Oral estrogen hormone replacement therapy linked to forearm melasma

High-dose oral estrogen-only hormone replacement therapy has the strongest documented association with melasma, particularly forearm melasma in women with Fitzpatrick skin types III through VI, meaning we must screen patient hormone regimens more closely before starting pigment-clearing therapies. A review published online on January 28, 2026, in Dermatologic Surgery notes that while case reports exist for combined oral and transdermal HRT, topical and vaginal formulations show minimal evidence of any melasma association. This distinction is useful when discussing alternative hormone delivery methods with patients or their prescribing physicians. Furthermore, there are no reported cases of melasma associated with in vitro fertilization. Authors Sabriya Abdeen, Emily Shao, and Davin Lim point out that HRT-associated melasma is underrepresented in the literature and the current evidence remains limited, consisting largely of case reports. For daily clinical management, we should counsel at-risk patients on this specific risk and ensure they are on strict photoprotection regimens, particularly when we are designing laser or topical treatment plans for patients on oral formulations who present with pigmentation on their faces or forearms.

Source: Dermatologic Surgery, https://doi.org/10.1097/DSS.0000000000005032