Hormones and melasma – a complicated question?

Dr. Irwin, My wife is an Asian in her late 40s and is suffering from melasma which appeared after extended sun exposure from a summer vacation last year. HQ, IPA (one cheek), and Fraxel Dual all made the melasma worse; Fraxel Dual, in particular, did the worst damage. She underwent a partial hysterectomy in late 2003 (ovaries intact). Our dermatologist recommended that her hormone levels be checked; blood tests are underway. The reproductive endocrinologist that we visited said that a visual exam of the vaginal wall indicated malfunctioning ovaries (hormones low), but the blood tests will give accurate measurements of how much. Everything that my wife has found regarding melasma is that hormone therapy makes the condition worse, but there must be a positive reason for my wife being referred to an endocrinologist. Do you think that hormone therapy might help or hurt her melasma (if the blood tests indicate low estrogen)? I can see other benefits for hormone therapy, but melasma has seriously adversely affected my wife's mental state; I would not want to encoursage her to seek hormone therapy if it might make her melasma even worse. I appreciate any insight you might provide. Thank you! KO

In general, estrogens in particular, more than progesterones or testosterone, make melasma worse.  I have a couple of thoughts for you though.

At the recent Paris conference (IMCAS 2012) there were several excellent talks on melasma and pigment issues and several were given by doctors from Asia, the Middle East and India.  I found these talks especially interesting and helpful.  The point was made, and I agree with this, that melasma is not always accurately diagnosed.  There are at least 5 or 6 other conditions that can look like melasma.  A biopsy in situations like this to make sure the diagnosis is correct may be very helpful.  Please discuss this with your dermatologist and make sure the biopsy is read by a dermatopathologist not a general pathologist. More info on melasma.

Also, just so you and your wife know this, there are vaginal estrogen delivery systems (particularly the ‘rings’ like Estring) that have very little or no systemic absorbtion of estrogen.  It’s the systemic absorption that usually triggers the melasma in susceptible women.  Please talk to your gynecologist!    Hope this helps,  Dr. I

Dr. Brandith Irwin, MD

Ask me your skincare question!

Hi, I’m Dr. Irwin, and I believe that consumers need and deserve a medically trained and unbiased skincare advocate.

  • All our content is written and researched by myself and my trained staff.
  • My medical office in Seattle has experience treating thousands of patients.
  • This site is not affiliated or financially tied to any product line.
Ask Me Something
SkinTour Skincare
One of the best investments in your skin is your daily skincare. Why? Because you can prevent many problems with blotchy skin color, lack of glow, texture, some types of acne, and fine lines with good skincare products. You can also correct some of these problems with effective skincare products. Great skincare is often more expensive because quality ingredients are expensive. Some companies spend on research/development which benefits all of us and adds to the cost. Are they worth it? In general - yes!