Background Melasma is a commonly acquired hypermelanosis of the skin due to various etiological factors. These include sun exposure, oral contraceptives, certain medications, and other factors.
Observations Melasma poses a therapeutic challenge to clinicians and current treatments are inconsistent. Melasma is especially troublesome during cosmetic procedures such as chemical peels and laser resurfacing in which severe rebound pigmentation can occur.
Methods 3-mm biopsies were taken from two female patients (ages 39, 45) with recalcitrant melasma from the forehead region. Frozen sections of the tissues were taken and mouse monoclonal antibody against human estrogen receptors was tested at various dilutions to determine the optimum concentrations required for reproducible immunostaining with minimal background staining.
Results The immunohistochemical staining showed the presence of estrogen receptors on lesional (pigmented) skin and the absence of these receptors on non-lesional (non-pigmented) skin. From a qualitative standpoint, the estrogen receptors seem to be localized only to the melasma affected skin.
Conclusion Our study demonstrates the role of estrogen receptors in melasma and suggests the direct role of estrogen in the pathogenesis of melasma. Therefore, patients with melasma would benefit from the competitive blockade of these estrogen receptors. The use of topical tamoxifen for blocking active estrogen receptors offers an additional therapeutic tool in treating melasma refractory to conventional therapy. Initial experience with topical tamoxifen has demonstrated clinical improvement in a number of melasma cases, although further work is required to demonstrate its efficacy. Additionally, these findings can be used to predict the likelihood of hyperpigmentation after laser resurfacing, chemical peels, and other cosmetic procedures.
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