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  • Title: Melasma and other skin manifestations or oral contraceptives.
    Author: Resnik SS.
    Journal: Trans N Engl Obstet Gynecol Soc; 1967; 21():101-7. PubMed ID: 5620604.
    Abstract:
    Pigmentary anomalies are among the least serious but most frequent skin changes resulting from oral contraceptive use. A pseudo "mask of pregnancy" called chloasma or melasma may be produced. It is a blotchy hyperpigmentation of the face which can be a disfiguring cosmetic and emotional problem. Melasma most often appears 1-4 months after taking the pill. Of 13 such patients closely studied, melasma of pregnancy had previously been present in 10. Only minimal improvement was noted in 7 even up to 4 years after stopping the drug. Histological examination of 10 biopsy specimens showed normal appearing epidermis with pigment in the basal cell layer of the skin. Of 199 patients taking oral contraceptives in one study, 24% had melasma; of 212 patients in a second study, 29% developed this problem. A history of temporary melasma during pregnancy is an important predictor. Reduced exposure to sunlight is recommended. Use of a hydroquinone cream as a bleaching agent results in only slight improvement. Changing the type of pill has had little effect but reducing the amount of progesterone may help. Other skin manifestations with oral contraceptives include: 1) acne vulgaris, which may be improved or aggravated; 2) alopecia or diffuse thinning of the entire scalp hair, which may be reversible; 3) treatment of aphthous stomatitis, which is controlled by estrogen therapy; and 4) erythema nodosum, which subsides when oral contraceptives are stopped. Urticarial reactions represent an allergic response to special drugs.
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