation although it is advised not to apply the medicine in areas where the infant may accidentally ingest it. Frequent sunscreen use would also be ok during pregnancy and breastfeeding to prevent melasma flares or worsening of melasma. Physical sunscreens, those that contain either zinc oxide or titanium dioxide, are safe to use during pregnancy. Treatments such as laser, microneedling, or peels are generally not considered during pregnancy given that the effects on the fetus are unknown. These treatments can be discussed with a board certified dermatologist after giving birth. Thanks for your question!