Role of estrogen, progesterone and prolactin in the etiopathogenesis of melasma in females

Authors

  • Khalid Mahmood
  • Muhammad Nadeem
  • Shahbaz Aman
  • Abdul Hameed
  • Atif Hasnain Kazmi

Keywords:

Melasma, estrogen, progesterone, prolactin

Abstract

Background Melasma is a commonly acquired hypermelanosis of facial skin due to various etiological factors including hormonal imbalance. Objectives To find out the relationship between hormonal imbalance and melasma in females.   Patients and methods One hundred and fifty female patients suffering from melasma, between the ages of 17-45 years, were enrolled in the study. They were examined by Wood’s lamp to see the type of melasma whether epidermal, dermal or mixed (dermoepidermal). Patients were investigated for levels of estrogen, progesterone and prolactin in two consecutive follicular and luteal phases on 9th and 18th day of cycle, respectively. Forty control cases were also investigated for the aforementioned hormonal levels in their follicular and luteal phases. Results Out of 150 patients, 138 completed the study while 12 patients were lost to follow up. Amongst the 138 evaluable patients, there were only 4 patients who had normal values for all the three hormones i.e. estrogen, progesterone and prolactin in all four phases. Fifteen patients (10.9%) had normal values of estrogen in both follicular (F1 & F2) and luteal phases (L1 & L2) while the remaining 123 patients (89.1%) had deranged values of estrogen (mostly increased) in any of the four phases. The values of progesterone were normal in 62 (44.9%) patients while they were deranged in 76 (55.1%) patients in all four phases. The levels of prolactin were normal in 134 (97.1%) patients while deranged in 4 (2.9%). Out of 40 controls, only 3 (7.5%) had increased values of estrogen in both follicular and luteal phases. Conclusion Estrogen is found to be the causative agent of melasma. 

References

Sanchez NP, Pathak MA, Sato S et al. Melasma: A clinical, light microscopic, ultrastructure and immunofluorescence study. J Am Acad Dermatol 1981; 4: 698-710.

Ahmad I, Wahid Z, Ansari M. Melasma: a comparative trial of azelaic acid (20%) cream alone and in combination with tretinoin (0.1%) cream. J Dermatol 2005; 45: 285-8.

Bari AU, Iqbal Z, Rehman SB. Melasma: an overview and therapeutic update. J Pak Assoc Dermatol 2003; 13: 21-9.

Fitzpatrick TB, Ortonne JP. Normal skin colour and general consideration of pigmentary disorders. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, eds. Fitzpatrick’s Dermatology in General Medicine, 6th edn. Philadelphia: McGraw-Hill; 2003. P. 819-23.

Grimes PE. Melasma: Etiologic and therapeutic considerations. Arch Dermatol 1995; 131: 1453-7.

Sodhi VK, Sausker WF. Dermatoses of pregnancy. Am Fam Physician 1988; 37: 131-8.

Victor FC, Gelber J, Rao B. Melasma: a review. J Cutan Med Surg 2004; 8: 97-102.

Perez M, Sanchez JL, Aguilo F. Endocrinologic profile of patients with idiopathic melasma. J Invest Dermatol 1983; 81: 543-5.

Wang SQ, Setlow R, Berwick M et al. Ultraviolet A and melanoma: a review. J Am Acad Dermatol 2001; 44: 837-46.

Urabe K, Nakayama J, Hori Y. Mixed epidermal and dermal hypermelanoses. In: Nordlund JJ, Boissy RE, Hearing VJ et al., eds. The Pigmentary System Physiology and Pathology, New York: Oxford University Press; 1998. p. 909-13.

Lieberman R, Moy L. Estrogen receptor expression in melasma: results from facial skin of affected patients. J Drug Dermatol 2008; 12: 27-30.

Breathnach AS. Melanin hyperpigmentation of skin: melasma, topical treatment with azelaic acid and other therapies. Cutis 1996; 57 (Suppl): 36-45.

Lawrence N, Cox SE, Brody HJ. Treatment of melasma with Jessner's solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination. J Am Acad Dermatol 1997; 36: 589-93.

Kim NR, Suh YL, Song SY et al. Peritoneal melanosis combined with serous cystadenoma of the ovary: a case report and literature review. Pathol Int 2002; 52: 724-9.

Lutfi RJ, Fridmanis M, Misiunas AL et al. Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of melasma. J Clin Endocrinol Metab 1985; 61: 28-31.

Hassan I, Kaur I, Sialy R et al. Hormonal milieu in the maintenance of melasma in fertile patients. J Dermatol 1998; 25: 510-2.

Prignano F, Ortonne JP, Buggiani G et al. Therapeutical approaches in melasma. Dermatol Clin 2007; 25: 337-42.

Balkrishnan R, McMichael AJ, Camacho FT et al. Development and validation of a health-related quality of life instrument for patients with melasma. Br J Dermatol 2003; 149: 572-7.

Montemarano AD. Melasma. The Skin Cancer Surgery Center, 2008, available from http://emedicine.medscape.com/article/1068640-overview.

Amer M, Metwalli M. Topical liquiritin improves melasma. Int J Dermatol 2000; 39: 299-301.

Carr BR. Disorders of the ovaries and female reproductive tract. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR, eds. Williams Textbook of Endocrinology, 9th edn. Philadelphia: WB Saunders; 1998: p. 751-817.

Wolf R, Wolf D, Tamir A et al. Melasma: a mask of stress. Br J Dermatol 1991; 125: 192-3.

Maeda K, Naganuma M, Fukuda M et al. Effect of pituitary and ovarian hormones on human melanocytes in vitro. Pigment Cell Res 1996; 9: 204-12.

Im S, Eun-So L, Kim W et al. Donor specific response of estrogen and progesterone on cultured human melanocytes. Korean Med Sci 2002; 17: 58-64.

Kippenherger S, Loitsch S, Solano F et al. Quantification of tyrosinase, TRP-1 and TRP-2 transcripts in human melanocytes by reverse transcriptase-competitive multiplex PCR--regulation by steroid hormones. J Invest Dermatol 1998; 110: 364-7.

Suzuki I, Cone RD, Im S et al. Binding of melanotropic hormones to the melanocortin receptor MC1R on human melanocytes stimulates proliferation and melanogenesis. Endocrinology 1996; 137: 1627-35.

Scott MC, Suzuki 1, Abdel-Malek ZA. Regulation of the human melanocortin 1 receptor expression in epidermal melanocytes by paracrine and endocrine factors and by ultraviolet radiation. Pigment Cell Res 2002; 15: 433-9.

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Published

2016-12-22

How to Cite

1.
Mahmood K, Nadeem M, Aman S, Hameed A, Kazmi AH. Role of estrogen, progesterone and prolactin in the etiopathogenesis of melasma in females. J Pak Assoc Dermatol [Internet]. 2016Dec.22 [cited 2024Nov.7];21(4):241-7. Available from: https://www.jpad.com.pk/index.php/jpad/article/view/483

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