Health for Life M.D.: Skin Care

Dallas, Texas: Is it safe for a pregnant woman to get a chemical peel or microdermabrasion? Are there other skin-care products that I should avoid?

A good rule is to avoid all medically nonnecessary procedures and treatments during pregnancy. However, because microdermabrasion is only a mechanical process, it should be completely safe during pregnancy, except for the very minor stress associated with the procedure. How safe a chemical peel is depends on the agent being used in the peel. For example, deep peels with phenol should absolutely be avoided; but a superficial peel with alpha hydroxy acids is very unlikely to be a problem. Tretinoin, the active ingredient in Retin-A and Renova, and other retinoids should also be avoided during pregnancy. Unfortunately we know very little about the safety of topical over-the-counter products during pregnancy. Most are probably safe. Still, it is prudent to use only what is needed during pregnancy, which for most people is soap, moisturizers and sunscreen, particularly those that contain physical blocks such as titanium dioxides.

Seattle, Wash.: When I go out in the sun, even when I wear sunscreen, I get brown blotches all over my forehead, cheeks and upper lip. My dermatologist says the only thing that can be done is to wear sunblock and a hat whenever I'm outside. Is there anything else I can do?

The problem you describe is most likely a condition called melasma. For reasons not now understood, the melanocytes (pigment-producing cells) in the areas you describe have been changed in a way that causes them to produce more melanin than the same cells in surrounding areas. Sunlight exposure increases the contrast between affected and surrounding skin. Although melasma can occur in anyone, most people affected by it are women who are using or have used oral contraceptives or are or have been pregnant. The condition may first appear while using oral contraceptives, during pregnancy, or up to a year or more afterward. Unfortunately, once melasma has occurred, it may recur at any time and often persists long after a person has stopped birth-control pills or is no longer pregnant. Melasma can be treated with a variety of topical therapies including retinoids, such as Tretinoin (Retin-A), and "bleaching agents" that contain hydroquinone. Chemical peels and laser have also been tried with varying results. Success rates for all treatments are modest. Unfortunately, even if the pigmentation is lightened, unprotected sunlight exposure often causes it to reappear. Therefore, very vigorous sun protection using agents that block UVB and UVA, such as the products you describe, is essential.

Stern is chairman of the Department of Dermatology at the Beth Israel Deaconess Medical Center and the Carl J. Herzog professor of dermatology at Harvard Medical School. He joined the staffs at both institutions in 1976. In addition to patient care and teaching of residents and students at the Beth Israel Deaconess Medical Center and Harvard Medical School, his research has focused on the prevention and treatment of skin diseases including skin cancer, photoaging, psoriasis and acne. He has served as coeditor of two dermatology journals and on the editorial board of other journals and he recently completed a service as chairman of the USFDA Dermatologic Drug Advisory Committee. For more information, go to www.health.harvard.edu Readers should consult a medical professional for an accurate diagnosis.

© 2006