Original Research Indian Journal of Clinical and Experimental Dermatology, October-December, 2015;1(1):21-24 21 A Role of Estrogen in Etiopathogenesis of Melasma in Female Patients- A Prospective Observational Study in a Tertiary Care Hospital Krishnendra Varma 1,* , Kiran Kumare 2 , Harsh Sharma 3 , Megha Sharma 4 1 Professor, 2,4 PG Student, 3 Assistant Professor, RD Gardi Medical College, Ujjain, Madhya Pradesh *Corresponding Author: Email: krishnendra_verma17@yahoo.co.in ABSTRACT Background: Melasma is a common patchy brown, tan or blue-gray facial skin discoloration usually seen in women in the reproductive years. Aim: To study the role of estrogen in etiopathogenesis of melasma in female patients. Objectives: To study the estrogen levels and its imbalance in female patients attending Dermatology OPD of C.R.G.H. within 1 year by correlating with the normal levels. Patients and Methods: Sixty -six female patients suffering from melasma, between the ages of 15-45 years, were enrolled in the study. Patients were investigated for estrogen levels at any time of their menstrual cycle and estrogen values estimated according to follicular and luteal phase values. Results: Amongst the sixty- six patients, there were only 18 (27.3%) patients who had normal values for estrogen while the remaining 48 patients (72.7%) had deranged values (mostly increased). Conclusion: Estrogen plays an important role in causation of melasma. Key Words: Melasma, estrogen, discolouration, reproductive years INTRODUCTION The word Melasma is derived from Greek word melas (black) while chloasma is derived from the word chloazein (green) and since the pigmentation is brown- black melasma is the preferred term. [1] Melasma is acquired hypermelanosis of sun-exposed areas. It presents as hyper pigmented macules, which can be confluent or punctate. The cheeks, upper lip, chin and forehead are the most common locations but it can occur on other sun-exposed locations. Melasma is common in constitutionally dark skin types, especially in people with light brown skins, especially in people of East and South East Asian and Hispanic origin who live in areas with intense solar ultraviolet radiation (UVR). [1] It is commoner in women than in men (9:1) and is rare before puberty, occurring most commonly in women of reproductive age. The exact etiology of melasma is not known but several factors have been implicated. UVR (UVA and UVB) and visible light cause peroxidation of lipids in cellular membranes, leading to generation of free radicals, which stimulate melanogenesis. Elevated levels of estrogens and progesterone (as occurring in pregnancy) are important. Melasma also develops with estrogen- and progesterone-containing pills. [2] However, progesterone may be more important, as melasma develops in postmenopausal woman who are given progesterone and not when given estrogen supplementation. Estrogens probably stimulate melanogenesis through estrogen receptors present on melanocytes. [1] Other hormones may also be important. Genetic factors are indicated because more than 30% of patients have a family history of melasma. [3] Constituents of cosmetics have been frequently incriminated. Drugs (phenytoin, griseofulvin, and NSAIDs) can cause melasma-like pigmentation. The face is most commonly affected though rarely pigmentation may extend on to ‘V’area of the neck or may be confined to the forearms. On the face, three patterns of melasma are recognized:  Centrofacial: The most frequent (63%) pattern, with pigmentation on cheeks, forehead, upper lip, nose, and chin.  Malar: Constituting 21%, with pigmentation present only on cheeks and nose.  Mandibular: The least common (16%), with pigmentation on ramus of the mandible. MATERIALS AND METHODS The present study was a prospective observational study in which sixty -six clinically diagnosed female melasma patients of reproductive age group i.e 15-45 years attending Dermatology Out Patient Department in C.R.G.H, Ujjain, Madhya Pradesh constituted the subject material for present study. These patients belonged to Ujjain and its adjoining districts. The patients with post inflammatory hyperpigmentation, other pigmentary disorders with epidermal dermal pigmentation e.g. Nevus of Ota, Nevus of Ito, Mongolian spots and previous cases of melasma were excluded. A detailed history and clinical examination of each patient was carried out. The personal data like family history of melasma, marital status, number of children, age of onset, use of drugs and cosmetics and exposure to sunlight was recorded. Area and extent of