Journal of Clinical and Aesthetic Dermatology

JUN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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16 16 In THIS ISSUE vol. 10, no. 6 • June 2017 • JCADOnlInE.COm L E T T E R TO T H E E D I TO R 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. 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. Philip R. Cohen, MD Department of Dermatology, University of California San Diego, La Jolla, California Topical Anti-Estrogen Therapy To Treat Melasma Philip R. Cohen, MD J Clin Aesthet Dermatol. 2017;10(6):16 Disclosure: The author reports no relevant conflicts of interest. Author correspondence: Philip R. Cohen, MD; E-mail: JCAD journal of clinical and aesthetic dermatology June 2017 • Volume 10 • Number 6

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