I’ve been asked why birth control pills cause skin discoloration. The fact is female’s hormones can cause the skin to become tan or brown. Generally speaking, it’s called melasma or chloasma and when it occurs during pregnancy it’s called the mask of pregnancy. The same female hormones estrogens which surge during your pregnancy is what causes the mask of pregnancy and those same female hormone estrogens are present in all birth control pills, hence the chloasma or melasma from birth control pills. Only about ten to twenty percent of women will get this from taking birth control pills. When it occurs, it’s generally on the face, the breasts and the abdomen and usually on the face it’s very symmetric so it occurs on both sides of the forehead, both upper cheeks, the whole upper lip and the chin. When it occurs on the abdomen, it’s usually a straight line up and down your stomach and it’s extremely sensitive to sunlight so if you have it and you go out in the sun without sun protection you can be sure it’s going to get much darker. We understand very well the science of why estrogens and ultraviolet-b independently and then even together cause the melanocytes -- your pigment forming cells -- to form more brown pigment. But what we don’t understand is why only those pigment cells in the distribution of this mask on your forehead, on your cheeks, your chin or breasts and abdomen, why only those pigment cells are the ones that are affected. After your pregnancy, or if you stop taking birth control pills, usually the discoloration will fade, not necessarily completely but usually it will fade. But whether it goes away but itself or goes away from treatment, it comes back very easily, almost as if you’ve been sensitized or you’re more susceptible. So, if you become pregnant again, or if you start taking a birth control pill again, you can be sure that discolorations are going to come back. But even without those estrogens, once you’ve had it, if you just go out in the sun without sun protection, it comes back again, almost as if the first experience with those estrogens had sensitized those cells and those areas just to be very sun sensitive. For the treatment of melasma or the mask of pregnancy, you can look at the episode on the treatment of melasma but this is a particular case where it’s so important to wear sunscreen everyday because you can be sure that without it, it’s going to come back and in this particular case, I believe that the chem-free sunscreens work better than traditional carbon based sunscreens.
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