Birth control is good for many things—clearing up acne and excess oil, lessening heavy periods and PMS symptoms, and preventing pregnancy. For many women, it’s a little miracle pill known to take care of a wide range of life’s minor annoyances. But it may present other concerns for some. Alternatively, the pill that may keep your skin clear and acne-free could also be equally troublesome and contribute to dark spots. Though everyone's experiences with the pill are unique, We spoke with dermatologists Corey L. Hartman, Joshua Zeichner, and Hadley King, about some of the ways the pill might flare up your melasma.
Meet the Expert
- Dr. Corey L. Hartman is a board-certified dermatologist and founder and medical director of Skin Wellness Dermatology in Alabama. He is Assistant Clinical Professor of Dermatology at the University of Alabama School of Medicine.
- Dr. Joshua Zeichner, M.D. is a dermatologist, as well as the Director of Cosmetic and Clinical Research in Dermatology at the Mount Sinai Hospital in New York City.
- Dr. Hadley King is a board-certified dermatologist specializing in cosmetic and surgical dermatology. She is the owner of Dr. Hadley King dermatology in New York City.
Can Birth Control Cause Melasma?
Have you ever heard of the “mask of pregnancy,” an area on the face (usually from the upper lip to forehead) that's covered in brown spots? It's common in pregnant women, but melasma (as it's more often referred to) affects plenty of women who are not expecting. According to Hartman, melasma is a pigmentary disorder that is common and complex. "Melasma appears as lacy, reticulated brown patches on sun-exposed skin," Hartman explains. "It exists at the intersection of ultraviolet light exposure, heat exposure, and hormone changes." Its association with hormones is what earned melasma the name "mask of pregnancy" Hartman explains. "Hormones are active during pregnancy and it can be a trigger for melasma," he says. "However it's not the only trigger."
Menopause, oral contraceptives, and even regular monthly hormone fluctuations can cause melasma to worsen "particularly if the skin is exposed to the sun or extreme heat," explains Hartman.
What Types of Birth Control Can Cause Melasma?
Hormonal contraceptives use estrogen and progesterone (or progesterone only) to prevent pregnancy. And whether you practice hormonal birth control by taking an oral contraceptive, using an IUD, or wearing a patch, all are equal in terms of their association with melasma. According to King, "Any hormonal birth control may contribute to melasma."
There are many different forms of contraceptives on the market, and King notes that no one is better than the other in terms of preventing melasma. If you're considering stopping birth control in hopes of stopping dark spots, King encourages you to manage your expectations. "It's likely to improve but it won't necessarily completely go away," she explains.
Birth Controls That Don't Cause Melasma
Non-hormonal birth control (think: condoms and diaphragms), as well as the barrier method, are not believed to spawn melasma. However, if you are using non-hormonal contraceptives and have melasma, it's worth investigating other possible sources. Zeichner tells us that the cause of melasma may be difficult to identify in some patients but it can be genetic.
Treatment Methods for Melasma
Experts recommend talking to your dermatologist to map out the best treatment plan for your melasma. This is because treatment looks different for everyone. However, Hartman says that while melasma can be treated, it cannot be cured. "Therapies include topical lightening agents like hydroquinone, cysteamine, tranexamic acid, and azelaic acid," he explains. "Lasers like Picosure and Fraxel, chemical peels, and microneedling are also potential treatment options." According to Hartman, a Picosure laser is especially effective for more stubborn cases of melasma. "It's a great option, especially for stubborn dermal melasma that is deeper in the skin and more difficult to treat," he says. "Though we've been using it for melasma for years, it recently gained official FDA approval for melasma as well."
While the majority of those options should be discussed with your doctor, there is one thing you can do to protect your skin before booking a trip to the derm. "Sun protection is the most important thing you can do to prevent sun-related dark spots like lentigines and melasma," King says. "Sun protection and avoidance are critical. That means you should apply a broad-spectrum sunscreen with SPF 30 or higher daily," she explains. "This combined with other sun-smart behaviors like avoiding peak UV hours, seeking shade, and wearing protective clothing like a broad-brimmed hat and UV-shielding sunglasses."
You can also use a variety of over-the-counter ingredients targeted to reduce the appearance of dark spots. These ingredients should also be used in conjunction with an SPF. King recommends kojic acid for managing dark spots. "Kojic acid is a chemical produced from some types of fungi," she says. "It works by blocking tyrosine from forming, which then prevents melanin production." Niacinamide is also recommended by King. Research has found that niacinamide can lessen the appearance of age spots and other pigmentation concerns.
Additionally, your skin may benefit from antioxidants like licorice extract, King says. "Licorice extract contains concentrations of flavonoids that equip the skin with antioxidant properties, which work to neutralize free radicals present in the environment," King says. "Topical application of skincare products infused with licorice extract can help to provide a healthy glow as well as enhance the skin's overall quality and appearance."
Hartman recommends Cyspera, a non-hydroquinone alternative for fading dark spots. "It works as well as hydroquinone to lighten dark spots and provide a more even complexion. Used once a day for only fifteen minutes, it's a game-changer product for discoloration," he says. "Retinols also help with discoloration. Start slowly, though, as irritation can occur when they are first introduced."
When to See a Professional
If you notice symptoms of melasma—or at least, what appears to be melasma—it's always best to check with a dermatologist. They will be able to confirm whether your symptoms are associated with melasma or are related to something else.
The Final Takeaway
While melasma, like any skin condition, can be frustrating to treat, it isn't impossible, though the causes may feel ambiguous. While there are many steps you can take in your skincare routine to help prevent further hyperpigmentation of your skin, your best bet is to speak to your doctor or dermatologist to help better understand if your birth control is impacting your skin. Regardless, they'll be able to tailor the best plan of action for your health and skin.
Cleveland Clinic. Birth Control: the Pill. Updated July 21, 2020.
Cleveland Clinic. Melasma. Updated July 27, 2020.
Navarrete-Solís J, Castanedo-Cázares JP, Torres-Álvarez B, et al. A double-blind, randomized clinical trial of niacinamide 4% versus hydroquinone 4% in the treatment of melasma. Dermatol Res Pract. 2011;2011:379173. doi:10.1155/2011/379173