Hormones and melasma – a complicated question?
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