Some degree of hyperpigmentation
develops in most pregnant
women. This coloration is more pronounced
in dark-skinned women; on
naturally pigmented areas, such as the
areolae, perineum, and umbilicus; and
on the axillae, inner thighs, and other
regions that are prone to friction.
The exact cause of physiologic
hyperpigmentation is not known.
levels are markedly elevated during
pregnancy. Estrogen and progesterone
reportedly have melanocytestimulating
effects. In pregnancy,
hypertrophy of the intermediate
lobe of the pituitary gland occurs
with increased metabolism of proopiomelanocortin
Oral contraceptives may produce
similar cutaneous changes.
Hyperpigmentation in a black
woman. The abdomen of a 25-yearold
African American woman in the
third trimester of pregnancy showed
linea nigra, intense linear hyperpigmentation
from the symphysis pubis
to the umbilicus (Figure 5). Less
pronounced hyperpigmentation was
noted from the umbilicus to the xiphoid
process; numerous striae also
Dark pigmentation in a white
woman.Increasing pigmentation of
the umbilicus began in the first
trimester of a 34-year-old woman's
pregnancy. The area continued to
darken until term (Figure 6). The
fine scar that bisects the patient's
umbilicus resulted from a previous
Chloasma. The "mask of pregnancy,"
or chloasma or melasma
gravidarum, is seen on a 28-year-old
woman who was 2 years postpartum
(Figure 7). The patient was gravida
5, para 3, aborta 2; her last child was
delivered by cesarean section because
of a breech presentation. After
delivery, the patient received 2 injections
of medroxyprogesterone, 150 mg,
3 months apart.
The discoloration developed initially
during the fifth month of her
pregnancy; it intensified throughout
the remainder of gestation and has
remained unchanged since delivery.
Exposure to sun temporarily heightens
the coloration. The patient has
not taken oral contraceptives or hormones
other than the medroxyprogesterone
injections since delivery.
In most women, the hyperpigmentation
regresses markedly or disappears
completely after delivery. A
hydroquinone cream can be used to
bleach or lighten the discoloration.
(Cases and photographs courtesy of Dr Robert P. Blereau.)
1. Shornick JK, Meek TJ, Nesbitt LT Jr, Gilliam JN.
Herpes gestationis in blacks. Arch Dermatol. 1984;
2. Winton GB, Lewis CW. Dermatoses in pregnancy.
J Am Acad Dermatol. 1982;6:977-998.
3. Kolodny RC. Herpes gestationis. A new assessment
of incidence, diagnosis, and fetal prognosis.
Am J Obstet Gynecol. 1969;104:39-45.
4. Holmes RC, Black MM. The fetal prognosis in
pemphigoid gestationis (herpes gestationis). Br J
5. Shornick JK. Herpes gestationis. J Am Acad Dermatol.