title: Melasma treatment: A novel approach using a topical agent that contains an anti-estrogen and a vascular endothelial growth factor inhibitor.
abstract: Melasma is an acquired disorder of pigmentation that presents with asymptomatic symmetric darkening of the face. The pathogenesis of this condition is multifactorial and influenced by several factors including female sex hormones, genetic predisposition and ultraviolet light exposure. The management of melasma is usually directed at more than one of the causative etiologic factors and often incorporates a combination of topical agents, with or without the addition of physical modalities. Estrogen and angiogenesis are significant factors in the etiology of melasma. A useful addition to the therapeutic armentarium for treating melasma would include a topical agent that could effect both of these causative factors. Specifically, a topical preparation consisting of an anti-estrogen and a vascular endothelial growth factor inhibitor would accomplish this goal. Suitable candidates that target estrogen receptors and vascular endothelial growth factor are currently used in medical oncology as systemic antineoplastic agents. The anti-estrogen could be either a selective estrogen receptor modulator (such as tamoxifen or raloxifene) or an aromatase inhibitor (such as anastrozole or letrozole or exemestane). The vascular endothelial growth factor inhibitor would be bevacizumab. In conclusion, a novel-topically administered-therapy for melasma would combine an anti-estrogen and a vascular endothelial growth factor inhibitor.
authors.affiliation: Department of Dermatology, University of California San Diego, San Diego, CA, United States. Electronic address: mitehead@gmail.com.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Cohen
mesh_terms: D000287:Administration, Topical; D000077384:Anastrozole; D000730:Androstadienes / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000737:chemistry; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D017495:Hyperpigmentation / Q000378:metabolism; D000077289:Letrozole; D008297:Male; D008548:Melanosis / Q000628:therapy*; D009389:Neovascularization, Pathologic; D009570:Nitriles / Q000627:therapeutic use; D011247:Pregnancy; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D011960:Receptors, Estrogen / Q000627:therapeutic use; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D013629:Tamoxifen / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D014466:Ultraviolet Rays; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D000730:Androstadienes; D047072:Aromatase Inhibitors; D004967:Estrogens; D009570:Nitriles; D011960:Receptors, Estrogen; D020845:Selective Estrogen Receptor Modulators; D014230:Triazoles; D042461:Vascular Endothelial Growth Factor A; D013629:Tamoxifen; D000077384:Anastrozole; D020849:Raloxifene Hydrochloride; D000077289:Letrozole; C056516:exemestane
keywords: Anastrozole; Anti-estrogen; Bevacizumab; Endothelial; Estrogen; Factor; Growth; Inhibitor; Melasma; Modulator; Receptor; Selective; Tamoxifen; Therapy; Topical; Treatment; Vascular