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Although Woods lamp examination remains useful to determine whether most of the pigmentation is in the epidermis or in the dermis, studies using laser confocal microscopy have demonstrated that all melasma are mixed, suggesting a common pathophysiology [2]

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doi: 10.1111/bjd.17992

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Estrogens, all in all, have been found to exhibit an inhibitory effect on excessive sebaceous gland activity in vivo.[53] In order to avoid the risk of endometrial hyperplasia, or even cancer, that can result from unopposed estrogen, it must be used in combination with a progestin