What’s the Link Between Melasma and Hormones?

In some ways, melasma — a condition that causes gray or brown patches on the face — is a mystery. Far more women than men have melasma, and experts have long believed that there is some connection between the condition and hormonal changes. Balcones Dermatology & Aesthetics in Austin, Texas, offers a range of treatments for the uneven pigmentation of melasma, regardless of the cause.

Although experts are not sure what causes melasma, some things are clear:

• Areas of the body exposed to the sun are more likely to develop melasma
• Women of reproductive age are most likely to be affected
• Melasma commonly occurs during pregnancy
• People with darker skin are more prone to developing melasma

Melasma is common during pregnancy

When a mother-to-be has melasma, the condition is sometimes called chloasma, or the mask of pregnancy. Melasma occurs fairly frequently during pregnancy — in fact, half of all melasma cases initially develop during pregnancy.

Most pregnant women experience some hyperpigmentation of the skin, but in 10-15% of them, that hyperpigmentation develops into melasma. This association between pregnancy — when there are big hormonal changes — and melasma supports the link between melasma and hormones.

Hormones in oral contraceptives may lead to melasma

About 10-25% of women who take oral contraceptives develop melasma, so if you are taking oral birth control and have noticed changes in the pigmentation of your skin, see a dermatologist to determine if you may have melasma. Some studies have shown that the skin of people with melasma is more responsive to the hormone estrogen than the skin of people who don’t have melasma. The same is true for progesterone, another hormone common in oral contraceptives.

One of the earliest studies on melasma and oral contraceptives was conducted in 1967. In that study, about a quarter of the participants taking oral contraceptives developed melasma, leading the researchers to believe there was a link between the hormones in the oral contraceptives and the development of melasma, although they were not able to identify exactly how the two were associated.  

The connection between thyroid disorder and melasma

If you have a thyroid disorder, you are about four times more likely to develop melasma than a person without a thyroid disorder. A recent study found that there’s a strong association between hypothyroidism and melasma, and both conditions involve hormonal imbalances. Scientists are still investigating how thyroid disorder and melasma are connected.

Other considerations

Although it seems likely that hormones can play a role in melasma, other factors may also be important. For example, sun exposure and the amount of melanin in the skin are risk factors for melasma. There are people who develop melasma without experiencing hormonal changes, and in those cases, UV exposure and genetics are likely implicated.

Treatment for melasma

Melasma during pregnancy usually resolves on its own as hormonal levels return to normal and doesn’t usually require treatment. When oral contraceptives are the cause, the condition generally clears up when you stop taking the medication — but it can take months or even years to fully resolve.

In cases where you need to keep taking oral contraceptives or the melasma is due to some other cause, there are other treatments. Some of them include:

• Hydroquinone — a cream, lotion, gel, or liquid that you apply to the skin
• Tretinoin and corticosteroids — prescription medications that can help lighten your skin
• Azelaic or kojic acid — prescription medications that can help lighten the dark spots of melasma
• Chemical peel, microdermabrasion, or dermabrasion — procedures that your dermatologist may perform to lessen the appearance of melasma
• Laser treatments or other light-based treatments — additional procedures to lighten the skin

You should discuss all treatments with your dermatologist. At Balcones Dermatology & Aesthetics, we know that the appropriate treatment method depends on a number of factors, including your age, any other conditions you may have, and your skin type.