Letter to the Editor: Topical Anti-Estrogen Therapy To Treat Melasma

by Philip R. Cohen, MD

Dear Editor:
I read with interest the recent report by Snyder et al[1] describing melasma associated with the application of a topical estrogen cream. The development of melasma is multifactorial and female sex hormones have been implicated in the pathogenesis of this condition.[2] Estrogen receptor expression is increased in melasma lesions.[3] Also, melanogenesis of cultured human melanocytes can be stimulated by estrogens and inhibited by estrogen antagonists.[4]

The induction of melasma with a topical estrogen raises the possibility that the treatment of this condition could be facilitated by the use of a topical anti-estrogen. I recently proposed a novel topical approach for the treatment of melasma that utilized an anti-estrogen, such as a selective estrogen receptor modulator (tamoxifen or raloxifene) or an aromatase inhibitor (anastrozole or tetrozole or exemestane).[5] The topical agent would also include a vascular endothelial growth factor inhibitor (bevacizumab) that would be directed toward blocking the angiogenesis component of melasma pathogenesis.[5] Investigation of this novel—topically administered—therapy for melasma is warranted.

Philip R. Cohen, MD
Department of Dermatology, University of California San Diego, La Jolla, California

Disclosure: The author reports no relevant conflicts of interest.

References
1. Snyder A, Schiechert RA, Zaiac MN. Melasma associated with topical estrogen cream. J Clin Aesthet Dermatol. 2017;10(2):57–58.
2. Lee A-Y. Recent progress in melasma pathogenesis. Pigm Cell Melanoma Res. 2015;28:648–660.
3. Jang YH, Lee JY, Kang HY, et al. Oestrogen and progesterone receptor expression in melasma: an immunohistochemical analysis. J Eur Acad Dermatol Venereol. 2010;24:1312–1316.
4. Kim NH, Cheong KA, Lee TR, Lee AY. PDZK1 upregulation in estrogen-related hyperpigmentation in melasma. J Invest Dermatol. 2012;132:2622–2631.
5. Cohen PR. Melasma treatment: a novel approach using a topical agent that contains an anti-estrogen and a vascular endothelial growth factor inhibitor. Med Hypotheses. 2017;101:1–5.

 

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Recent Articles:

Mycobacteroides abscessus: Identification and Treatment Challenges
Beyond Skin Deep: The Systemic Impact of Topical Corticosteroids in Dermatology
Selected Abstracts from Elevate-Derm West Conference
Skin 101: Understanding the Fundamentals of Skin Barrier Physiology—Why is This Important for Clinicians?
From the Masterclasses in Dermatology 2024 Meeting: Updates in Psoriasis Treatments
He Who Wills the End Wills the Means: An Overview of Trusts for Physicians
Achievement of Optimal Treatment Targets with Oral Janus Kinase Inhibition in Elderly Patients with Atopic Dermatitis: A Real-world, Multicenter, Retrospective Study
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Investigating Efficacy of Atopic Dermatitis Systemic Therapeutics After Discontinuation Part I: Biologics
Efficacy of Mild-to-Moderate Chronic Hand Eczema Treatment Using Petrolatum and Panthenol Ointment vs. 0.1% Triamcinolone Acetonide in 10% Urea Cream: A Split-hand, Evaluator-blinded, Randomized, Controlled Trial
1 2 3 162

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