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Can birth control pills cause melasma?

Birth control pills that contain estrogen can cause melasma--patchy, irregular brown spots on the face and neck. Melasma is also called chloasma or "pregnancy mask," since it may also appear during pregnancy. You may not like the look of melasma, but it is not dangerous.

A tendency to develop melasma appears to be hereditary, and exposure to sunlight worsens it. In most women, the spots will fade after they give birth or stop taking birth control pills. But the spots sometimes do persist.

All estrogen-containing birth control pills have the potential to cause melasma. But it’s less likely to occur with birth control pills that contain relatively low amounts of estrogen, such as Loestrin, Alesse, >Demulen, or Estrostep. Nonestrogen birth control pills such as >Nor-QD and Micronor are also unlikely to cause melasma.

The best way to prevent or reduce melasma is to limit sun exposure. When outdoors, use a sunscreen with an SPF of at least 15 that blocks both UVA and UVB rays. Examples include Eucerin Daily Sun Defense SPF 15, Sensitive Skin Lotion and Bain de Soleil Oil-Free Faces Sunscreen SPF 15.

Over-the-counter skin bleaches that contain hydroquinone (such as >Ambi) can help fade existing melasma spots. Products containing both hydroquinone and glycolic acid (M.D. Forte Skin Bleaching Gel) or kojic acid (Philosophy When Lightening Strikes) may also help fade melasma spots. Hydroquinone is also available in higher strengths by prescription. Other possible treatments include Azelaic acid and Tretinoin. If you are pregnant or aren't sure whether you have melasma, check with your doctor before trying skin bleaches.

Sources:
Contraceptive Technology. Ardent Media, 1998.
Dickey, R. P. Managing Contraceptive Pill Patients. EMIS Inc., 1998.
Gabbe. Obstetrics--Normal and Problem Pregnancies. Churchill Livingstone, Inc., 1996.
Garcia A. “The Combination of Glycolic Acid and Hydroquinone or Kojic Acid for the Treatment of Melasma and Related Conditions.” Dermatological Surgery 22(5) 1996.
Habif, Thomas. Clinical Dermatology. Mosby-Year Book Inc., 1996.
Medline Plus. Medline, 2006.
Rakel. Conn's Current Therapy. W. B. Saunders Company, 2000.

This response prepared 6/7/2001.
This information updated 2/6/2007.

>Loestrin
>Estrostep.
>Micronor
>glycolic acid

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