Melasma & Dark Spot Treatments (Hydroquinone, Vitamin C, Azelaic Acid)
Everyday exposureBeauty & personal careAlso called · 10 names▾▴
pregnancy melasma, pregnancy mask, chloasma, dark spots pregnancy, brown patches on face, hydroquinone pregnancy, azelaic acid melasma, vitamin C pregnancy, melasma breastfeeding, pregnancy dark patches
Skin care
General information · effects depend on amount, timing, and how it is used. About these sources
Research strength: 3 / 5
ACOG recommends daily sunscreen and a wide-brimmed hat to help keep melasma from getting worse. AAD lists hydroquinone among ingredients not recommended during pregnancy, and Cassiano et al. also advise against its use and report substantial absorption; the pregnancy data are limited. A small study of mixed skin-lightening products did not isolate hydroquinone, and the reviewed sources do not report pregnancy outcome studies for topical vitamin C. Cassiano et al. describe azelaic acid as a topical treatment option, but the evidence differs by ingredient. Because the evidence differs by ingredient, this grouped entry is rated for use with a provider's input. Ask your provider about your situation.
Last reviewed: 2026-10-18
Research strength: 3 / 5
ACOG and AAD describe sun protection as a main step for pregnancy-related melasma. Wester et al. measured 45.3% plus or minus 11.2% in-vivo bioavailability after 24-hour use of radiolabeled 2% hydroquinone cream in volunteers; this was not a pregnancy study. Mahé et al. followed 99 women who were 6 to 9 months pregnant; the study found no difference in its main pregnancy outcomes between users of mixed skin-lightening products and other participants. Because hydroquinone was not studied on its own, that result does not establish its pregnancy outcomes. Cassiano et al. describe azelaic acid as a separate topical option. Because the evidence differs by ingredient, this grouped entry is rated for use with a provider's input. Ask your provider about your situation.
Last reviewed: 2026-10-18
Sources
- ACOG: Skin Conditions During PregnancyProfessional society
- AAD: Pregnancy Skin Care Guidance
- Wester et al. 1998, hydroquinone absorption studyUS government
- Mahé et al. 2007, pregnancy skin-lightener studyUS government
- Cassiano et al. 2022, Dermatology and TherapyUS government
- Bozzo et al. 2011, Canadian Family Physician reviewUS government
Research strength: 3 / 5
ACOG says pregnancy-related dark patches often fade after birth, though some can last for years. AAD lists hydroquinone among ingredients not recommended during pregnancy, while Cassiano et al. describe azelaic acid as a topical melasma option. Lakhdar et al. studied SPF 50+ sunscreen in 200 pregnant women; 185 completed follow-up, and 5 new cases were reported, compared with 53% in an earlier usual-condition study. That study had no concurrent comparison group and did not test hydroquinone or vitamin C. Because the evidence differs by ingredient, this grouped entry is rated for use with a provider's input. Ask your provider about your situation.
Last reviewed: 2026-10-18
Melasma & Dark Spot Treatments (Hydroquinone, Vitamin C, Azelaic Acid) — Breastfeeding
Research strength: 1 / 5
LactMed reports that topical hydroquinone has not been studied during breastfeeding and that relevant milk and infant data were not found. LactMed says hydroquinone is not contraindicated, though some experts advise against long-term use; it also says to prevent infant contact with treated skin or ingestion of product. Cassiano et al. list azelaic acid as an option during breastfeeding, but this does not fill the hydroquinone data gap. A 2026 review notes that high-quality safety data and formal guidance for cosmetic skin treatments remain limited overall, without giving hydroquinone-specific infant outcomes. Because the evidence differs by ingredient, this grouped entry is rated for use with a provider's input. Ask your provider about your situation.
Last reviewed: 2026-10-18
Pregnancy
ACOG recommends sunscreen and a wide-brimmed hat to help prevent melasma from getting worse, and notes that dark spots often fade after birth. AAD lists hydroquinone among ingredients not recommended during pregnancy. Cassiano et al. also advise against hydroquinone during pregnancy and describe the evidence gap and its high absorption. This precaution conflicts in tone with a 2011 review, which said one small pregnancy study had not found increased adverse events while recommending that exposure be minimized pending further research; see the disagreements section. Wester et al. (1998) measured in-vivo bioavailability after radiolabeled 2% hydroquinone cream was applied for 24 hours. The PubMed abstract reports 45.3% plus or minus 11.2% of the dose, with most radioactivity excreted during the first 24 hours. The abstract does not state the participant count. This was an absorption study, not a pregnancy-outcome study. Mahé et al. (2007) studied 99 women who were 6 to 9 months pregnant. Sixty-eight reported using skin-lightening products, with hydroquinone used by 64 and highly potent topical steroids by 28. The abstract found no difference in the main pregnancy outcomes between skin-lightener users and other participants, but the products were mixed and exposure was gathered by questions, so the result cannot be assigned to hydroquinone alone. The presence of potent steroid use means the study was not a hydroquinone-only comparison. Lakhdar et al. (2007) tested an SPF 50+ broad-spectrum sunscreen with UVA-PF 28 in a 12-month clinical study of 200 pregnant participants; 185 completed it. Five new melasma cases were reported, or 2.7%, compared with 53% in a prior usual-condition study by the same investigators in the same area and time frame. The 53% figure is a historical comparison, not a concurrent control group. The results suggest a possible role for photoprotection but do not establish an effect size or address hydroquinone. The sources reviewed did not identify pregnancy outcome studies for topical vitamin C.
Breastfeeding
LactMed reports that topical hydroquinone has not been studied during breastfeeding and that relevant published information on maternal levels, infant levels, effects in breastfed infants, and effects on lactation was not found as of its March 15, 2026 revision. LactMed says hydroquinone is not contraindicated during breastfeeding, while noting that some experts advise against long-term use. It says to prevent infant skin contact with treated areas and ingestion of product from maternal skin. Cassiano et al. list azelaic acid as a topical option for pregnant and breastfeeding patients, but that statement does not provide hydroquinone milk or infant measurements. A 2026 narrative review says high-quality safety data and formal guidance for cosmetic treatments remain limited; its abstract does not give hydroquinone-specific infant outcomes. The reviewed sources did not identify direct breastfeeding outcome data for topical vitamin C.
This entry groups three ingredients with different evidence. Hydroquinone reduces pigment production and has measurable absorption through skin. Cassiano et al. describe azelaic acid as a topical treatment for melasma. AAD describes vitamin C products as an option for skin-color changes, but its page does not report pregnancy outcomes for vitamin C or identify it as a melasma-specific treatment. FDA's statements about hydroquinone concern skin-lightening products, especially the unapproved over-the-counter product category; prescription products are a separate category.
What was tested
Wester et al. used radiolabeled 2% hydroquinone cream for 24 hours in a human topical absorption study; the PubMed abstract reports 45.3% plus or minus 11.2% in-vivo bioavailability but does not state the participant count. Mahé et al. followed 99 women at 6 to 9 months of pregnancy and compared self-reported skin-lightener users with other participants; products included hydroquinone and highly potent topical steroids, so this was not a hydroquinone-only study. Lakhdar et al. evaluated SPF 50+ broad-spectrum sunscreen in 200 pregnant participants, with a historical comparison rather than a concurrent control. The sources reviewed did not identify pregnancy outcome testing of topical vitamin C or direct breastfeeding studies of topical hydroquinone.
Hydroquinone use during pregnancy
- Source A says
- AAD lists hydroquinone among ingredients not recommended during pregnancy. Cassiano et al. state that hydroquinone should not be used during pregnancy, citing limited pregnancy safety data and high systemic absorption. (AAD: Pregnancy Skin Care Guidance, Cassiano et al. 2022, Dermatology and Therapy)
- Source B says
- Bozzo et al. describe one small pregnancy study with no increase in adverse events and say the available data did not appear to show an increased risk of major malformations or other adverse effects, while advising that exposure be minimized until further studies are available. (Bozzo et al. 2011, Canadian Family Physician review, Mahé et al. 2007, pregnancy skin-lightener study)
- Why they differ
- The 2011 review interprets one small mixed-product pregnancy study as not showing an increase in adverse events, but notes the small sample and measurable absorption. The newer AAD page lists hydroquinone among ingredients not recommended during pregnancy, and the 2022 review takes a precautionary position. Mahé et al. did not isolate hydroquinone, so the study cannot resolve the ingredient-specific question.
- What the evidence shows overall
- The available study does not establish a hydroquinone-specific pregnancy outcome, and the reviewed sources do not establish that topical hydroquinone causes a specific pregnancy harm. They also do not provide enough human evidence for a generally compatible rating. Under R2, the grouped entry receives an Insufficient Evidence rating; photoprotection and other ingredients are described separately.
- ACOG recommends sunscreen and a wide-brimmed hat outdoors to help prevent melasma from getting worse. (ACOG: Skin Conditions During Pregnancy)
- AAD describes shade, sun-protective clothing, and broad-spectrum water-resistant sunscreen with SPF 30 or higher as parts of a pregnancy skin-care routine; it also mentions vitamin C products for changes in skin color. (AAD: Pregnancy Skin Care Guidance)
- Cassiano et al. list azelaic acid as a topical melasma treatment option for pregnant and breastfeeding patients. (Cassiano et al. 2022, Dermatology and Therapy)
- FDA states that over-the-counter skin-lightening products containing hydroquinone are not approved for over-the-counter sale, while prescription skin products containing hydroquinone may be obtained through a health care provider. (FDA: Skin Product Information)
- ACOG notes that pregnancy-related melasma often fades after birth and suggests discussing persistent patches with a dermatologist. (ACOG: Skin Conditions During Pregnancy)
General research, not specific to pregnancy.
FDA reports that hydroquinone can be absorbed through skin and has received reports of rashes, facial swelling, and permanent skin discoloration from skin-lightening products containing hydroquinone. FDA's warnings focus on over-the-counter skin-lightening products, which are not approved for sale; prescription products are a separate category.
- FDA says hydroquinone-containing over-the-counter skin-lightening products are not approved for over-the-counter sale and that prescription skin products containing hydroquinone may be obtained from a health care provider. (FDA: Skin Product Information)
- FDA's consumer warning, current as of August 24, 2026, advises against over-the-counter skin-lightening products after tests found high levels of mercury and/or hydroquinone in certain products. This warning concerns that product category. (FDA: Consumer Warning on OTC Skin-Lightening Products)
- On April 19, 2022, FDA issued warning letters to 12 companies selling over-the-counter skin-lightening products containing hydroquinone that did not meet legal requirements for over-the-counter drugs. (FDA: 2022 OTC Skin-Lightening Action)
- ACOG says pregnancy-related dark spots and melasma often fade after birth, though some patches can last for years. (ACOG: Skin Conditions During Pregnancy)
Experiences from moms and non-medical voices. Not medical evidence.
A forum participant wrote: “I have a slight discoloration on my forehead between my eyebrows. My dermatologist prescribed Azelaic Acid (a cream) and it helped significantly.” This is an anecdote, not research evidence.
A forum participant wrote: “mine did go away after birth. Just faded away. This pregnancy I didn’t have it at all.” This is an anecdote, not research evidence.
A forum participant wrote: “Azelaic acid is a great option for dark spots and is the product recommended to me by my dermatologist! The Ordinary has a great one for a great price!” This is an anecdote, not research evidence.
Collected 2026-10-18
- ACOG: Skin Conditions During PregnancyProfessional societySecondary
- AAD: Pregnancy Skin Care GuidanceSecondaryPage dated 2025-06-26Independent check
- FDA: Skin Product InformationUS governmentSecondary
- FDA: Consumer Warning on OTC Skin-Lightening ProductsUS governmentSecondaryPage dated 2026-08-24
- FDA: 2022 OTC Skin-Lightening ActionUS governmentSecondary
- LactMed: HydroquinoneUS governmentSecondaryPage dated 2026-03-15
- Cassiano et al. 2022, Dermatology and TherapyUS governmentPrimaryIndependent check
- Wester et al. 1998, hydroquinone absorption studyUS governmentPrimaryIndependent check
- Mahé et al. 2007, pregnancy skin-lightener studyUS governmentPrimaryIndependent check
- Lakhdar et al. 2007, sunscreen study in pregnancyUS governmentPrimaryIndependent check
- Bozzo et al. 2011, Canadian Family Physician reviewUS governmentPrimaryIndependent check
- Kovacs et al. 2026, cosmetic dermatology reviewUS governmentPrimary
- What to Expect forum: Pregnancy MelasmaAnecdotal
- What to Expect forum, July 2022 BabiesAnecdotal
Last reviewed 2026-10-18
Independent check 2026-10-18
Not yet clinician-reviewed
Ask your provider about your situation.