Melasma, patchy dark spots on facial skin, develops in women and can cause significant effects on quality of life due to the difficulty in treating the condition. Melasma appears during the reproductive years and is frequently associated with female sex hormones. Oral contraceptives can hasten the development of melasma (as can pregnancy), which suggests that that female sex hormones accelerate the development and aggravation of melasma. However, associating melasma definitely with hormones has proved difficult.
A recent study aimed to review the literature on blood levels of hormones in women and men with melasma and to report whether or not a clear correlation can be identified. The study looked at case series and two studies that looked at hormonal levels and melasma in both men and women. Several studies of women with melasma examined the role of hormone levels. One conclusion was that decreased estradiol levels in melasma patients may corroborate the hypothesis that mild ovarian dysfunction might be a factor in the development of melasma. Other studies noted that female melasma patients had a greater presence of ovarian cysts and androgenic hormones. There were few studies that included men and looked at endocrinology, and the few that exist found conflicting results. One study suggests sun exposure, and family history as the main causative factors of melasma, while others point to the introduction of estrogens or anti- androgen medications as a cause. The authors state that the role of hormones in the onset of melasma in men is contrasting and need to be verified in studies with larger sample sizes.
The individual case series presented in the review further demonstrate how difficult it is to demonstrate a clear relationship between hormones and melasma. The authors state that while hormonal therapies, pregnancy and oral contraceptives still present the greatest risk for developing melasma, the role of genetic predisposition and exposure to sunlight are also main factors for melasma development. Despite previous research linking melasma to hormones, we do not have the data to clearly define the relationship. The authors conclude that the literature currently shows that the correlation between melasma onset and hormonal changes in both men and women is not clear.