Abstract
Hormonal changes in pregnancy are the important etiology of melasma. The presence of melasma in more than 75% of pregnancies. At the end of pregnancy, estrogen levels increase. Estrogen, especially estradiol triggers increased synthesis of melanin. This paper is aimed to determine the relationship between estradiol hormone with melasma and the type ofmelasma in pregnant women. This study used a cross-sectional study design to determine the relationship of estradiol hormone with melasma. It was conducted from September-November 2015. Skin examination was performed on 64 pregnant women (15-49 years old) who suffered from melasma in the third trimester and who did not, and the blood was drawn to measure the level of serum estradiol hormone. The study results that the levels of estradiol was slightly higher in women with melasma than those without melasma (13811.7 vs 12820.5), but not statistically significant (p>0.05). There was slightly higher levels of estradiol in women with the mixed type of melasma than the other types (14444.10 vs 14047.25 and 12243.50), but it was not statistically significant (p>0.05). Estradiol levels correlated significantly (p<0.05) with maternal age (r = 0.238) and gestational age (r = 0.435); but did not correlate significantly (p>0.05) with MASI (Melasma Area Severity Index) score and the type of melasma. The study concluded that estradiol levels in women with melasma are higher than not melasma and in mothers with type mix melasma were higher than other types, but not statistically significant. Estradiol level correlated with maternal age and gestational age.
Highlights
Melasma is a common pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face
This study chose estradiol hormone as its subject, as it is one of the most active forms of estrogen associated with the appearance of melasma, based on previous research and supporting journals which showed that estrogen increases the activity of tyrosinase and the number of melanocytes. [10]
The existence of a second estrogen receptor (ERβ) in human skin has a certain role that is different from the classical estrogen receptors (ERα), which has the potential to increase the diversity in the mechanism of action of estrogen
Summary
Melasma is a common pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face. It typically affects women of reproductive age with Fitzpatrick skin type IV-VI. The presence of melasma in up to 75% of pregnancies, the increased incidence of the disease in women on oral contraceptive pills (OCP), the histological finding of increased estrogen receptor expression in affected skin, the strong correlation between estradiol levels and melanogenesis, and the association of melasma with hormone replacement therapy in post-menopausal women all support this theory [6] Athar Moin et al, found that pregnant women who suffer from melasma is more common in third trimester and the higher parity, melasma is increasing. The presence of melasma in up to 75% of pregnancies, the increased incidence of the disease in women on oral contraceptive pills (OCP), the histological finding of increased estrogen receptor expression in affected skin, the strong correlation between estradiol levels and melanogenesis, and the association of melasma with hormone replacement therapy in post-menopausal women all support this theory [6] Athar Moin et al, found that pregnant women who suffer from melasma is more common in third trimester and the higher parity, melasma is increasing. [7]
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