How common is melasma with topical estrogen, and who is most at risk?
Melasma with topical estrogen appears to be uncommon. Dr. Ellen Gendler notes that in controlled studies of topical estrogen, melasma hasn't been reported, and in our three month M4 study here at Alloy, we didn't see increased pigmentation either. There are some real-world reports, so it can happen, but it seems to be rare.
The people most likely to be cautious are those who’ve had melasma before, especially if it showed up during pregnancy or while on birth control pills. Dr. Gendler’s view is that people who develop melasma with topical estrogen are probably often the ones with a prior history. If that applies to you, here at Alloy we’d usually suggest starting on a small area instead of the whole face and stopping if pigmentation seems to worsen.
For more detail, this Alloy article on topical estrogen and skin and this short video chapter on melasma and topical estrogen are both helpful.
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