Can my Premarin be causing my melasma?

Question

I had a complete hysterectomy at the age of 30. Because of my age my doctor told me I needed to take hormone replacement therapy. I have been on Premarin 1.25mg for the past 7 years. About two years ago I noticed brown spots on my forehead and upper lip. My PS told me it was Melasma and prescribed Hydroquinone 4% and Retin A. I was wondering if I should revisit the use of Premarin or at least decrease the dosage? If the Melasma is hormone related will it go away with discontinuing the Premarin?

Jeff Angobaldo, MD · Answer

Thank you for your question.  I would suggest doing a fractional treatment for melasma.  Apply hydroquinone morning and evening two weeks prior to your treatment.  The fractional treatment would help to suppress the discoloration and improve texture of your skin along with shrinking your pores.

Raffy Karamanoukian, MD, FACS · Answer

Melasma is associated with hyperpigmentation caused by a combination of hormones, sun exposure, inflammation, and deposition of melanin pigment. In our office, we specialize in melasma treatments and start with Melapads, Melarase AM, Melarase PM, and Replenish; followed by pulsed dye laser to eliminate inflammatory erythema and light fractional laser. 
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Jason Emer, MD · Answer

I recommend getting a formal evaluation with a cosmetic dermatologist. Some medications can stimulate melanocytes. Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, Cosmelan, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

Davin Lim, MBBS, FACD - Account Suspended · Answer

Hormones play a role but the timing is not correct. Yes, homormal control can decrease your melasma however stopping therapy will unlikely make a difference. Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. 
  
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. 
  
In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient. 
  
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia

David E. Berman, MD (retired) · Answer

stopping your premarin is not likely to make your Melasma go away. the Picosure laser is the newest and best way to treat melasma with no downtime. you should plan 3 treatments, each done a month apart. these lasers are harder to find because they are expensive for the plastic surgeon or dermatologist to buy.david berman md

Can my Premarin be causing my melasma?

Answers (5)

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