The Skin Real

So why is everyone suddenly freaking out about topical estrogen and melasma?
It comes down to a case report — one woman using topical estrogen who developed melasma on her arms. That’s it. That’s the source of a lot of the panic online.

Here’s how I want you to think about it:
→ yes, there’s a hypothetical, and even a potentially real, risk of estrogen worsening melasma.
→ but one case report doesn’t mean it’s going to happen to you.
→ melasma also has a very strong sun component — it doesn’t show up without that trigger.
→ this woman likely had two hits: topical estrogen and living somewhere sunny.
→ she probably also had a genetic susceptibility to melasma in the first place.

Melasma is almost always multifactorial — hormones, sun exposure, and genetics all playing a role together, not one thing acting alone. So before you swear off topical estrogen based on a single case, know the fuller picture.

Want the deeper dive into hormones and skin? Check out my podcast The Skin Real, “Does Topical Estrogen Make Melasma Worse?”

Just ask my husband and kids.
RIP Dolly Parton ❤️

Save this if you’re using permethrin 1% shampoo, and send it to a parent who needs this.

    •    Start with a non-conditioning shampoo.
    •    Skip conditioner and silicone products - they make the treatment work less well.
    •    Apply to damp hair from scalp to ends, then leave it on for a full 10 minutes.
    •    After that, rinse with water only, and don’t shampoo again for 24-48 hours.

That last step matters because permethrin keeps working after you rinse it out.
Tiny details, big difference.